THE EVOLUTION OF SENIORS’ FALLS PREVENTION IN BRITISH COLUMBIA

Dr. Vicky Scott, Lillian Baaske, Dorry Smith, Tessa Graham, Dr. Elaine Gallagher, Dr. Ian Pike, Matt Herman & Mike Vanderbeck

B.C. Seniors

Those 65+ account for 13.7% of the B.C. population

1995 to 2004 population 65+ rose from 475,300 to 574,400 (21% increase)

2004 to 2010, number of seniors is expected to grow by another 17% to 672,000

Between 2001 to 2021 the average age in B.C. will increase from 38.2 to 42.6 years

Outline

Laying the Groundwork Policy Considerations Environmental Scan in B.C. Translation of Research to Practice The Interior Health Authority Experience

Laying the Groundwork for B.C.’s Success

15 years of sustained collaboration Champions positioned to support and influence Recognition of opportunities and timing Shared vision and commitment Leadership Strategic investment of limited resources Strategic multi-sectoral partnerships Involve the right people in decisions, including those

affected by the problem Respect for roles and responsibilities

Essential Questions for Falls Prevention Planning

What is the nature and magnitude of the problem in your region?

What policies do you need to support prevention? Who should be involved in prevention? Who is at risk for falls and injuries? What are the best prevention strategies? How will you know if the strategies work? How will prevention efforts be sustained?

What is the nature and magnitude of the falls in

your region?

Are you using the best data sources to highlight the problem? Do you know how the problem has changed over time and what is expected in the future? Do you know the economic burden of falls for your region and how this compares to other health issues and other regions?

RESEARCH

Who is at risk for falls and injuries?

What are the best practices and prevention

strategies?

What are the risk factors for falling and sustaining a fall-related injury? Who is at greatest risk? How does risk vary across sub-populations of men and women, active seniors vs. frail seniors in the community, seniors in acute care or residential settings?

How do we know what works best to reduce risk and minimize outcomes? How do we know what will work in practice? What policies are needed for strategies to be effective? Can you translate the evidence into a business case for resources to support cost-effective prevention?

What are the most reliable sources of

evidence?

Who in your region is conducting research on falls prevention? Can you access those who are able to identify reliable sources of research and translate findings into effective practice?

POLICY

How will you engage policy makers, health care

managers and agencies to support your research and

translation efforts?

What policies do you need to support evidence-based

prevention?

What evidence do you need to affect decision-making, program planning, evaluation and resource allocation? Who has the greatest potential for effecting change in policy and practice? Who will fund research efforts?

Can research be used to create a climate for this issue? What evidence is needed before this issue will gain the support of policy-makers and those that will resource prevention efforts?

What policies, regulations or guidelines do you need

to support falls prevention?

How will you resource the strategies? What time commitments are required? Will you engage those at risk, volunteers, staff and managers? How will you contact your target audience? Who has the greatest potential for planning, implementing and evaluating prevention activities?

PRACTICE

How will you know if the strategies work?

How will prevention efforts be sustained?

What will be evaluated? What process and outcome measures will you use? How will you know if your strategies are cost-effective? How will you know if there are gaps in your efforts? How will you share this information and for what purpose?

How will you use the evaluation outcomes to improve your prevention plan? What research and policy support do you need to maintain effective prevention efforts?

Scott et al., 2005. Evolution of Seniors’ Falls Prevention in British Columbia

Falls & Injury Prevention Planning

Policy Considerations

Action on falls did not happen overnight Important ingredients: policy decisions,

champions, evidence, opportunities and timing Collaborative jurisdictional action on aging:

the context

Policy Considerations

Key policy and documents commissioned/released by F/P/T Ministers

Evidence led to action and engagement of experts and those affected by the problem

Commitment to injury prevention and falls was built over time

Nationally unique partnership between Health Canada and Veterans Affairs launched in 2001

Policy Considerations

Continued federal/provincial/regional collaboration following the HC/VAC program

Critical mass of individuals involved at different levels in the issue developed: state of readiness to act

Environment created to support further collaboration

Development and release of the Environmental Scan: Seniors and Veterans Falls Prevention Initiatives in B.C. 2005

Establishment and support of BC Falls Prevention Coalition 2005

Overview of Activities

Ottawa Charter (1986) National Framework on Aging (1998) BC Office for Injury Prevention (OIP) – focus 0-24 years Deputy PHO created BCIRPU – focus on all ages (1997) BC Summit on Falls Prevention (1998) F/P/T Ministers of Health and Safety and Security

Working Group (SSWG) (1999) – Seniors’ injury seen as priority

F/P/T Advisory Committee on Population Health - Sub-committee of Public Health – Falls Among Elderly seen as priority

Activities Continued

OIP and B.C. Office for Seniors jointly created Falls Prevention Specialist position (2001)

Veterans Affairs and Health Canada Falls Initiative (2001-2004)

Special PHO report on Falls and Injuries among the Elderly (2004)

Partnership with Knowledge Network for social marketing of falls prevention (2004)

BC Falls Prevention Coalition (2005)

B.C. Research History

Scope of the problem Risk factor evidence Prevention evidence Capacity building Sustainability Dissemination

Scope of the Problem

First profiled as a serious issue in B.C. in 1989 at an Inter-ministerial Committee on Aging

MOH led a provincial meeting on fall-related hospitalizations (Dr. Bob Fisk, 1990)

1st RCT on falls in B.C. “Head Over Heels” (Gallagher & Brunt, 1991)

Health Canada funded the “STEPS” project on falls in public places (Gallagher & Scott, 1994)

Mortality and Morbidity of Falls in B.C. (Scott & Gallagher, 1997 )

Risk Factors & Prevention

U.Vic: Risk factors for falls and injuries among frail community seniors (Scott & Gallagher, 2000)

Population Health/BCIRPU: “Stepping In” Fall Prevention in LTC (Scott et al., 2003)

BCIRPU: EDISS Reports on Fall Injury in Emergency Dept. (2004); “SAIL” Pilot and RCT (Scott et al., 2004/2005)

UBC: Risk reduction for women with osteoporosis (Lui-Ambrose & Kahn, 2003); Strength & Balance in Reducing Falls (Donaldson & Kahn, 2005); Fall Risk for Women with Visual Impairment (Szabo & Kahn, 2006); ED Fall Outcomes (Salter, 2004)

SFU: Biomechanics of Falls & Hip Fractures (Robinovitch, 2005); Floor Stiffness & Risk of Hip Fracture (Laing, 2003-)

Other: Paramedics for Early Intervention of Falls (Robinson, 2004); OT Falls Assessment (Dixon, 2004); Centre for Hip Health (Oxland, 2006)

Capacity Building, Sustainability & Dissemination

F/P/T: Systematic Review of Best Practice in Falls Prevention (2000)

F/P/T: National Inventory of Falls Prevention (2000) BCIRPU: Economic Burden of Unintentional Injury in

B.C. (Smartrisk, 2001); Unintentional Fall-related Injury and Deaths: Trends, Patterns & Projections (BCIRPU, 2002)

MOH/BCIRPU: Prevention of Falls & Injury Among the Ederly: PHO Report

PHAC/MOH: Environmental Scan: Seniors & Veterans Falls Prevention Initiatives in B.C.

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*age standardized to 1991 Canadian population**Quebec and Rural hospitals in Manitoba do not submit to the Discharge Abstract Database (DAD)

Source: Acute separations from 1998/99 to 2002/03 Canadian Institute of Health Information Discharge Abstract Database.

Fall-related Hospital Rates per 1,000 by Provinces and Territories, 1998/99 – 2002/03, Ages 65+

FALLS IN SENIORS, HOSPITAL CASES AND RATES, B.C., 1992/93 TO 2004/05

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* Age-Standardized.Source: Discharge Abstract Database, Population Health Surveillance and Epidemiology, B.C. Ministry of Health.Age-Specif ic Rates - the number of hospital cases or days in the population for a specif ic age-group, multiplied by 1,000.Age-Standardized Rates - the number of hospital cases or days in the population for all age groups of interest (i.e. 65-74, 75-84, and 85+ years), adjusted to a standard population (the 1991 Canada population), multiplied by 1,000.

Trend (regression analysis): p < 0.001 p < 0.001 p < 0.001 p < 0.001

FALLS IN SENIORS, HOSPITAL DAYS AND RATES, B.C., 1992/93 TO 2004/05

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Rate 65 - 74 Rate 75 - 84 Rate 85+ Rate 65+ *Trend (regression analysis): p < 0.001 p = 0.420 p = 0.603 p = 0.250

* Age-Standardized.Source: Discharge Abstract Database, Population Health Surveillanc and Epidemiology, B.C. Ministry of Health.Age-Specif ic Rates - the number of hospital cases or days in the population for a specif ic age-group, multiplied by 1,000.Age-Standardized Rates - the number of hospital cases or days in the population for all age groups of interest (i.e. 65-74, 75-84, and 85+ years), adjusted to

Environmental Scan

Environmental Scan of Seniors and Veterans Falls Prevention Initiatives

Dr. Vicky Scott, Senior Advisor on Falls Prevention, BCIRPU

Dr. Elaine Gallagher, Professor, UVic School of Nursing

Dr. Mariana Brussoni, Associate Director, BCIRPU

Kristine Votova, Doctoral Student, University of Victoria

Dorry Smith, Researcher, BCIRPU

Purpose and Background

Why falls? 85% of all injuries to the elderly $180 million in direct health costs (BC,1998)

Why a falls’ inventory? Reflect changes since the previous scan (Scott, Dukeshire,

Gallagher, & Scanlan, 2001) Aid practitioners/researchers to better understand critical

factors

End result: prevent falls, promote networking and contribute to a collective effort currently underway in the province to reduce falls and injuries among older persons

Methods of Data Collection

Epidemiological data Vital Statistics (mortality) Ministry of Health (hospital separation)

Inventory data Province-wide survey of seniors falls prevention

initiatives

Critical factors of success In-depth interviews with successful programs

Results

116 completed inventories submitted

Nine-fold increase in reported initiatives

Initiatives categorized: Policy Research Practice

Results

Community/Pre-Frail and Well-Elderly (32%)

LTC/Frail and Cognitively Impaired Elderly (30%)

Acute Care/Geriatric Rehab Services (5%)

Cross-Site (11%)

Research (11%)

Policy (8%)

Private Providers (3%)

Information Provided in the Scan

Initiatives’ descriptive information

Key findings of critical factors of success

Recommendations to healthcare settings and providers

Indexes of tables

Translating Research to Practice

Evidence-based Applicable Affordable Effective Sustainable

The Interior Health Authority experience

1995: Researchers bring the issue of falls to the region

2000: North Okanagan Health Region (NOHR) planners were alarmed at the high rate of falls for their Health Area

Evidence to Practice Example

Evidence to Action

Partnerships formed Communities buy-in Three year funding received from HCVAC

Climate for Change

Four health areas merge in 2000 creating a climate change

New health region holds Population Health Conference in 2002 and Falls Program is showcased

Aging Population = Higher Falls Numbers

Pop Health Jump Starts Falls Focus

Champions were identified

Project funds were strategically dispersed

Strategic Plan was drafted

Falls Prevention Manager appointed by Population Health to provide leadership and support of regional efforts

Building Capacity

Created inventory with BCIRPU

Hired BCIRPU to produce a comprehensive falls report

Identified and supported falls pilots in each sector and health area based on sound research/best practices

Working with Municipal Councils, community groups and seniors to develop partnership to address local fall issues

Action to Practice

Internal: Residential Falls Program Acute Care Project Community Health Care Workers Project

External: Safe Communities falls prevention program

Challenges

Constant change

Compliance (Forms)

Reliable “real time” internal data

Developing universal reporting systems

Sustaining the programs beyond the project phase

Next Steps in Interior Health

Mandatory Performance Management indicators

Across sector falls reports

Hand over clinical piece to Performance Management

Will expand focus to include assisted living and well seniors in the community

What we have learned in B.C.

It takes time Need the evidence Need the right partners Need to integrate prevention into policy and

practice Need to evaluate and disseminate Need to build sustainability in from the start Need to celebrate your successes

Next Steps for B.C.

CFPC – national standardized training – B.C. climate created opportunity to do this

Accountability by HAs and Professionals Regional performance indicators Setting-specific practice indicators

BCFPC Monitoring and supporting Priority setting Disseminating

Questions?Questions?

Thank You!Merci!