Health Care Professional Educational Module

1
Health Care Professional Educational Module
2
Module Goals

• To increase
• Health care professional knowledge about
  falls-related issues and prevention interventions
  among older adults
• The number of health care professionals who
  attend the Stand Strong for Life Health Care
  Professional Educational module
• The number of health care professionals who
  educate older adults about fall prevention using
  the Stand Strong for Life intervention

3
Module Goals

• To Increase
• The number of health care professionals who
  attend the Stand Strong for Life Health Care
  Professional Educational module
• The number of emergency departments, hospitals,
  and senior living facilities that implement falls
  prevention initiatives
• Community partnerships among health agencies to
  increase falls prevention among
  community-dwelling older adults

4
Intervention Content

• Stand Strong for Life Health Care Professional
  Educational Module
• Stand Strong for Life Community-dwelling older
  adults PowerPoint presentation
• Four brochures that accompany the
  community-dwelling older adult presentation
• Resources and Tools

5
Definition of Fall

• A fall is any event in which a person
  unintentionally comes to rest on the ground or
  another lower level such as a chair, toilet, or
  bed.12

6
Scope of the Problem

• For adults 65, falls are the leading cause of
  injury-related death3,4
• Each year, more than one-third of older adults
  fall5-9
• In 2004, 2.9 M older adults were treated for
  non-fatal injuries in U.S. emergency departments
  of those, 1.9 M were the result of falls10
• Nearly one-half of all falls among older adults
  occur in or around their homes10

7
Scope of the Problem

• Of those who fall, 20 to 30 suffer moderate to
  severe injuries13
• Nearly 50 of those hospitalized after a fall die
  within one year9
• In 2003, nearly 13,820 older adults died from
  fall-related injuries of those, approximately
  50 were age 85 and older.10

8
Cost of Falls Among Older Adults

• Fall-related injury costs 20 billion per year21
• By 2020, total annual direct cost is expected to
  reach 32,4 million21
• Direct costs do not account for the long-term
  consequences of these injuries22

9
Challenges to Be Met

• Between 2000 and 2030, the older adult population
  (65) is projected to grow from 35 million (12.4
  of the population) to over 70 million (20 of the
  population)1,2
• The U.S. public health service estimates that 66
  percent (2/3) of deaths related to fall are
  preventable14
• How do we go about facing the challenge of
  reducing falls and fall-related injuries among
  older adults?

10
Risk Factors

• Internal integral to patients system
• Medical conditions
• Aging process
• External physical environment
• Living environment
• Emergency Department/Hospital/ Senior Living
  Facility
• Outdoors

11

• Falls among older adults are usually not the
  result of a single risk factor, but of a
  combination of internal and external factors24

12
Internal Risk Factors

• History of Falls (Previous Falls)
• Medication use (Polypharmacy)
• Balance, gait, and muscle strength (Lack of
  Physical exercises)
• Vision impairment
• Podiatric problems

13
History of Falls (Previous falls)

• Older adults who have previously fallen or who
  stumble frequently are 2 to 3 times more likely
  to fall within the next year9,25,33
• Previous falls often leads to fear of falling,
  which may lead to decreased activity and loss of
  self-confidence27

14
History of Falls (Previous falls)
15
Visual Impairment

• Poor visual acuity27
• Older adults experience decreased night vision,
  altered depth perception, decline in peripheral
  vision, and glare intolerance25,37
• Also be aware of old or new prescription
  glasses27

16
Medication Use (Polypharmacy)

• Types of medications25,32
• Psychoactive medicines
• Number of administered or prescribed medications
  (polypharmacy)25,27
• Rule of thumb 4 or more medications
• Number and types of over-the-counter medication
  (NSAIDs, vitamins, supplements, homeopathy, etc.)

17
Balance, Gait, and Muscle Strength (Lack of
physical activity)

• Less than 25 of older adults exercise
  regularly40
• By age 65, a 20 decrease in strength and
  flexibility usually occurs41,42
• After age 70, decrease in strength is even
  greater 41,42

18
Podiatric Conditions

• Nearly 75 of older adults have some type of foot
  and ankle problems49
• Decreased sensation in the feet21
• Foot conditions can impair balance function50

19
External Risk Factors

• Unsafe home environment
• Inadequate footwear
• Unsafe outdoor environment
• Unsafe emergency department/ hospital/facility
  environment

20
Unsafe Home Environment22,25

• Slippery flooring and carpeting
• Use of throw rugs
• Inadequate furnishing design and position
• Poor lighting
• Lack of equipment in bathroom and bathtub
• Lack of or structurally unsecured handrails
• Clutter
• Inadequate assistive devices

21
Inadequate Footwear

• Improper shoes can27
• Lead to painful mobility
• Increase potential for feet problems
• Prevent older adults from staying active
• Increase the risk for falls

22
Unsafe Outdoor Environment

• Uneven sidewalk, terrain, curbs, sidewalks
• Lack of or structurally unsecured handrail
• Hazardous materials (ice, snow, gravel, etc.)
• Poor lighting

23
Unsafe ED/Hospital/Facility Environment

• Transfer to or from a bed or chair17
• Bed height16
• Attachment to equipment (IV, oxygen)17
• Slippery floors
• Lack of assistive devices
• Clutter, tripping hazard
• Unreachable bell, side table
• Improper lighting
• Mechanical restraints19,20

24
How Can You Prevent Falls From Occurring?

• The goal of a falls prevention program is to
  reduce the number of risk factors

25
Intervention Model

• Community Setting Presentation/Intervention
• Emergency department, hospital, senior living
  community Intervention

26
Falls-Risk Assessment(Previous falls)

• Falls-Risk Assessment Tools
• Morse Fall Scale (MFS)
• Hendrich II Fall Risk Scale
• Falls Assessment/Screening/ Diagnosis Scale

27
Falls-Risk Assessment(Previous falls)

• Community Presentation
• Conducted before presentation
• Emergency Department, Hospital, or Senior Living
  Community
• Conduct screening when fitting (triage,
  admission, move-in)

28
Vision Examination(Visual impairment)

• In all settings
• Educate older adults
• Refer to primary care provider for regular eye
  examinations

29
Medication Review(Polypharmacy)

• Community Presentation
• Educate older adult
• Refer to primary care provider or pharmacist
• Distribute Safe Medication Card
• Emergency Department, Hospital, or Senior Living
  Community
• Educate older adult
• Refer to primary care provider or pharmacist
• Refer to Stand Strong for Life
• Distribute Safe Medication Card

30
Physical Activity(Reduced balance, gait, and
muscle strength)

• Community Presentation
• Educate older adult
• Distribute and Practice Healthy Movements
• Distribute Health Calendar Contract
• Refer to primary care provider or community and
  home health services
• Emergency Department, Hospital, or Senior Living
  Community
• Educate older adult
• Distribute Healthy Movements
• Refer to Stand Strong for Life (medium and high
  risk)

31
Examples of Physical Activities

• Walking
• Gardening
• Dancing
• Strength, resistance, and flexibility exercises
• Yoga
• Tai Chi

32
In-Home safety(Unsafe home environment)

• Community Presentation
• Educate older adult
• Distribute Check for Safety A Home Fall
  Prevention Checklist for Older Adults brochure
• Refer to community and home health services
• Emergency Department, Hospital, or Senior Living
  Community
• Educate older adult
• Distribute Check for Safety brochure
• Refer to Stand Strong for Life community
  presentation (medium and high risk)
• Refer to community and home health
• services

33
In-Home Modifications and Assistive Devices

• Widening doorways
• Remove any clutter (staircase, floor)
• Remove throw rugs
• Remove electric cords
• Install railings on stairways
• Install grab bars in bathtub, shower, and by
  toilet
• Use shower chair
• Install raised toilet seat

34
Feet and Footwear Check(Podiatric problems and
inadequate footwear)

• Community Presentation
• Educate older adult
• Distribute Foot and Footwear Check brochure
• Refer to primary care physician and home health
  services, if needed
• Emergency Department, Hospital, or Senior Living
  Community
• Educate older adult
• Distribute Foot and Footwear Check brochure
• Refer to Stand Strong for Life community
  presentation
• Refer to primary care physician and home health
  services, if needed

35
Adequate/Inadequate Footwear

• Adequate
• Proper fit
• Non slippery soles
• Low heels
• Inadequate
• Floppy slippers
• Loose fitting
• Wearing socks only

36
Assistive Devices

• Cane
• Walker
• Hip protectors
• Grip bars
• Shower chair
• Raised toilet seat

37
Community Services and Referrals

• Home care service agencies
• Personal trainer or exercise program dedicated to
  older adults
• Social services
• Day care
• Meals on Wheels