Promoting Fall Prevention The Pivotal Role of State Coalitions

1
Promoting Fall PreventionThe Pivotal Role of
State Coalitions
Falls FreeTM Coalition Bonita Lynn Beattie, PT,
MPT, MHA National Council on Aging Center for
Healthy Aging March, 2007 www.healthyagingprograms
.org
2
Falls In Older Adults A Growing Public Health
Concern for the United States

• In 2003
• 13,700 died from falls
• 1.8 million treated in EDs
• 1.3 million treated released
• 460,000 hospitalized
• Admission rates with age (39 of fall related
  admissions are 85)

How many non-reported falls?
3
Economic Impact

• In 2000, total cost of fatal fall injuries
• among people 65
• Total 19 billion
• Fatal falls 0.2 billion
• Nonfatal injuries 19 billion

• ___________
• Stevens JA, Inj Prev, 2006

4
Interventions What Works?

• Comprehensive clinical assessment1
• Exercise for balance strength2
• Medication management3
• Vision correction4
• Reducing home hazards5

• ___________
• 1. American Geriatrics Society, JAGS, 2001
• 2. Lord SR, JAGS, 2001
  
• 3. Cumming RG, Drugs Aging, 1998
  
• 4. Ray W, Topics in Geriatric R Rehab,1990
• 5. Day L, BMJ 2002 Gill TM, JAGS, 1999
  

5
Falls Free National Summit

• Preparation Steering Committee, National
  Environmental Scan, Review Research Papers
• 58 National organizations represented
• Experts in their fields, representing diverse
  backgrounds
• Two day summit grappling with the issues,
  developing strategies to activate what we know
  about falls prevention
• Resulted in 36 actionable strategies and action
  steps largely doable in 18 months

6
National Action Plan Organized Around Risk Factor
Management
Physical Mobility
Home Safety
Home Safety
Medications Management
Medications Management
Environmental Safety
Environmental Safety
Cross Cutting Issues
7
NCOA Coordinating Growing Momentum in Fall
Prevention

• 2005
• Released National Action Plan
• Organized Falls Free Coalition
• Created Falls Free E-Newsletter
• Convened Advocacy Work Group
• Increasing Conference Presentations online
  training and practice improvement modules within
  Prof Orgs APTA, AOTA, ABIM
• AGS/BGS invites select Summit attendees to assist
  in the Revision of Clinical Guidelines

• 2006
• S. Bill 1531 H. Bill 5608
• 3 State Coalitions join Falls Free Coalition
• New State Coalitions begin to form
• CDC/NCIPC identifies Fall Prevention as priority
• CDC MMWR calling new attention to growing issue
• Maine successfully introduces legislation
• AoA funds state dissemination of Fall Prevention
  programs
• NCOA invited to multiple national Advisory
  Committees on Fall Prevention

• 2007
• National Action Plan Progress Report
• Home Safety Workgroup meets to select Creative
  Programs Practices in Home Safety
• State Coalition Leaders Workgroup to meet to work
  on Resource Guide for State Coalition building
• Advocacy Workgroup working to re-introduce
  legislation
• NCIPC begins coordinating with Falls Free
  Coalition
• WHO invites NCOA to share Falls Free at
  International Fall Prevention Meeting

• 2004
• National Environmental Scan
• Literature Review
• National Summit

8
Pivotal Role of State Coalitions

• True impact is at the state and local level where
• committed partnerships work to address the issues
  
• and marshal the resources unique to the
  communities

Lessons learned from effective coalitions can
serve to advise and lead other interested states
to strategically address this growing public
health issue
9
State Coalition Workgroup

• In February, 12 state leaders came together to
  address
• common challenges and to share resources more
• importantly to guide NCOA in the development of a
  
• resource guide for emerging State Coalitions

10
State Fall Prevention Coalitions
WA
ME
MN
NH
WI
MA
NY
MI
CT
OH
DE
CA
NC
AZ
Active Fall Prevention Coalitions
HI
Developing Fall Prevention Coalitions
Exploring Fall Prevention Coalitions
11
Next Steps
12
State Coalition Leaders

• Anne Esdale, Injury and Violence Prevention
  Section, Michigan Department of Community Health,
  MI
• Rhonda Siegel, New Hampshire Department of Health
  Human Services, NH
• Barb Alberson, State Local Injury Control
  Section, California Department of Health Services
• Peggy Haynes, Partnership for Healthy Aging,
  Portland, ME

13
The Michigan Fall Prevention Partnership

• Anne Esdale
• Injury and Violence Prevention Section
• Michigan Department of Community Health
• Lansing, Michigan
• ASA/NCOA Conference March 2007

14
Cornerstones of the State Coalition

• Statewide Fall Prevention Partnership
• Founding Members
• Michigan State Medical Society
• Michigan Pharmacists Association
• Central Michigan Universitys College for Health
  Professions
• The Partnership has 30 members from public
  health, the aging services network, health care
  and academia.
• The State Health Department is seen as the
  neutral convener.

15
Hospital-Based Fall Prevention Clinic
Demonstration

• Three year CDC grant to develop, implement and
  evaluate two hospital-based fall prevention
  clinics.
• Evaluation showed that participants in the fall
  prevention clinic program had 34 percent fewer
  falls than those in the control group.

16
Mission of the Partnership

• To bring fall prevention efforts into the
  mainstream of patient safety improvement
  endeavors and the design of communities to
  maximize health and independence for older
  adults.
• Priority Activity
• To develop strategies for a state Call to
  Action document for mobilizing a coordinated
  effort to address fall prevention.

17
Priority Strategies of the Partnership

• Educate health professionals about fall
  prevention.
• Raise awareness and disseminate information about
  fall prevention to older adults and their
  caregivers.
• Increase the availability of appropriate physical
  therapy and exercise programs and services for
  older adults.
• Maximize the opportunity to address medication
  review and management by nurses and pharmacists.

18
Key Funding Sources for Partnership

• CDC fall prevention grant funding
• Small amount of state funding for consulting firm
• After grant ended, difficult to fund funding to
  support infrastructure
• Contacted foundations but no interest
• Partners did not have resources to dedicate

19
Fall Prevention Publications

• The Role of the Physician in Promoting Fall
  Prevention for Older Adults (Physician Brochure)
• Why You Need to Talk to Your Doctor About Falling
  (Older Adult Brochure)
• Older Adult Falls in Michigan Facts for Health,
  Wellness and Aging Services Providers (Brochure
  for Health, Wellness and Aging Services
  Providers)
• Falls and Fall Injuries Among Michigans Older
  Adults (Descriptive analysis of falls)

20
Fall Prevention Toolkit Developed

• Comprehensive Fall Prevention for
  Community-Dwelling Older Adults Planning for
  Success in Identifying and Referring Older Adults
  Through Hospital-Based Programs
• Contains a manual, fact sheet, educational
  brochures, medication card and DVD
• DVD demonstrates evidence-based fall risk
  assessment tests and interventions

21
Product Availability

• All products, except DVD, available through
• www.michigan.gov/injuryprevention
• DVD contact Cheryl Rockefeller _at_
  RockefellerC_at_michigan.gov or [phone]

22
Successes of the Partnership

• Sustained interdisciplinary collaborations
• Hospital-based program with documented positive
  outcome reduction of falls
• Professional education and educational materials
• Statewide conferences
• Initiation of community-based program with Matter
  of Balance
• Medicaid letter writing campaign

23
Challenges

• Hard to sell model to health care because of
  limited revenue generation potential.
• Required system changes difficult to implement.
• Older adults do not define this as a priority
  issue.
• Physicians are not taking the lead.
• Lack of understanding of reimbursement for health
  care delivered services.

24
Other Challenges

• Recruitment of older adults is difficult in the
  hospital setting.
• The required interdisciplinary model is difficult
  to develop and sustain in the hospital.
• This model requires advanced skill training of
  physical therapists not entry level skills!

25
Lessons Learned from Michigan

• Integration of fall prevention with chronic
  disease programs is recommended.
• More emphasis should be placed on the community
  model rather than the health care model.
• The goal should be to reach younger populations
  with prevention education before falls and
  injuries occur.
• A social marketing campaign is needed to educate
  older adults, their families and providers about
  fall risk factors and the prevention of falls.

26
Contact

• Linda Scarpetta, MPH
• Manager, Injury Violence Prevention Section
• Michigan Department of Community Health
• P.O.Box 30195
• Lansing, MI. 48909
• scarpettal_at_michigan.gov

27
Rhonda Siegel New Hampshire Injury Prevention
Concord, New Hampshire
28
History of Falls Task Force

• In 1999, New Hampshire released an injury
  surveillance report which included rate of falls
  deaths, hospitalizations, and emergency
  department visits in the elderly (65 and older)
  population. Unlike other injury causes, the rates
  due to elderly falls either stayed the same over
  time or had gone up.
• The New Hampshire Falls Risk Reduction Task Force
  (Task Force) was organized soon after the report
  to address the issues that arose in the report.
• With an electronic membership of over 200
  professionals statewide, the Task Force is made
  up of a variety of disciplines, all working with
  the elderly, and all sharing a commitment to
  reducing the risk and numbers of falls among New
  Hampshires elderly.

29
History of Falls Task Force

• Meets on a monthly basis (approximately 10-20
  regulars attend).
• Every meeting is started with a current
  literature review.
• The Task Force is co-lead by the Injury
  Prevention Program at the NH Department of Health
  and Human Services and the Injury Prevention
  Center at Dartmouth College.
• No ongoing funding for Task Force. All members
  agencies donate their time in-kind. All
  activities are grant funded.
• The New Hampshire Falls Risk Reduction Task Force
  is known statewide, nationally, and
  internationally.
• Was mentioned in USA Today and parodied on
  Saturday Night live.

30
Some Sources of Funding (Not Ongoing)

• CDC conference grant
• CDC injury surveillance grant
• Endowment for Health (NH based organization)
• NH Charitable Foundation
• NH Council on the Arts

31
Goals and Objectives of Task Force

• Reduce the rate of death and disability in the
  elderly due to falls
• Reduce the risk of falling in the elderly
  population
• Educate and train professionals working with the
  elderly

32
Successes/Multifactorial Assessment, and
Intervention Pilot Project in an Elderly Housing
Site

• Funded by HUD in collaboration with a
  multidisciplinary group of organizations.
• Lebanon Housing Authority
• Lebanon Fire Department
• DHMC Physical Therapy Department
• Statewide Injury Prevention Program
• Volunteer Pharmacist
• Lebanon Senior Center
• Notre Dame College
• NH Falls Risk Reduction Task Force

33
Successes/Multifactorial Assessment, and
Intervention Pilot Project in an Elderly Housing
Site

• Project included
• Educational Programs
• Individual Assessments including Medical,
  Physical Therapy and Pharmacy
• Recommended Modifications of Treatment and
  Behaviors
• Home Inspections and Modifications
• Group and Individual Exercise Programs

34
Successes/Multifactorial Assessment, and
Intervention Pilot Project in an Elderly Housing
Site

• Reduce incidence of falls amongst participants
• Increase knowledge of fall risk factors
• Assess for environmental risks, medical
  conditions, balance/strength deficits, and
  polypharmacy
• Decrease fall risk hazards in and around homes
• Increase strength, flexibility and balance
  through exercise to reduce fall
• Identify pharmaceutical risks for participant and
  physician
• Identify medical conditions linked to fall risk

35
(No Transcript)
36
Successes/Multifactorial Assessment, and
Intervention Pilot Project in an Elderly Housing
Site

• 66 of program participants showed improvement
  using the Timed Up and Go test.
• 100 of those who participated in at least half
  of the exercise sessions had improved scores.
• 2.5 times as many participants reported having
  information about household hazards following
  program completion.
• There was a small increase in the number of
  participants indicating they had received help in
  managing their medications

37
Successes/ Collaboration with the Senior Theatre
Troupe, Senior Moments

• As a result of focus groups located throughout
  the state.
• Key finding was recognizing the role and
  importance of peers as support systems and
  information channels.
• Also developed You CAN Reduce Your Risk of
  Falling, a health communications campaign

38
(No Transcript)
39
Successes/ 2005-2006 Best Practice, Falls Risk
Reduction Project

• 20 teams across the state. These teams were
  initially trained in March of 2005 and completed
  a yearlong project in June of 2006. Teams worked
  with mentors from the Task Force Teams on
  facilitating a falls risk reduction project in
  their setting. Teams represented community based,
  long term care, and acute care settings and were
  representative of the whole state.
• Working with the Harvard Injury Control Research
  Center to evaluate project

40
(No Transcript)
41
Current Projects

• Advocating routine falls screening in primary
  care practices according to AGS guidelines.
• The New Hampshire Falls Risk Reduction Task Force
• Presents
• Assessing Your Elderly Patients for Falls
  Integrating Falls Screening into Your Practice
• With Kenneth Dolkart, MD, FACP

42
Roadblocks

• The Task Force is always seeking funding for its
  activities, which takes up quite a bit of time.
• The Task Force s membership has stabilized.
  However, finding new (and active) members is
  always a goal. Active participation in the Task
  Force also takes up a lot of time. This is
  sometimes difficult for its members, many of whom
  are practicing clinicians.