Preventing Falls: What Works

1. Preventing Falls: What Works Fortunately, we have some good research and evidence around what actually works to prevent falls. Fortunately, we have some good research and evidence around what actually works to prevent falls.

2. What Works We�re going to focus on the CDC�s recommendations for the fall prevention strategies that have the most solid research and evidence behind them: Having a clinical assessment Engaging in exercise, particularly exercise with strength and balance components. Working with a doctor or pharmacist to have your medications reviewed and managed. Maximizing vision. Improving home safety. We will now dive a little deeper into each one of these prevention strategies.We�re going to focus on the CDC�s recommendations for the fall prevention strategies that have the most solid research and evidence behind them: Having a clinical assessment Engaging in exercise, particularly exercise with strength and balance components. Working with a doctor or pharmacist to have your medications reviewed and managed. Maximizing vision. Improving home safety. We will now dive a little deeper into each one of these prevention strategies.

3. Clinical Assessment A clinical assessment to determine someone�s fall risk factors is an important part of addressing how to keep them from falling. Just asking the question, �Have you fallen in the past year?� can help determine that person�s falls risk since we know that if someone has already fallen, he or she is 2-3 times more likely to fall again. The American Geriatrics Society has developed guidelines for conducting clinical falls risk assessments (website is above on the slide). The guidelines include asking questions about whether someone has fallen, frequency and circumstances of the fall, if the person has had difficulties with gait and balance, and many more. An assessment , of course, isn�t enough. Once the fall risks have been determined, an appropriate falls prevention plan needs to be put in place.A clinical assessment to determine someone�s fall risk factors is an important part of addressing how to keep them from falling. Just asking the question, �Have you fallen in the past year?� can help determine that person�s falls risk since we know that if someone has already fallen, he or she is 2-3 times more likely to fall again. The American Geriatrics Society has developed guidelines for conducting clinical falls risk assessments (website is above on the slide). The guidelines include asking questions about whether someone has fallen, frequency and circumstances of the fall, if the person has had difficulties with gait and balance, and many more. An assessment , of course, isn�t enough. Once the fall risks have been determined, an appropriate falls prevention plan needs to be put in place.

4. Exercise for Balance and Strength The evidence behind exercise or physical activity to increase balance and strength to prevent falls is substantial. It just makes sense�people who have better leg strength are better able to handle every day circumstances such as walking up and down stairs. As we age, our muscles tend to become less flexible and strong, and our joints become stiffer. That can also affect balance. Exercise is the best way to improve strength and mobility. Greater strength and mobility mean that we might be able to recover our balance, therefore avoiding a fall. Evidence shows that exercise programs like Tai Chi that increase strength and improve balance are especially good. The evidence behind exercise or physical activity to increase balance and strength to prevent falls is substantial. It just makes sense�people who have better leg strength are better able to handle every day circumstances such as walking up and down stairs. As we age, our muscles tend to become less flexible and strong, and our joints become stiffer. That can also affect balance. Exercise is the best way to improve strength and mobility. Greater strength and mobility mean that we might be able to recover our balance, therefore avoiding a fall. Evidence shows that exercise programs like Tai Chi that increase strength and improve balance are especially good.

5. Hallmarks of Effective Exercise Programs Exercise can reduce fall rates if: Programs challenge balance Programs include 50+ hours of exercise Motivate older adults to participate Exercise can reduce falls rates if the programs challenge balance, include 50+ hours of exercise per year (depending on the program), and motivate older adults to participate in them. Exercise can reduce falls rates if the programs challenge balance, include 50+ hours of exercise per year (depending on the program), and motivate older adults to participate in them.

6. CDC Guide to Preventing Falls The CDC is in the process of updating this compendium that includes many community-based programs that have been found effective in reducing falls.The CDC is in the process of updating this compendium that includes many community-based programs that have been found effective in reducing falls.

7. Exercise-Based Interventions This slide highlights several exercise-based programs that are included in the CDC�s Guide to Preventing Falls: What Works. Please note that the CDC�s National Center for Injury Prevention and Control is funding four state health departments�to conduct pilot programs that refine the�processes needed to implement two evidence-based falls prevention: Dr. Fuzhong Li�sTai Chi: Moving for Better Balance (shown with the arrow beside it above) and Stepping On (discussed in an upcoming slide).�Grantee states include California, New York, Oregon, and Wisconsin. The goal is to disseminate�these�programs nationally in 2011.This slide highlights several exercise-based programs that are included in the CDC�s Guide to Preventing Falls: What Works. Please note that the CDC�s National Center for Injury Prevention and Control is funding four state health departments�to conduct pilot programs that refine the�processes needed to implement two evidence-based falls prevention: Dr. Fuzhong Li�sTai Chi: Moving for Better Balance (shown with the arrow beside it above) and Stepping On (discussed in an upcoming slide).�Grantee states include California, New York, Oregon, and Wisconsin. The goal is to disseminate�these�programs nationally in 2011.

8. Improve Home Safety Improving home safety is an important strategy to address falls prevention. We will discuss some steps that seniors can take to make their homes safer.Improving home safety is an important strategy to address falls prevention. We will discuss some steps that seniors can take to make their homes safer.

9. Home Modification Strategies Handrails in stairwells, bathrooms, and hallways Good lighting in hallways and stairwells Use color-contrasting on stair edges Removing trip hazards such as rugs, cords, and floor clutter Using night lights and flashlights to increase light To make a home safer, handrails should be placed on BOTH side of stairs and grab bars should be appropriately placed in bathrooms. Since we need more light when we get older, increased lighting in hallways and stairwells is important. Depth perception can be a problem for older adults, especially when wearing multi-focal lenses. Color-contrasting tape on stair edges can help. Tripping hazards such as rugs or cords should be taped down or removed and floor clutter should be cleared. Night lights and flashlights should be available in bedrooms and bathrooms for nighttime safety. Additional home safety tips are available at http://www.homesafetycouncil.org/SafetyGuide/sg_falls_w001.asp.To make a home safer, handrails should be placed on BOTH side of stairs and grab bars should be appropriately placed in bathrooms. Since we need more light when we get older, increased lighting in hallways and stairwells is important. Depth perception can be a problem for older adults, especially when wearing multi-focal lenses. Color-contrasting tape on stair edges can help. Tripping hazards such as rugs or cords should be taped down or removed and floor clutter should be cleared. Night lights and flashlights should be available in bedrooms and bathrooms for nighttime safety. Additional home safety tips are available at http://www.homesafetycouncil.org/SafetyGuide/sg_falls_w001.asp.

10. Home Modification Interventions The CDC�s Guide to Preventing Falls: What Works includes two home modification interventions, shown above.The CDC�s Guide to Preventing Falls: What Works includes two home modification interventions, shown above.

11. Review and Manage Medications Many older adults take multiple medications. Some medications can affect coordination and balance. Other medications, including some over-the-counter drugs, may not interact well together. Many older adults take multiple medications. Some medications can affect coordination and balance. Other medications, including some over-the-counter drugs, may not interact well together.

12. Medications Risks Medications are metabolized differently in older adults. Some may cause dizziness or drowsiness, or as previously discussed, affect balance and coordination. Just taking 4 or more medications or any psychoactive drug increases an elder�s risk of falling. It�s important to have all medications reviewed by a doctor or pharmacist. It�s also best to use one pharmacy for continuity and to make it easier to have medications reviewed.Medications are metabolized differently in older adults. Some may cause dizziness or drowsiness, or as previously discussed, affect balance and coordination. Just taking 4 or more medications or any psychoactive drug increases an elder�s risk of falling. It�s important to have all medications reviewed by a doctor or pharmacist. It�s also best to use one pharmacy for continuity and to make it easier to have medications reviewed.

13. Maximize Vision Contrast sensitivity and depth perception have been found to be the most common visual deficits associated with falls. In addition to the �maximizing vision� tips on the slide, adjust glasses when out of alignment and keep glasses clean. And as previously discussed, increase lighting wherever possible.Contrast sensitivity and depth perception have been found to be the most common visual deficits associated with falls. In addition to the �maximizing vision� tips on the slide, adjust glasses when out of alignment and keep glasses clean. And as previously discussed, increase lighting wherever possible.

14. Multi-Faceted Interventions The CDC�s National Center for Injury Prevention and Control is funding four state health departments�to conduct pilot programs that refine the�processes needed to implement two evidence-based falls prevention: Stepping On (highlighted above) and Dr. Fuzhong Li�sTai Chi: Moving for Better Balance (discussed in slide #7).�Stepping On is a program that addresses several fall risk factors, with the target audience being community-dwelling older adults. The CDC�s National Center for Injury Prevention and Control is funding four state health departments�to conduct pilot programs that refine the�processes needed to implement two evidence-based falls prevention: Stepping On (highlighted above) and Dr. Fuzhong Li�sTai Chi: Moving for Better Balance (discussed in slide #7).�Stepping On is a program that addresses several fall risk factors, with the target audience being community-dwelling older adults.

15. What encourages seniors to enroll in a fall prevention program? Feel that program is relevant Believe it will improve quality of life Low intensity exercise Acknowledgement: Dr. Rita Noonan, CDC Invitation from a healthcare provider Involved in decision making Good self-efficacy Social support Research shows us that older adults enroll in a fall prevention program if the following are true: They feel that the program is relevant They believe that it will improve their quality of life The program includes low, not high, intensity exercise They receive an invitation to attend the program from a healthcare provider They are involved in making a decision about their participation They have good self-efficacy about the program�in other words, they have confidence that the program will make a positive difference and reduce their risk of falling Their family and friends support their decision to participate in the program.Research shows us that older adults enroll in a fall prevention program if the following are true: They feel that the program is relevant They believe that it will improve their quality of life The program includes low, not high, intensity exercise They receive an invitation to attend the program from a healthcare provider They are involved in making a decision about their participation They have good self-efficacy about the program�in other words, they have confidence that the program will make a positive difference and reduce their risk of falling Their family and friends support their decision to participate in the program.

16. What discourages seniors? Fatalism Denial of fall risk Poor self-efficacy No history of exercise Fear of falling Poor health & functional abilities Low health expectations Stigma of programs for older adults Now we�ll discuss what may prevent older adults from enrolling in a falls prevention program: Fatalism�they may feel like they are going to die anyway, so what�s the point of trying to prevent it? Denial of fall risk, even with people who have fallen multiple times Poor self-efficacy�they may have no confidence that the program will make a difference No history of exercise. Fear of falling Poor health and functional abilities Low health expectations Stigma of programs for older adults�they may not want to go to a program specifically designed for seniors.Now we�ll discuss what may prevent older adults from enrolling in a falls prevention program: Fatalism�they may feel like they are going to die anyway, so what�s the point of trying to prevent it? Denial of fall risk, even with people who have fallen multiple times Poor self-efficacy�they may have no confidence that the program will make a difference No history of exercise. Fear of falling Poor health and functional abilities Low health expectations Stigma of programs for older adults�they may not want to go to a program specifically designed for seniors.

17. What Works Today we have discussed falls prevention strategies with the strong evidence to show that they are effective. Other strategies to consider include the following: Combat osteoporosis by taking recommended amounts of calcium each day (and start early in life) Take approximately 700-1,000 international units of Vitamin D each day Wear adequate footwear Use a walker, cane, or other assistive device when needed, but learn how to properly use the devices Know how your pets react to �risky situations� such as walks or visitors, and send them to obedience school, if necessary. According to the CDC, over 86,000 people fall each year because of pets; the highest risk of injury is for people 75 and older. Today we have discussed falls prevention strategies with the strong evidence to show that they are effective. Other strategies to consider include the following: Combat osteoporosis by taking recommended amounts of calcium each day (and start early in life) Take approximately 700-1,000 international units of Vitamin D each day Wear adequate footwear Use a walker, cane, or other assistive device when needed, but learn how to properly use the devices Know how your pets react to �risky situations� such as walks or visitors, and send them to obedience school, if necessary. According to the CDC, over 86,000 people fall each year because of pets; the highest risk of injury is for people 75 and older.

18. 18 Let�s stop falls before they happen!Let�s stop falls before they happen!

19. Questions?Questions?