1 / 33

Fall Prevention in the Primary Care Practice

Fall Prevention in the Primary Care Practice. Joel Botler, MD & Elaine McMahon, MS, RN MaineHealth Elder Care Services. MaineHealth Learning Community PRISM 6 - Preparing for an Aging Maine Thursday, September 25, 2008. Why Falls, Why Now?. A Growing Public Health Crisis.

wilma
Télécharger la présentation

Fall Prevention in the Primary Care Practice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Fall Prevention in the Primary Care Practice Joel Botler, MD & Elaine McMahon, MS, RN MaineHealth Elder Care Services MaineHealth Learning CommunityPRISM 6 - Preparing for an Aging Maine Thursday, September 25, 2008

  2. Why Falls, Why Now? A Growing Public Health Crisis • Falls are a leading cause of unintentional injury and death among those over 65. • Deaths from falls rose 31% between 1999 and 2003. (National Safety Council) • 15,802 deaths in patients over 65 related to falls in 2005. • In 2006, 5.8 million people over 65 (15.9%) reported falls in the prior 3 months. 1.8 million sustained an injury. MMWR 3/07/08

  3. Falls in Maine for population 65+ • 12,406 fall injury hospital discharges. 2000-2004 • 7,395 emergency department visits treated and released for an injury due to an unintentional fall. 2004 • 32,300 falls (16.9%) in the prior 6 months. 2006 MMWR 3/0708 Maine acute care hospitals 2000-2004 Fall injury hospital discharges for Maine residents, 65+.

  4. What do we know about falls? • 1/2 to 2/3 of falls occur around the home • A majority of falls occur during routine activities • Falls usually aren’t caused by just one issue. It’s a combination of things coming together. • A large portion of falls are preventable!

  5. U.S. 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

  6. National Regulations CMS: • Physician Quality Reporting Initiative • Screening for future fall risk Have you fallen 2 or more times in the past 12 months? Have you fallen once with an injury in the past 12 months? • Non-coverage to hospitals for complications of falls

  7. Medicare V code 15.88- Personal History of fall • Developed by CDC & CMS to identify older adults who have fallen and are predisposed to recurrent falls • Qualification of the Medicare V code 15.88 is based upon the presence and documentation of at least one of the following: • Recent history of falls in last 6-12 months* • Health-related falls risk factors* • Health behaviors related to falls* * Documentation qualifies for use of Medicare V code 15.88, which is a secondary ICD10 code to be used with primary ICD10 codes.

  8. What do we know about falls? • 30% of older adults fall each year • Falls are the leading cause of unintentional injury hospitalization and death among older Mainers* *Healthy Maine 2010 • 1/3 to 1/2 of older adults acknowledge fear of falls Fear of falling is associated with: • depression • decreased mobility and social activity • increased frailty • increased risk for falls as a result of deconditioning

  9. What do we know about falls? • 75% of falls occur in and around the home • A majority of falls occur during routine activities • Falls don’t “just happen”. Often, more than one underlying cause or risk factor is involved in a fall.

  10. What do we know about falls? Falls are : • Common • Predictable • Preventable Falls are not a natural part of aging!

  11. Fall Risk Factors • Lower body weakness- 4x • Problems with gait and balance -3x • Impaired vision/ hearing- 2.5x • Postural Hypotension (drop in blood pressure with standing) • Medications • Pills for depression, sleep, blood pressure, heart problems • Four or more of any medications

  12. Fall Risk Factors • Impaired cognition-1.8X • Depression- 2.2X • Problems with ADLs and IADLS- 2.3X • Inappropriate footwear • Fear of Falling • Chronic diseases such as Parkinson’s, Diabetes, Arthritis Risk Factors & the Odds Ratio of Predicting Falls -Rubenstein 2002

  13. Modifiable Muscle weakness Gait & balance problems Vision problems Medications Not Modifiable Older age Female Chronic diseases Arthritis, stroke, Parkinson’s Cognitive impairment Personal Risk Factors

  14. Not Modifiable Cold temperature Uneven pavement Poor public space designs Modifiable Clutter in hallways No stair railings or grab bars Loose rugs Dim Lighting Environmental Risk Factors

  15. Risk of falls by number of predisposing factors 78% 60% 32% 19% 8% Tinetti, 2007

  16. Fall Prevention Strategies Good News! The more risks you eliminate, the lower your chances are of falling.

  17. Fall Prevention • Screening is the first step in preventing future falls. • Screening questions In the past year have you had: • Two or more falls? • One fall with injury? • Who can benefit most? • History of recurrent falls • Fall resulting in injury • Abnormality of gait and/or balance

  18. Multifactorial Assessment for Fall Risk 1. Patient’s story about the fall 2. Assess: • Gait & balance • Orthostatic blood pressure • Vision • Cognitive status • Chronic conditions • ADLs & IADLs • Environmental hazards 3. Review medications

  19. Timed Up & GO (TUG) The Timed Up & Go is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.” (Podsiadlo, D., & Richardson, S., 1991).

  20. Timed Up & Go (TUG) The Timed Up and Go test measures the time it takes to stand up from an arm chair, walk a distance of approximately 10 feet, turn, walk back to the chair, and sit down. Equipment: standard arm chair, tape measure, masking tape/cone, stop watch Normal= < 14 seconds

  21. Assessing Postural Hypotension • Measure patient’s blood pressure after 2-5 > minutes in a supine position. • Measure blood pressure immediately and 2 minutes after standing. • Postural Hypotension: > 20 mm Hg (or > 20%) drop in systolic pressure with or without symptoms.

  22. All patients- 65 years and older Screen for falls annually Multifactorial Fall Prevention Screening and Intervention Screening questions: In the past year have you had: Two or more fall? One fall with injury? “No” on screening questions “Yes” on either screening question Reassess at least annually • Perform a multifactorial fall risks assessment: Fall history • Gait, balance, strength • Medications • Postural hypotension • Medical history Neurological Cardiovascular • Vision • Environmental hazards Intervention needed? No • Initiate intervention: • Exercise Program • PT/OT referral- gait and balance training • Medication modification • Vision evaluated and corrected • Treatment of postural hypotension • Home safety evaluation and modifications Yes

  23. Fall Prevention Strategies for Older Adults • Talk to your doctor • Report falls as soon as possible • Be active- exercise to increase lower body strength & improve balance. Try Tai Chi, for example • Use medications safely- review all medications with your doctor at least annually • Have your vision checked • Wear shoes that are comfortable and supportive, with non-slip soles and wide low heels • Make your home safe

  24. Home Safety • Improve lighting • Use non-skid area rugs • Keep pathways clear • Have handrails from top to bottom on both sides of all stairs • Install grab bars in the bathroom • Store frequently used items at a convenient height

  25. The Bottom Line • Screening is the first step in preventing future falls. • Performing a multifactorial fall assessment and treating the patient’s risk factors can reduce falls by 30-40% (Chang JT et. Al, 2004)

  26. Recent Literature Lack of Effectiveness of a Multidisciplinary Fall-Prevention Program in Elderly People at Risk: A Randomized Controlled Trial. JAGS August 2008 Effect of Dissemination of Evidence in Reducing Injuries from Falls.NEJM July 2008

  27. MaineHealth Clinical Improvement Registry Preventive Health Module Healthy Aging • Population: Age 65 and over • Metric = Falls • Two or more falls within the past 12 months yes/ no • One fall with injury yes/ no

  28. Fall Prevention Toolkit • Fall Prevention Overview • Basic components of a multifactorial fall risk assessment • The Story of Your Fall • Visit Form: Falls/Mobility Problems • Medications and Fall Prevention • Timed Up and Go Test • Assessment: Postural Hypotension • AGS Clinical Practice Guideline • Algorithm- fall prevention screening & intervention • Maine & National Fall Prevention Resources

  29. Fall Prevention Toolkit • Fall risk factors • How do falls affect people? • What can you do to avoid falls? • Manage your medications • Have your vision and hearing checked • Take care of your feet • Have your blood pressure checked • Make your home safe • Talk to your doctor • What to do after a fall • Maine & National Resources

  30. A Matter of Balance • 8 session class designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls. • AoA funded translational research to developed lay leader model. • Outcomes demonstrate significant improvement in: • falls self-efficacy • falls control • falls management • exercise level (6 months) • monthly falls (12 months)

  31. A Matter of Balance Class During 8 two-hour classes, participants learn: • To view falls and fear of falling as controllable • To set realistic goals for increasing activity • To change their environment to reduce fall risk factors • To promote exercise to increase strength and balance Designed to benefit community-dwelling older adults who: • Are concerned about falls • Have sustained a fall in the past • Restrict activities because of concerns about falling • Are interested in improving flexibility, balance and strength • Are age 60 or older, ambulatory and able to problem-solve

  32. Fall Prevention Resources Maine Medical Center Falls Clinic- 207-662-2847 MaineHealth’s Partnership for Healthy Aging- 207-775-1095 or www.mainehealth.org/pfha * Fall PreventionTool Kit- order through J.S. McCarthy * Healthy Choices for ME (www.maine.gov/dhhs/beas/choices and www.211maine.org) Other resources: • American Geriatrics Society http://www.americangeriatrics.org • National Council on the Aging- Center for Healthy Aging www.healthyagingprograms.com • National Institute on Aging www.nih.gov/nia

  33. For more information….. MaineHealth Elder Care Services 465 Congress St, Suite 701 Portland, ME 04101 207-775-1095 Pfha@mmc.org www.mainehealth.org/pfha

More Related