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Stopping Falls, Saving Lives

Tuesday, March 13, 2018   (0 Comments)
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Carolyn Ham, Older Adult Falls Prevention Specialist, Injury and Violence Prevention, Washington State Department of Health

 

Helping older adult patients prevent injuries can save lives, and improve quality of life for patients and families. Falls are the leading cause of injury-related death and hospitalization for adults ages 65 and older. According to the Centers for Disease Control, every 11 seconds an older adult is treated in the emergency department for a fall, and every 19 minutes an older adult dies from a fall. However, many falls are preventable with evidence-based interventions. Falling is not a normal part of getting older, and the negative cycle started by a fall can be stopped. Healthcare providers can help patients prevent falls by following three easy steps:

  1. Screen
  2. Assess
  3. Intervene

 

These three steps are key components of the STEADI (Stopping Elderly Accidents, Deaths & Injuries) toolkit. Developed by the CDC in collaboration with the University of Washington, STEADI helps clinicians decrease falls risk for older adult patients. The first step is a validated self-assessment screening questionnaire that patients fill out. It asks whether they have fallen in the last year, if they are worried about falling, and questions designed to uncover risk factors. Providers can use this questionnaire to talk with patients about risk factors and discuss possible referrals and interventions.

 

STEADI has step-by-step guides to administering three functional assessments that quantify a patient’s falls risk. The tests take a total of 10 minutes to administer, and can be done by the provider, by a nurse, or by a medical assistant. The last piece of STEADI is an algorithm that sorts patients into low, moderate, or high falls risk based on their responses on the questionnaire and results of the functional tests. The algorithm has recommendations for interventions based on the patient’s risk level.

 

Graphic credit: STEADI

 

One recommendations for patients with low and moderate risk level is to participate in an evidence-based falls prevention program in their community. These programs are proven to decrease the risk of falls in older adults, and are available at low or no cost from local organizations. The full list of programs can be found on the website of the National Council on Aging’s Falls Prevention Resource Center. In Washington State, listings of evidence-based falls prevention programs are available on LivingWell and Washington Tracking Network. Maps and information on available programs are available from the Oregon Health Authority, Idaho Department of Health and Welfare and Alaska Commission on Aging.

 

Photo Credit: National Council on Aging 2017

 

Programs are offered in groups or one-on-one, and include exercise and education. Studies show they are effective at reducing fear of falling and improving strength and balance. Participants in the program Tai Chi (or Tai Ji Quan): Moving for Better Balance saw a 55% reduction in falls rate after completing the program. Of those participating in A Matter of Balance, 97% reported they felt more comfortable discussing their fear of falling.

 

In addition to programs referrals, providers can help older adults prevent falls by addressing other risk factors. Review medications to ensure they are not unnecessarily increasing risk. The Beers List, developed by the American Geriatrics Society, lists potentially inappropriate medications for use in older adults, including those that increase falls risk. Home safety is an important factor in preventing falls. The CDC has developed a free “Check For Safety” brochure that can be used as a patient handout.

 

Two other risk factors for falls that are not as commonly discussed are nutrition and substance misuse. Malnutrition can be caused by difficulty swallowing, loss of appetite, inadequate income, or even isolation. Older adults can be underweight, overweight, or normal weight and be malnourished. A nutritionist or dietitian can help determine what is causing the malnutrition, and Meals On Wheels is a great intervention when income or difficulty accessing the community are factors.

 

Substance misuse, including alcohol, can develop at any age. It puts older adults at increased risk for falls, especially in combination with medications. The rate of misuse among older adults is rising, and there is significant under-diagnosis. Be on the lookout for the signs of substance misuse when an older adult is having frequent falls. Let patients know that treatment is effective, and recovery from substance misuse is possible.

 

Falls negatively impact quality of life for older adults across our region. Healthcare providers have a key role in helping patients stay safe and independent. If you have questions or would like to request resources, please reach out the Washington State Department of Health Older Adult Falls Prevention Program. Thank you for helping to stop falls and save lives through screening, assessment and intervention!

 

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