Establishing Fall PreventionProject ECHO

Shannon Martin OTD, OTR/L, BCGJennifer Nash, PT, DPT, NCS, CEEAA, MSCS, CDP

Mission: to reduce the incidence of falls in Nevada through sustainable evidence-based fall prevention programs.Vision: to provide a common forum for diverse organizations and members to address fall prevention in targeted populations including older adults, adults with disabilities or chronic disease, rural populations, and marginalized groups by fostering trust and communication across a variety of stakeholders.

Next Meeting: • March 11th, 2019• 12pm – 1 pm

Email to get further details• nvgoesfallsfreecoalition@gmail.com

Nevada Goes Falls Free Coalition Board MembersChair- Shannon Martin

Vice-Chair- Jennifer NashSecretary – Sandy McGinnis

Treasurer- Kristie McWhorterCommunications Coordinators- Mindy Renfro &

Shaina Meyer

PLEASE JOIN US!

Learning Objectives

• Review the use and benefits of three Evidence-based Fall Prevention programs now being disseminated in Nevada (Otago, Stepping On, and Tai Ji Quan)

• Discuss how to utilize the STEADI fall risk toolkit, analyze results, and make appropriate referrals to meet each individual’s needs for fall risk reduction

• Describe referral patterns to engage the interdisciplinary health care team and community service partners for multifactorial fall prevention

Nevada Fall Statistics• Leading cause of unintentional injury-related death in 2015

among adults 55+ in Clark County (30.1 per 100,000)• From 2011-2014, falls were the number 1 cause for injury

related hospitalization and ER visits in Clark County• Adults aged 55-64 year olds in Clark County fall rate is higher

than the national rate among the same age group (6.8 vs. 5.9 per 100,000 from 2011-2015)

CDC’s Fall Prevention Initiative -STEADI

It’s working!• CDC reports that the incidence of falls has improved since 2010. • 1 in 3 is now 1 in 4 older adults fall each year• Yet, over 3 million are treated in emergency departments

annually for fall injuries

STEADI toolkit: Ask the right questions

• Have you had a fall in the past year?

• Do you worry about falling?

• Do you feel unsteady when standing or walking?

https://www.cdc.gov/steadi/materials.html

STEADI toolkit: Types of Fall Risk Factors

• Physical risk factors: Changes in your body that increase your risk for a fall

• Behavioral risk factors: Things we do or don’t do that increase our fall risk

• Environmental risk factors: Hazards in our home or community

Most falls result from a number of risk factors:

CDC, 2017c

STEADI toolkit: functional assessments

• 30-second Chair Stand Test• 4-Stage Balance Test• Timed Up and Go Test• Measuring Orthostatic Blood Pressure

https://www.cdc.gov/steadi/materials.html

STEADI AlgorithmStay Independent questionnaire

STEADI Fall Prevention Patient Referral Form

https://www.cdc.gov/steadi/pdf/STEADI-Form-PatientReferral-508.pdf

Evidence-BasedFall Prevention

Programsin

Nevada

Otago Exercise Program

• Done one-to-one with a trained PT and is delivered as part of a complete PT program

• Includes exercise and walking program designed for you

• If you or your physician feel you should begin with PT, be sure your PT includes the Otago exercise program

• Great start for later Stepping On® program

• Reduces falls by 35-40% in frail, older adults Photo courtesy of the National Council on Aging

https://www.med.unc.edu/aging/cgec/exercise-program

Stepping On®

• Seven weekly 2-hour classes including peer discussion, exercise, expert lectures

• Great follow-up to Otago (OEP)

• Classes include standing exercises that are done by a chair independently

• One should feel safe standing and walking independently before you begin the Stepping On program

• Reduces falls by 31% in community residing older adults

https://wihealthyaging.org/stepping-on

Tai Ji Quan: Moving for Better Balance

• Fantastic program for ongoing fitness and balance training

• Does not include educational component

• Reduces falls by 58% in adults 70 and older compared to stretching program

• Classes are usually on-going and not limited to certain weeks

• Participants should be able to stand on one leg for 5 seconds

• Reduces fall by 31% in adults 70 and older compared to multi-modal exercise program

Courtesy of the National Council on Aging

EBP OverviewProgram Overview Setting Training

RequirementsDelivered by

Otago Increase strength, balance & endurance

Home, OP, ALF, community

Online training PT, PTA

Stepping On Make decisions and promote behavioral change to reduce fall risk

Community 22 hour training OT, PT, fitnessprofessionals,Guest experts

Tai Ji Quan Improve strength & balance in functional tasks

Community 2 day training, refresher courses

Qualified instructors

Finding Evidence-BasedFalls Prevention Programs

• Local Senior Center

• Area Agency on Aging www.eldercare.gov or 1-800-677-1116

• Hospitals or health clinics

• YMCA for programs like Tai Chi

• Nevada Goes Falls Free Coalition

Photo courtesy of the National Council on Aging

Evidence-Based Resources

• National Council on Aging• Provides information on evidence-based falls prevention programs, state

falls prevention coalitions, consumer material and the 2016 Falls Free® National Action Plan

• https://www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-programs-for-older-adults/

• Falls Free® Initiative• Provides resources and evidence-based practice to reduce fall-related

injuries and death among older adults• http://www.ncoa.org/improve-health/center-for-healthy-aging/falls-

prevention/falls-free-initiative.html• Join Nevada Goes Falls Free! Coalition today

Collaborative Fall prevention practice

Collaborative Approach

Screening Further Assessment Referral Intervention

Improving the Collaborative Approach

Team Capacity

Communication

Roles

Primary Care Model

The Future of Collaborative Team Approach to Fall Prevention?

• “Offer potential to better address complex health care needs of older adults through care coordination and multicomponent intervention delivered by health care professional across disciplines.”

• (Eckstrom, et al., 2016,p. 1706)

What can you do?

• Provide resources for fall prevention• See the STEADI toolkit for handouts on Staying Independent, Postural

Hypotension, Fall prevention strategies, Home Safety Checklist, Caregiver Handout, & Chair Rise Exercise Handout

• Provide home exercise program to improve balance and prevent falls

• Go4Life from NIH is great resource• Refer patients/clients to appropriate fall prevention

programs in community• Join NGFFC to stay engaged in community of

practitioners dedicated to fall prevention

Falls Prevention Resources in Nevada

Sanford Center for Aging:

1. Tai Ji Quana) Location: Reno Buddhist Centerb) Date/Time: Mar 4- Aug 19, 2019

from 12:30 pm-1:30 pmc) Duration: Monday's and

Wednesday's for 24 weeks (6 months)

d) Cost: Free

2. Stepping On (TBD)

St. Rose Dignity Health:1. Tai Ji Quan

a) Location: Rosa de Lima Campusb) Date/Time: Jan 8- Mar 26, 2019

from 8:00 am- 9:00 amc) Duration: Tuesday'sd) Cost: Free

2. Stepping Ona) Location: St. Rose Community

Outreach Center- Green Valleyb) Date/Time: Jan 21- Mar 4, 2019

from 2:30 pm- 4:30 pmc) Cost: Free

Did you know that 1 out of 3 people 65 and older fall each year? Learn to prevent serious injuries like hip fractures in these seven-week courses!

Falls Prevention Resources in Nevada

City of Henderson Parks & Rec/ UNLV:

1. Tai Ji Quana) Location: Downtown Senior Centerb) Date/Time: Jan 29 – July 9, 2019

from 10:00 am - 11:00 amc) Duration: Tuesdays and Fridays for

24 weeks (6 months)d) Cost: Free

2. Stepping On (TBD)

Cleveland Clinc Lou Ruvo Center:1. Stepping On

a) Location: 888 W. Bonneville, Las Vegas, NV 89106

b) Date/Time: Jan 14- Mar 4, 2019 from 10:30 am- 12:30 pm

c) Duration: Mondaysd) Cost: Free

2. Tai Ji Quan (TBD)

Did you know that 1 out of 3 people 65 and older fall each year? Learn to prevent serious injuries like hip fractures in these seven-week courses!

Falls Prevention Resources in Nevada

UMC:

1. Stepping Ona) Location: Healthy Living Instituteb) Date/Time: Jan 25- Mar 8, 2019

from 11:00 am-1:00 pmc) Duration: Fridays for 7 weeks d) Cost: Free

Did you know that 1 out of 3 people 65 and older fall each year? Learn to prevent serious injuries like hip fractures in these seven-week courses!

Stepping On: Upcoming Leader Training

If you would like to be trained/train staff in this evidence-based program, training will be held mid/late March. Please contact Heather Haslem: hhaslem@unr.edu.

References• Baxter, P., & Markle-Reid, M. (2009). An interprofessional team approach to fall prevention for

older home care clients at risk of falling: health care providers share their experiences. International Journal of Integrated Care, 9, 1-10.

• Centers for Disease Control and Preventions. (2017). STEADI- Older Adult Fall Prevention. STEADI Materials for Health Care Providers. Retrieved from https://www.cdc.gov/steadi/materials.html

• Eckstrom, E., Neal, M.B., Cotrell, V., Casey, C.M., McKenzie, G., Morgove, M. W., DeLander, G.E., Simonson, W., & Lasater, K. (2016). An interprofessional approach to reducing the risk of falls through enhanced collaborative practice. Journal of the American Geriatrics Society, 64(8), 1701-1707

• National Council on Aging (2017). Select Evidence-Based Falls Prevention Programs. Retrieved from https://www.ncoa.org/resources/select-evidence-based-falls-prevention-programs/

• National Institute on Aging. Go4Life. Retrieved from https://go4life.nia.nih.gov/exercises• Peranich, L., Reynolds, K.B., O’Brien, S.P., Bosch, J., & Cranfill, T. (2010). The roles of

occupational therapy, physical therapy, and speech/language pathology in primary care.Occupational Science and Occupational Therapy Faculty and Staff Research, 6(1), 36-43. Retrieved from https://encompass.eku.edu/cgi/viewcontent.cgi?article=1000&context=ot_fsresearch