stand up & be strong! mn apta evidence-based falls prevention co-sponsored by the mn department...
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Stand Up & Be Strong!
MN APTA Evidence-Based Falls Prevention
Co-sponsored by the MN Department of Human Services
MN ChapterAmerican Physical Therapy Association
www.mnapta.org651-635-0046
Stand Up & Be Strong!Stand Up & Be Strong! MN APTA Evidence-Based Falls MN APTA Evidence-Based Falls PreventionPrevention
You will be able to:•Measure fall risk due to lower body weakness•Incorporate screening of older adults into
your program•Understand action steps to reduce this risk
Project Manager: Kris Gjerde, PT, Minnesota Chapter American Physical Therapy Association
Minnesota Minnesota Falls Prevention Falls Prevention InitiativeInitiative MN Board on Aging RFP: Community Service/ System MN Board on Aging RFP: Community Service/ System
Change/ Service Development (CSSD) grants to foster Change/ Service Development (CSSD) grants to foster decreased nursing home utilizationdecreased nursing home utilization
MN Chapter APTA ‘system change’ proposal: MN Chapter APTA ‘system change’ proposal: community based fall risk screen and action steps community based fall risk screen and action steps piloted in 10 Western MN Countiespiloted in 10 Western MN Counties
MN APTA Collaborative partners: MN APTA Collaborative partners: PrimeWest Health Services PrimeWest Health Services
Area Agencies on AgingArea Agencies on Aging Local Health Care providersLocal Health Care providers County public health departments County public health departments
Other CSSD Falls Prevention granteesOther CSSD Falls Prevention grantees::Mayo Medical School-in home assessment by geriatric Mayo Medical School-in home assessment by geriatric fellow, Olmstead County MN fellow, Olmstead County MN
Fairview Ridges-in home assessment by PT Dakota Fairview Ridges-in home assessment by PT Dakota CountyCounty
Stand Up & Be Strong!
651-635-0046www.mnapta.org
MN ChapterAmerican Physical Therapy Association
Kris Gjerde, PTProject Manager
Specific Project Goals:Specific Project Goals:
1.1. Create a community-based system Create a community-based system that makes assessment of fall risk that makes assessment of fall risk & prevention of falls routinely & prevention of falls routinely availableavailable
2.2. Enable individuals to assess lower Enable individuals to assess lower body strength and related fall riskbody strength and related fall risk
3.3. Enable individuals to take action to Enable individuals to take action to decrease risk or maintain low riskdecrease risk or maintain low risk
MN APTA MN APTA Stand Up & Be Strong!Stand Up & Be Strong!
Demonstration project designed Demonstration project designed to prevent falls in older adultsto prevent falls in older adults
Community based system changeCommunity based system change
Co-sponsored MN Dept of Human Co-sponsored MN Dept of Human ServicesServices
Why Is This Unique?Why Is This Unique?
MN CSSD grants are highly competitiveMN CSSD grants are highly competitive
MN Chapter received the first state MN Chapter received the first state grant to a professional associationgrant to a professional association
Innovative approach to sustainable Innovative approach to sustainable system change system change
Use of membership network to Use of membership network to disseminate public health programdisseminate public health program
MN APTA WorkgroupMN APTA Workgroup
Reviewed the evidenceReviewed the evidence Identified Fall Risk FactorsIdentified Fall Risk Factors
– Decreased strength and balanceDecreased strength and balance– Medication useMedication use– Vision impairmentVision impairment– Unsafe home environmentUnsafe home environment– Unsafe outside environmentUnsafe outside environment– Having fallen in past year Having fallen in past year – Fear of fallingFear of falling
Stand Up!Stand Up!Guiding EvidenceGuiding Evidence Rand Report on Falls for CMS, 2003 Rand Report on Falls for CMS, 2003
– Multifactor approaches are most Multifactor approaches are most effectiveeffective
– Two most effective interventions are: Two most effective interventions are: lower body strengthening lower body strengthening medication reviewmedication review
– Strengthening was mentioned but not Strengthening was mentioned but not provided in the nine national programs provided in the nine national programs reviewed by Randreviewed by Rand
Stand Up!Stand Up! DevelopmentDevelopment Combined the expertise of MN APTA membersCombined the expertise of MN APTA members
Assumptions:Assumptions:– Physical therapists will serve as trainers & consultantsPhysical therapists will serve as trainers & consultants
– Focus: community dwelling older adultsFocus: community dwelling older adults
– Adults currently perform single repetition of sit to Adults currently perform single repetition of sit to standstand
Requirements of screening tool:Requirements of screening tool:– Enables self assessmentEnables self assessment
– Applicable to groups or individualsApplicable to groups or individuals
– Community based, not medical interventionCommunity based, not medical intervention
– Includes action steps that allow variable techniqueIncludes action steps that allow variable technique
MN APTA MN APTA Falls Prevention Falls Prevention InitiativeInitiative Oct. 2005: MN APTA invited members Oct. 2005: MN APTA invited members
in 10 pilot counties to participatein 10 pilot counties to participate
Apr 2006: MN APTA trained 30 PTsApr 2006: MN APTA trained 30 PTs
May-Dec. 2006 PTs trained 587 May-Dec. 2006 PTs trained 587 community partnerscommunity partners
Jun. 2006: Community partners Jun. 2006: Community partners started screening participants started screening participants
Jan. 2007: Statewide dissemination Jan. 2007: Statewide dissemination beganbegan
Primary Fall Risk Primary Fall Risk ScreenScreen
1.1. Have you fallen in the past Have you fallen in the past year?year?
2.2. Are you afraid that you might Are you afraid that you might fall?fall?
3.3. Do you frequently need to use Do you frequently need to use your arms to rise from chairs?your arms to rise from chairs?
““YES” indicates that you may YES” indicates that you may be at risk be at risk
Physical PrescreenPhysical Prescreen
Cross your armsCross your arms
Rise to standing positionRise to standing position
Successful rise: continue with Successful rise: continue with timed sit to standtimed sit to stand
Unable: Proceed to high risk Unable: Proceed to high risk category category
Timed Sit to StandTimed Sit to Stand
Risk ScoreRisk Score
ActionAction StepsSteps
High Risk: Consult your doctor or Physical High Risk: Consult your doctor or Physical Therapist for advice & instruction to improve Therapist for advice & instruction to improve your strength. Do the exercises only if you your strength. Do the exercises only if you feel safe doing them on your own.feel safe doing them on your own.
Moderate Risk: Do the exercises. Seek Moderate Risk: Do the exercises. Seek assistance if you do not feel safe assistance if you do not feel safe
Low Risk: Continue your active lifestyle, add Low Risk: Continue your active lifestyle, add the exercises to your programthe exercises to your program
Groups: Add the two exercises to your Groups: Add the two exercises to your programprogram
Reassess every 3 monthsReassess every 3 months
ExercisesExercises
Sit to StandSit to Stand
Side Hip RaiseSide Hip Raise
ReachReach
576 Physical Therapist trained576 Physical Therapist trained
1296 Community Partners trained1296 Community Partners trained
1855 Individuals screened1855 Individuals screened
June 2006 – June 2007June 2006 – June 2007
Adults aged 65 and olderAdults aged 65 and older
Risk Score 1662 totalRisk Score 1662 total Percent Percent
High High 741 741 45% 45% Moderate Moderate 518 518 31% 31%
Low Low 359 359 22% 22%
Unknown Unknown 44 44 2% 2%
Uptake Uptake
Follow up calls at 1, 3, 6 monthsFollow up calls at 1, 3, 6 months
Retention of informationRetention of information
Action taken after screeningAction taken after screening– MD, PT visitMD, PT visit
– Performed exercises Performed exercises
– Increased activityIncreased activity
– Falls since screenFalls since screen
Overall functional mobilityOverall functional mobility– 4 mobility questions from SF 364 mobility questions from SF 36
What’s Next?What’s Next?
Screen Older Adults in your communityScreen Older Adults in your community– Assisted LivingAssisted Living
– Home HealthHome Health
– Senior CentersSenior Centers
– Area Agency on AgingArea Agency on Aging
– EMS, Sheriff Dept, Fire DeptEMS, Sheriff Dept, Fire Dept
– Parish NurseParish Nurse
– Faith based programsFaith based programs
To Learn More…To Learn More…
www.mnapta.orgwww.mnapta.org
www.healthyagingprograms.orgwww.healthyagingprograms.org
www.cdc.govwww.cdc.gov
www.aoa.govwww.aoa.gov
www.minnesotasafetycouncil.org/www.minnesotasafetycouncil.org/
www.stopfalls.orgwww.stopfalls.org
Stand Up & Be Stand Up & Be Strong!Strong!
Kris Gjerde, PTKris Gjerde, PT
Minnesota Chapter Minnesota Chapter
American Physical Therapy American Physical Therapy AssociationAssociation
www.mnapta.orgwww.mnapta.org