Falls Prevention Awareness Day and Month Fall 2017 Anne Hvizdak Statewide Coordinator Evidence-Based Health Promotion Programs, Department of Health Services Bureau of Aging & Disability Resources

Objectives of Presentation Review statistics identifying the high incidence of falls. Recognize multifactorial risks and causes of falls in older adults.  Review balance screenings and assessments for falls risk that are easily administered. Discuss strategies for falls prevention in the community. Identify your role in promoting community readiness. Identify resources to help with falls prevention. Learn the role participants can play in reducing falls risk and falls at their locations.

What is a Fall? Three types of falls: Fall Near Fall Un-witnessed Fall

The Burden of Falls How Big is the Problem in Wisconsin? In 2016, about 25.7% of Wisconsin residents aged 65 and older reported falling in the last year. This accounts for 241,580 older adults. Among those that suffered from a fall, 8.8% caused an injury that limited regular activities for at least a day or required medical attention. In 2015, 1,216 Wisconsin residents aged 65 and older died from an unintentional fall. How Costly are these Falls? The total charges associated with these hospital visits in 2014 were at least $732 million. Source: http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html

The Burden of Falls How Big is the Problem Nationally? In 2010, the total direct medical costs of fall injuries for people 65 and older, adjusted for inflation, was $30 billion. By 2020, the annual direct and indirect cost of fall injuries is expected to reach $67.7 billion (in 2012 dollars). Among community-dwelling older adults, fall-related injury is one of the 20 most expensive medical conditions. Source: http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html

The Burden of Falls in Wisconsin Place of Injury for Falls-related death in persons 65+, Wisconsin, 2015 Home 54.7% Residential institution 32.4% School, Institution or other public area 1.3% Trade and Service Area 2.4% Street or highway 1.4% Other 7.1% Place of Death for Falls-related death in persons 65+, Wisconsin, 2015 Hospital 44.1%  Home 7.7% Nursing Home 26.3%  CBRF 7.7% Facility-based hospice 12.7%  Other 1.5% 1.9% http://www.dhs.wisconsin.gov/health/injuryprevention/pdffiles/FINAL_BOF_080210.pdf

The Burden of Falls in Wisconsin Discharge status of fall-related inpatient hospitalizations for persons 65+, 2014: Transferred to a nursing home 62.1% Home 14.5% Home with home health service 5.1% Transferred to rehab or outpatient services 5.4% Expired 3.3% Discharged to hospice 2.9% Left against medical advice 0.1%

How Wisconsin Is Aging 4 counties have 21-24% of their population 65+: Door, Vilas, Iron and Burnett

How Wisconsin Is Aging 5 years later: 14 counties now have 21-24% of their population 65+

How Wisconsin Is Aging 20 counties have more than 27% of their Population 65+:

Consider the Implication for Falls! How Wisconsin Is Aging Consider the Implication for Falls! Source: WI DOA Demographic Services, Population Projections, Vintage 2013.

Falls, suicide, and unintentional drug overdose account for more than two-thirds of injury-related deaths in Wisconsin – 2012-14 Falls is also the leading cause of injury-related hospitalizations and emergency room visits in Wisconsin.

Deaths caused by falls and unintentional drug overdose have dramatically increased since 2000. 2014

Falls related emergency department visits have continued to increase since 2002. Decreases in other injury related visits can be due to an increase in urgent care visits.

Fall-related ED Visits by County, 2013-2015

Fall-related Inpatient Hospitalizations by County, 2013-2015

Fall-related Deaths by County, 2013-2015

Highest rates for ED, Hospitalizations, and Deaths, 2013-2015

Lowest rates for ED, Hospitalizations, and Deaths, 2013-2015

Multifactorial and Interacting Causes of Falls Intrinsic Risk Factors Gait and Balance Impairments Multiple Falls Advanced Age Vision/Visual Impairments Postural Hypotension Cognition/Dementia Medications – High risk/contraindicated Impaired ADL’s Extrinsic Risk Factors - Environmental hazards: poor lighting, uneven or slippery surfaces - Poor footwear - Restraints - Assistive devices Use of non-sturdy furniture or equipment Precipitating Causes Trips and Slips Dizziness, Orthostasis (“head rush”) Other medical conditions like arrhythmia, syncope, seizure, hypoglycemia, neuropathy Infection Generalized weakness Unsafe activity Person FALL Activity Environment

Causes and Risk Factors for Falls “A characteristic that is found significantly more often in individuals who subsequently experience an adverse event than in individuals who do not experience the event.” Top Causes of Falls in Older Persons Top Risk Factors for Falls: Accident and environment related Lower Extremity weakness Gait and balance disorders or weakness History of Falls Dizziness and vertigo Gait deficit, balance deficit Confusion Age 80 or older Postural hypotension Use assistive device Visual disorder Visual deficit Syncope Arthritis Other specified causes Impaired ADL Unknown impairment Depression Cognitive Impairment Geriatric Research Education and Clinical Center, VA Sepulveda Ambulatory Care Center and Nursing Home, North Hills, CA., 2006

Assessing for Falls Risk Factors CDC STEADI toolkit: Stopping Elderly Accidents, Deaths and Injuries www.cdc.gov/injury/STEADI Timed up and go Patient Self Risk Assessment Four Stage Balance Test

STEADI Patient Self Assessment www.cdc.gov/injury/STEADI Please circle “Yes” or “No” for each statement below Why it matters   Yes (2) No (0) I have fallen in the past year. People who have fallen once are likely to fall again. I use or have been advised to use a cane or walker to get around safely. People who have been advised to use a cane or walker may already be more likely to fall. Yes (1) No (0) Sometimes I feel unsteady when I am walking. Unsteadiness or needing support while walking are signs of poor balance. I steady myself by holding onto furniture when walking at home. This is also a sign of poor balance. I am worried about falling. People who are worried about falling are more likely to fall. I need to push with my hands to stand up from a chair. This is a sign of weak leg muscles, a major reason for falling. I have some trouble stepping up onto a curb. This is also a sign of weak leg muscles. I often to rush to the toilet. Rushing to the bathroom, especially at night, increases your chance of falling. I have lost some feeling in my feet. Numbness in your feet can cause stumbles and lead to falls. I take medicine that sometimes makes me feel light-headed or more tired than usual. Side effects from medicines can sometimes increase your chance of falling. I take medicine to help me sleep or improve my mood. These medicines can sometimes increase your chance of falling. I often feel sad or depressed. Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls. Total_______ Add up the number of points for each “yes” answer. If you scored 4 points or more, you may be at risk for falling. Discuss this with your doctor.

Assessing Falls Risk Factors Timed Up and Go Test Test of basic mobility skills of older adults who can walk on their own. Adapted from the original “Get Up and Go” Test Measures time for person to rise from sitting in standard arm chair, walk 10 feet, turn, walk back to the chair and sit down. Predictive Results: Seconds Rating Balance problems <10 Freely Mobile can be distinguished <20 Mostly Independent by the amount of 20-29 Variable mobility time it takes to >20 Impaired mobility complete the task.

Exercises that improve Strength and Balance Strength, flexibility, balance and reaction time are considered the most readily modifiable risk factors for falls. However, exercise alone will not decrease falls. Balance and lower body strength exercises are aimed at improving the ability to control and maintain the body's position while standing still and moving. Evidence-Based Health Promotion Programs assist older adults improve strength and balance for falls prevention in Community Based settings

Wisconsin Institute for Healthy Aging Lists evidence-based health promotion programs actively promoted in Wisconsin Popular examples: Stepping On, Strong Bones, Walk with Ease, Tai Chi Programs, Matter of Balance www.wihealthyaging.org Resources for leaders Statewide workshop list Lists Community Academic Aging Research Network (CAARN) Falls Prevention Projects underway in various counties

Stepping On Falls Prevention Program most widely available in Wisconsin Covers topics, including vision, home hazards, medicines and practical exercises to improve strength and balance. Designed for people who are living at home and who have fallen or are fearful of falling. Participants must be able to walk by themselves or with a cane. A seven week community-based workshop offered using adult education principles that build older adults' confidence in their ability to reduce falls. Older adults learn specific knowledge and skills to prevent falls. Mutual support and success build participants confidence in their ability to manage their own health behaviors to reduce their risk of falls and remain independent. We use expert presenters such as Physical therapists, Vision Experts, Medication experts and Community Mobility experts to enhance our programs. Developed in Australia, “Americanized” in Wisconsin, WIHA holds the National License. Endorsed by CDC.

Where Workshops are Held ADRC/Aging Units Senior Centers Hospitals, clinics Faith based locations Community Centers Physical Therapy Rehabilitation Facilities Schools YMCA Recreation facilities

Wisconsin Injury Prevention Program Falls Prevention Initiative- State Falls coalition Meets 2nd Thursday 1:30-3:00PM odd numbered months contact Molly Zemke if interested in joining: Molly Zemke, MPH Injury & Violence Prevention Strategic Plan Coordinator molly.zemke@wisconsin.gov Wisconsin Burden of Falls Report (pdf) Find out more about the consequences of fall-related injuries in Wisconsin  Wisconsin Falls Action Plan (pdf) Read about Wisconsin's plan for preventing falls

Wisconsin Community Falls Prevention Coalition Website Examples Safe Communities of Madison – Dane County http://www.safercommunity.net/ La Crosse County Falls Prevention Coalition http://www.lacrossestopfalls.org/preventionCoalition.asp Winnebago County Fall Prevention Coalition http://www.co.winnebago.wi.us/health/units/general-public-health/facts-about-falls Kenosha County Falls Prevention Coalition https://sites.google.com/site/strongandsteadykenosha/home

National Council on Aging’s National Falls Resource Center has promoted September 2017 as Falls Prevention Awareness Month… and Sept. 22 2017 as National Falls Prevention Awareness Day “10 Years Standing Together to Prevent Falls” http://www.ncoa.org/improve-health/center-for-healthy-aging/falls-prevention/falls-prevention-awareness.html

Centers for Disease Control Website Resources Centers for Disease Control and Prevention (CDC): Falls Prevention (website) Preventing Falls: What Works - A CDC Compendium of Effective Community-Based Interventions from Around the World (pdf) STEADI Tool Kit www.cdc.gov/steadi/index.html CDC: Falls Facts (pdf)  CDC: Falls Reports (pdf)  Preventing Falls: How to Develop Community-Based Fall Prevention Programs for Older Adult (pdf)

Best Practice Guidelines Examples Resource from Agency for Healthcare Research and Quality (AHRQ): www.ahrq.gov http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/index.html

Best Practice Guidelines, Continued Resource from US Dept. of Veterans Affairs: http://www.patientsafety.gov/SafetyTopics/fallstoolkit

Questions? Please Contact: Anne Hvizdak Statewide Coordinator Evidence-Based Health Promotion Programs Department of Health Services Anne.Hvizdak@wisconsin.gov 608-266-3111