Falls Prevention Awareness Day and Month Fall 2018 Anne Hvizdak, Statewide Coordinator EBHPP Office on Aging Anne.Hvizdak@wisconsin.gov

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. Discuss falls prevention strategies 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.

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% (241,580) of Wisconsin residents aged 65 and older reported falling in the last year. 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 2016, 1,360 Wisconsin residents aged 65 and older died from an unintentional fall. How Costly are these Falls? The total charges in Wisconsin for Falls related hospital visits in 2015 were at least $771 million. Source: https://www.dhs.wisconsin.gov/wish/index.htm 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

Percent of Population Ages 60 and Older Source: Wisconsin Department of Administration, Demographic Services Center, Vintage 2013 Population Projections

Percent of Population Ages 60 and Older Source: Wisconsin Department of Administration, Demographic Services Center, Vintage 2013 Population Projections

Percent of Population Ages 60 and Older Source: Wisconsin Department of Administration, Demographic Services Center, Vintage 2013 Population Projections

Percent of Population Ages 60 and Older Source: Wisconsin Department of Administration, Demographic Services Center, Vintage 2013 Population Projections

Percent of Population Ages 60 and Older 2030 Source: Wisconsin Department of Administration, Demographic Services Center, Vintage 2013 Population Projections

Percent of Population Ages 60 and Older Source: Wisconsin Department of Administration, Demographic Services Center, Vintage 2013 Population Projections

Percent of Population Ages 60 and Older Source: Wisconsin Department of Administration, Demographic Services Center, Vintage 2013 Population Projections

Population Ages 60 and Older Growth Rate, 2010-2020 Source: Wisconsin Department of Administration, Demographic Services Center, Vintage 2013 Projections Statewide growth = 36%

Population Ages 0 to 59 Growth Rate, 2010-2020 Source: Wisconsin Department of Administration, Demographic Services Center, Vintage 2013 Projections Statewide growth = -2%

Fall-related Emergency Department Visits by County, 2013-2015 https://www.dhs.wisconsin.gov/wish/index.htm

Falls related emergency department visits have increased since 2002 Falls related emergency department visits have increased since 2002. *Decreases in other injury related visits can be due to an increase in urgent care visits. https://www.dhs.wisconsin.gov/wish/index.htm

Deaths caused by falls and unintentional drug overdose have dramatically increased since 2000. 2014 https://www.dhs.wisconsin.gov/wish/index.htm

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. https://www.dhs.wisconsin.gov/wish/index.htm

Fall-related Inpatient Hospitalizations by County, 2013-2015 https://www.dhs.wisconsin.gov/wish/index.htm

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%

Fall-related Deaths by County, 2014-2016 Ages 65 and Older, Injury Death Rate per 100,000 population, Underlying Cause of Injury Death = Falls https://www.dhs.wisconsin.gov/wish/index.htm

Place of Injury for Falls-related death in persons 65+, Wisconsin, 2017 Home 60.1% Assisted Living 21.0% Nursing Home 11.6% Business/public places 3.7% Hospital/health Care office 1.2% Other 2.5% 1.9% https://www.dhs.wisconsin.gov/wish/index.htm http://www.dhs.wisconsin.gov/health/injuryprevention/pdffiles/FINAL_BOF_080210.pdf

Place of Death for Falls-related death in persons 65+, Wisconsin, 2017 Hospital 39.0% Nursing Home 38.9% Assisted Living 11.7% Home 10.0% Other 1.5% https://www.dhs.wisconsin.gov/wish/index.htm

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 Timed up and go Patient Self Risk Assessment Four Stage Balance Test Targeted modules for Primary Care Physicians, Pharmacists and Electronic Health Record algorithms. www.cdc.gov/injury/STEADI

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. www.cdc.steadi.gov

STEADI Patient Self Assessment 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. www.cdc.gov/injury/STEADI

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.

Health Promotion Workshops promoted by Wisconsin Institute for Healthy Aging Living Well with Chronic Conditions (Stanford’s Chronic Disease Self-Management program, available in English and Spanish) Healthy Living With Diabetes ( Stanford’s Diabetes Self-Management Program available in Spanish and English) Stepping On (available in English and Spanish) Powerful Tools For Caregivers and Powerful Tools for Caregivers of Adult Children (available in English) Walk with Ease Visit the WIHA website www.wihealthyaging.org for information about these and other evidence-based health promotion programs in Wisconsin.

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, Matter of Balance Resources for program leaders Statewide workshop list Lists Community Academic Aging Research Network (CAARN) Falls Prevention Projects underway in various counties. www.wihealthyaging.org

Stepping On Weekly Topics Introduction, Overview, Choosing What to Cover The Exercises and Moving About Safely Advancing Exercises and Home Hazards Vision and Falls, Community Safety and Footwear Medication Management, Bone Health and Sleeping Better Getting Out and About Review and Plan Ahead VAL

Additional Evidence-Based Health Promotion Programs National Diabetes Prevention Program Memory Care Connections REACH Screening Brief Intervention Referral and Treatment (SBIRT) Strong Bodies Savvy Caregiver Mental Health First Aide Chronic Pain Self-Management Program

Additional Falls Prevention/Physical Activity Evidence-based programs Arthritis Foundation Exercise Program Tai Chi: Moving for Better Balance Tai Chi Fundamentals/Prime A Matter of Balance Fit and Strong SAIL Additional evidence-based health promotion programs found here: https://wihealthyaging.org/programs-services

Common Evidence-Based Workshop Locations 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 Governor’s Proclamation for Falls Prevention Day and Month 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 Finding Balance Together Coalition (Fox Valley) www.FindingBalanceTogether.org  Kenosha County Falls Prevention Coalition https://sites.google.com/site/strongandsteadykenosha/home

Assisted Living Training Opportunities Wisconsin Assisted Living Association (WALA) offers the Walking Tall Falls Prevention Program with a list of consultants that can offer training. Leading Age-Quality Improvement Task Force has a falls focused initiative that includes technical assistance, mentoring and module templates targeted at Residential Care Apartment Complexes (RCAC) and Community Based Residential Facilities (CBRF). Private contractors offer Falls prevention training.

MetaStar- Skilled/Assisted Living Resource Metastar-part of the Lake Superior Quality Innovation Network. Identified by Centers for Medicare and Medicaid Services (CMS) as the Quality Improvement Organization (QIO) for Wisconsin Michigan and Minnesota. Aims to help skilled nursing facilities provide quality care in Long Term Care Programs. Utilizes CRISP Falls prevention program Toni Kettner: falls contact person for Metastar Nursing Home Project Specialist 608-441-8290 www.metastar.com

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)

Skilled Nursing/ Assisted Living Falls Resource 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

US Dept. of Veterans Affairs (VA) Falls Prevention VA National Center for Public Safety Original Tool kit created 2004 Current edition with revisions updated 2014 https://www.patientsafety.va.gov/professionals/onthejob/falls.asp NCPS@va.gov.

National Council on Aging’s National Falls Resource Center has promoted September 2018 as Falls Prevention Awareness Month… and Sept. 22 2018 as National Falls Prevention Awareness Day *2018 focus is medication management http://www.ncoa.org/improve-health/center-for-healthy-aging/falls-prevention/falls-prevention-awareness.html

Help Yourself to Better Health Simple steps you can take to have more control of your health Helping people live healthier lives through evidence-based health promotion programs https://wihealthyaging.org/help-yourself-to-better-health-campaign

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