Stand Up & Be Strong! MN APTA Evidence-Based Falls Prevention Co-sponsored by the MN Department of Human Services MN Chapter American Physical Therapy Association

Stand Up & Be Strong! MN APTA Evidence-Based Falls Prevention 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 Falls Prevention Initiative MN Board on Aging RFP: Community Service/ System Change/ Service Development (CSSD) grants to foster decreased nursing home utilization MN Board on Aging RFP: Community Service/ System Change/ Service Development (CSSD) grants to foster decreased nursing home utilization MN Chapter APTA ‘system change’ proposal: community based fall risk screen and action steps piloted in 10 Western MN Counties MN Chapter APTA ‘system change’ proposal: community based fall risk screen and action steps piloted in 10 Western MN Counties MN APTA Collaborative partners: PrimeWest Health Services Area Agencies on Aging Local Health Care providers County public health departments MN APTA Collaborative partners: PrimeWest Health Services Area Agencies on Aging Local Health Care providers County public health departments Other CSSD Falls Prevention grantees: Other CSSD Falls Prevention grantees: Mayo Medical School-in home assessment by geriatric fellow, Olmstead County MN Fairview Ridges-in home assessment by PT Dakota County

Stand Up & Be Strong! MN Chapter American Physical Therapy Association Kris Gjerde, PT Project Manager

Specific Project Goals: 1. Create a community-based system that makes assessment of fall risk & prevention of falls routinely available 2. Enable individuals to assess lower body strength and related fall risk 3. Enable individuals to take action to decrease risk or maintain low risk

MN APTA Stand Up & Be Strong! Demonstration project designed to prevent falls in older adults Demonstration project designed to prevent falls in older adults Community based system change Community based system change Co-sponsored MN Dept of Human Services Co-sponsored MN Dept of Human Services

Why Is This Unique? MN CSSD grants are highly competitive MN CSSD grants are highly competitive MN Chapter received the first state grant to a professional association MN Chapter received the first state grant to a professional association Innovative approach to sustainable system change Innovative approach to sustainable system change Use of membership network to disseminate public health program Use of membership network to disseminate public health program

MN APTA Workgroup Reviewed the evidence Reviewed the evidence Identified Fall Risk Factors Identified Fall Risk Factors –Decreased strength and balance –Medication use –Vision impairment –Unsafe home environment –Unsafe outside environment –Having fallen in past year –Fear of falling

Stand Up! Guiding Evidence Rand Report on Falls for CMS, 2003 Rand Report on Falls for CMS, 2003 –Multifactor approaches are most effective –Two most effective interventions are: lower body strengthening medication review –Strengthening was mentioned but not provided in the nine national programs reviewed by Rand

Stand Up! Development Combined the expertise of MN APTA members Combined the expertise of MN APTA members Assumptions: Assumptions: –Physical therapists will serve as trainers & consultants –Focus: community dwelling older adults –Adults currently perform single repetition of sit to stand Requirements of screening tool: Requirements of screening tool: –Enables self assessment –Applicable to groups or individuals –Community based, not medical intervention –Includes action steps that allow variable technique

MN APTA Falls Prevention Initiative Oct. 2005: MN APTA invited members in 10 pilot counties to participate Oct. 2005: MN APTA invited members in 10 pilot counties to participate Apr 2006: MN APTA trained 30 PTs Apr 2006: MN APTA trained 30 PTs May-Dec PTs trained 587 community partners May-Dec PTs trained 587 community partners Jun. 2006: Community partners started screening participants Jun. 2006: Community partners started screening participants Jan. 2007: Statewide dissemination began Jan. 2007: Statewide dissemination began

Primary Fall Risk Screen 1. Have you fallen in the past year? 2. Are you afraid that you might fall? 3. Do you frequently need to use your arms to rise from chairs? “YES” indicates that you may be at risk “YES” indicates that you may be at risk

Physical Prescreen Cross your arms Cross your arms Rise to standing position Rise to standing position Successful rise: continue with timed sit to stand Successful rise: continue with timed sit to stand Unable: Proceed to high risk category Unable: Proceed to high risk category

Timed Sit to Stand

Risk Score

ActionSteps High Risk: Consult your doctor or Physical Therapist for advice & instruction to improve your strength. Do the exercises only if you feel safe doing them on your own. High Risk: Consult your doctor or Physical Therapist for advice & instruction to improve your strength. Do the exercises only if you feel safe doing them on your own. Moderate Risk: Do the exercises. Seek assistance if you do not feel safe Moderate Risk: Do the exercises. Seek assistance if you do not feel safe Low Risk: Continue your active lifestyle, add the exercises to your program Low Risk: Continue your active lifestyle, add the exercises to your program Groups: Add the two exercises to your program Groups: Add the two exercises to your program Reassess every 3 months Reassess every 3 months

Exercises Sit to Stand Sit to Stand Side Hip Raise Side Hip Raise

Reach 576 Physical Therapist trained 576 Physical Therapist trained 1296 Community Partners trained 1296 Community Partners trained 1855 Individuals screened 1855 Individuals screened

June 2006 – June 2007 Adults aged 65 and older Risk Score 1662 total Percent Risk Score 1662 total Percent High % High % Moderate % Moderate % Low % Low % Unknown 44 2% Unknown 44 2%

Uptake Follow up calls at 1, 3, 6 months Retention of information Retention of information Action taken after screening Action taken after screening –MD, PT visit –Performed exercises –Increased activity –Falls since screen Overall functional mobility Overall functional mobility –4 mobility questions from SF 36

What’s Next? Screen Older Adults in your community Screen Older Adults in your community –Assisted Living –Home Health –Senior Centers –Area Agency on Aging –EMS, Sheriff Dept, Fire Dept –Parish Nurse –Faith based programs

To Learn More…

Stand Up & Be Strong! Kris Gjerde, PT Minnesota Chapter American Physical Therapy Association