1. Primary Care Physicians’ Perceptions and Practices Regarding Fall Prevention in Adults Over 65 Years Taylor S. Jones, MPH

2. Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Taylor Jones, MPH “No relationships to disclose”

3. Overview Learning objectives Learning objectives Background Background Methods Methods Results Results Discussion Discussion Recommendations Recommendations

4. Learning Objectives List five risk factors and/or barriers that have been identified for older adult falls. List five risk factors and/or barriers that have been identified for older adult falls. Explain the significance of physician knowledge on older adult falls and the concern of overcoming barriers in order to address fall risk factors. Explain the significance of physician knowledge on older adult falls and the concern of overcoming barriers in order to address fall risk factors. Discuss how physician education is important for older adult fall prevention and the significance of assessing barriers. Discuss how physician education is important for older adult fall prevention and the significance of assessing barriers.

5. National Problem Adults 65 and older Stevens 2006 **Hornbrook et al. 1994; Hausdorff et al. 2001; Stevens 2006; CDC 2005 How big is the problem?** How big is the problem?** –Leading cause of injury deaths in the United States. –Fall injury is associated with mortality, disability, premature nursing home admissions, reduced function, etc. –Growth rate for older adults is expected to jump to 4% as baby boomers age.

6. National and Local Problem Adults 65 and older Fall related injuries are associated with substantial economic costs Fall related injuries are associated with substantial economic costs Average length of stay:4.8 days Average length of stay:4.8 days Average total charge: $25,976 Average total charge: $25,976 Direct medical cost for fall-related injuries totals more than $263 million* in CO! Direct medical cost for fall-related injuries totals more than $263 million* in CO! * Injury Epidemiology Program. CDPHE (2008)

7. National and Local Problem Adults 65 and older What are the outcomes linked to falls? What are the outcomes linked to falls? –Hip/femur fractures –Traumatic brain injuries (TBI) –Post-fall anxiety

8. Fall Prevention How can older adult falls be prevented? How can older adult falls be prevented? –Healthcare provider intervention Post-fall assessment Post-fall assessment Risk factor screening Risk factor screening –Reduce falls by 30-40%

9. Fall Prevention Risk Factors Risk Factors –Classified as: Intrinsic Factors Intrinsic Factors –Factors originating with the individual Vision and balance Vision and balance Psychological (fear of falling) Psychological (fear of falling) Disease (chronic and acute) Disease (chronic and acute) Medication use Medication use Extrinsic Factors Extrinsic Factors –Factors outside the person Physical environment (poor lighting, rugs) Physical environment (poor lighting, rugs) Assistive devices (cane, walker) Assistive devices (cane, walker)

10. Fall Prevention Common risk factors Common risk factors –History of falling –Lack of exercise and/or balance –Visual impairment –Four or more prescription medications –Environmental

11. Methods

12. Methods Statewide Healthcare provider database Statewide Healthcare provider database –Family practice, geriatric, internal medicine, urgent care (N=675) Random sample N=100 Random sample N=100 –Online or paper Online survey link provided Online survey link provided –Survey Monkey™ (www.surveymonkey.com) Fax or mail paper survey to TCHD Fax or mail paper survey to TCHD –Follow up phone calls and appointments

13. Methods continued… Survey questions included: Survey questions included: –Demographics Gender Gender Practice type (group, solo, residency, etc) Practice type (group, solo, residency, etc) Specialty (family practice, geriatrics, etc) Specialty (family practice, geriatrics, etc) Medicare status (accept or deny) Medicare status (accept or deny) –Medicare is a Federal health insurance program that pays for hospital and medical care for elderly and certain disabled Americans –Patients must be at least 65 years old

14. Methods continued… Survey questions included: Survey questions included: –Knowledge, attitudes and practices –Current guidelines and resource needs –Barriers to fall prevention screening –Assessment of current knowledge/skills Incentive Incentive –$5 gift card

15. Methods continued…

16. Results

17. Results Random selection Random selection –N=100 Total sample size Total sample size –N=99 67/99= 67.6% completed questionnaire 67/99= 67.6% completed questionnaire

18. The Study Results *Residency and less than one year of practice was defined at 0.5 for practice years **Some physicians did not complete demographic information

19. The Study Results

21. Physician perception on risk factors Physician perception on risk factors –Highest ranked Risk factors Risk factors –Polypharmacy –Physical inactivity Screening methods Screening methods –Medication review and physical activity –Lowest ranked History of falling History of falling Environmental Environmental

22. The Study Results Table 4. Unadjusted physician difference based on specialty (n=66)

23. The Study Results Table 5. Unadjusted physician difference based on practice type (n=65)

24. The Study Results Medicare Utilize home safety assessment (%) odds ratio (OR) 95% confidence interval [CI ] Accepts79%refref Denies21%0.2190.06-0.76 Table 6. Unadjusted physician differences by Medicare acceptance (n=67)

25. The Study Results *Controlling for physician practice type, specialty, number of years in practice, percent of older patients seen, physician gender, and Medicare status ** Statistically significant Table 7. Physician differences by Medicare acceptance- adjusted for other demographic variables*

26. The Study Conclusion Physician needs Physician needs –Educational materials –Additional training –Quick screening tools Targeting physicians who may see smaller number’s of older adult patients Targeting physicians who may see smaller number’s of older adult patients

27. The Study Conclusion TCHD Follow up TCHD Follow up –Included in the follow up mailing was a summary of the results, key findings, and continuing education information –Provided information about Fall Prevention Network http://www.fallpreventionnetwork.com/ http://www.fallpreventionnetwork.com/

28. What’s next? Physician awareness Physician awareness –Clinical guidelines Physician-initiated screening Physician-initiated screening –Patients don’t feel they are at risk

29. THANK YOU! Tista Ghosh Tista Ghosh Kimberley Horn Kimberley Horn Jana Smith Jana Smith Richard Vogt Richard Vogt Anita Watkins Anita Watkins Kathryn Bird Kathryn Bird Anne Childs Anne Childs Joan Reynolds Joan Reynolds Jayme Champlin Jayme Champlin Contact info: Taylor Jones, tjones@tchd.org, 720-200-1532 tjones@tchd.org

30. Questions? “We've put more effort into helping folks reach old age than into helping them enjoy it.” ~Frank A. Clark ~Frank A. Clark