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

2. 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.

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

4. 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:

5. 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:

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

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

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

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

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

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

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

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

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

15. Fall-related Emergency Department Visits by County, 2013-2015

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

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

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

19. Fall-related Inpatient Hospitalizations by County, 2013-2015

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

21. Fall-related Deaths by County, 2014-2016
Ages 65 and Older, Injury Death Rate per 100,000 population, Underlying Cause of Injury Death = Falls

22. Place of Injury for Falls-related death in persons 65+, Wisconsin, 2017
Home %
Assisted Living %
Nursing Home %
Business/public places %
Hospital/health Care office 1.2%
Other % %

23. Place of Death for Falls-related death in persons 65+, Wisconsin, 2017
Hospital %
Nursing Home 38.9%
Assisted Living 11.7%
Home %
Other 1.5%

24. 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

25. 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

26. 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.

27. 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
Variable mobility time it takes to
>20 Impaired mobility complete the task.

28. 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.

29. 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.

30. 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 for information about these and other evidence-based health promotion programs
in Wisconsin.

31. 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.

32. 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

33. 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

34. 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:

35. 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

36. 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

37. Wisconsin Community Falls Prevention Coalition Website Examples
Safe Communities of Madison – Dane County
La Crosse County Falls Prevention Coalition
Finding Balance Together Coalition (Fox Valley)
Kenosha County Falls Prevention Coalition

38. 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.

39. 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

40. 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
CDC: Falls Facts (pdf) 
CDC: Falls Reports (pdf) 
Preventing Falls: How to Develop Community-Based Fall Prevention Programs for Older Adult (pdf)

41. Skilled Nursing/ Assisted Living Falls Resource
Resource from Agency for Healthcare Research and Quality (AHRQ):

42. 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

43. National Council on Aging’s National Falls Resource Center has promoted September 2018 as Falls Prevention Awareness Month… and Sept as National Falls Prevention Awareness Day *2018 focus is medication management

44. 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

45. Questions? Please Contact: Anne Hvizdak
Statewide Coordinator- Evidence-Based Health Promotion Programs
Office on Aging
Department of Health Services