1. ACOVE 2: Falls and Mobility

2. Falls Pretest Question 1 n = 67

3. ACOVE 2 Falls and Mobility Quality Indicators All elders 65+ should have documentation that they were asked annually about falls. All elders 65+ should have documentation that they were asked annually about falls. If a 65+ elder reports a history of 2 or more falls (or 1 fall with injury) in the previous year, then there should be documentation of a basic fall history. If a 65+ elder reports a history of 2 or more falls (or 1 fall with injury) in the previous year, then there should be documentation of a basic fall history. If a 65+ elder reports a history of 2 or more falls (or 1 fall with injury) in the previous year, then there should be documentation of a basic exam. If a 65+ elder reports a history of 2 or more falls (or 1 fall with injury) in the previous year, then there should be documentation of a basic exam.

4. ACOVE 2 Falls and Mobility Learning Objectives Knowledge: 1. 1. Understand consequences of falls 2. 2. Identify risk factors for falls 3. 3. Understand the Fall Assessment algorithm 4. Improve knowledge about: 1. 1. Gait and balance disorders in elders 2. 2. Assessments 3. 3. Fall evaluation and intervention

6. ACOVE 2 Falls and Mobility Learning Objectives Skills: 1. Evaluate medications 2. Evaluate gait/mobility 3. Appropriate referral and self-management education

7. ACOVE 2 Falls and Mobility Detailing Key Messages Consequences of FallsRisk Factors for FallsEvaluation & Treatment Restricted MobilityMore than 4 MedicationsMedication Review Decreased ADLsGait & Balance Abnormalities Gait & Balance Evaluation (TUG) Increased NH PlacementDecreased Visual AcuityReferral to PT Increased Risk for DeathOrthostatic HypotensionVision Evaluation Depressive SymptomsOrthostatic Hypotension Cognitive Impairment

9. ACOVE 2 Falls and Mobility What We Hope to Achieve At UIM: 1. Improved risk factor management and prevention of future falls. 2.Early intervention, BEFORE falls occur. 3.Discontinuation or avoidance of high risk medications.

10. ACOVE 2 Falls and Mobility What We Hope to Achieve In the Hospital: 1. Knowledge learned in the clinic will persist: –Consider patient stability at discharge –Consider need for Physical Therapy 2.Avoid high risk medications.

11. From Knowledge to Performance: Intervention Sequence for each ACOVE Faculty & intervention Development Resident Lecture Identify Patients at the time of care Cue MDs to act Provide decision support Record data on clinical intervention Assess performance: Extract and analyze Clinical data Resident Detailing

12. ACOVE 3: Dementia and Aging Quality Indicators Out-Patient: If new to a primary care practice or inpatient service… Cognitive and Functional Screening Annual evaluation for changes in memory and function. IF screens positive for dementia… Clinical Cognitive Evaluation IF screens positive for dementia… Medication Review IF newly diagnosed with dementia… Neurological Examination IF newly diagnosed with dementia… Laboratory Testing In-Patient: IF a VE has a diagnosed dementia, Depression Screening IF a VE with dementia has a caregiver… Caregiver Support and Patient Safety Information IF a VE with dementia is physically restrained in the hospital… Safety concerns justifying the use of restraints should be documented in the medical record and communicated to the patient, caregiver, or guardian.

13. ACOVE 3 Dementia The 3 D’s Dementia – Depression – Delirium Learning Objectives: Learn the testing characteristics of the Mini-Cog and PHQ2 screens Learn the testing characteristics of the Mini-Cog and PHQ2 screens Understand the importance of depression screening for demented patients Understand the importance of depression screening for demented patients Recognize secondary causes of dementia Recognize secondary causes of dementia Differentiate different types of dementia Differentiate different types of dementia Learn strategies of managing behavioral symptoms Learn strategies of managing behavioral symptoms