2. MELISSA BENDERMAN, MEGAN CLINARD, MARISSA HERRERA, SHANNON MIENK, SALLY MURPHY, JOSHUA SCHAD, ERICA ZACHE FERRIS STATE UNIVERSITY At Risk Elderly Residents of Traverse City

3. Abstract The population of residents in Traverse City continues to grow faster than the national average (MDCH 2003). Among people 65 years old and older, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma ( Zeischegg 2010). As the geriatric population in Traverse City increases, area residents will need to assist the elderly in accessing available services. Current demographics relating to this increase are reviewed. Suggested interventions to decrease risk for injuries or ambulatory care sensitive conditions and hospitalizations related to falls, and ways to evaluate outcomes are presented.

4. Problem Statement Residents in Traverse City who are 65 years or older are at risk for injuries and ambulatory care sensitive condition or hospitalizations related to falls, as evidenced by: 1. Review of the an ambulatory care sensitive condition data for the age group of 65 and older shows Grand Traverse County increased by 33.1% while the state benchmark increased by 30.7% (MDCH, 2009). 2. Thirty-eight percent of people over 65 report hearing problems, vision difficulties, cognitive impairment or ambulation problems that hinder their self care (Administration on Aging, 2010).

5. Data to Support To further facilitate a study of the data of the demographic with the greatest growth and search for a problem that can be remedied, the data for ambulatory care sensitive hospitalizations was reviewed. The Michigan Department of Community Health (MDCH) defines an ambulatory care sensitive condition (ACSC) as “hospitalizations for conditions where timely and effective ambulatory care can decrease hospitalizations by preventing the onset of an illness or condition, controlling an acute episode of an illness or managing a chronic disease of condition” (MDCH, 2009). GTC’s increase in ACSC was 2.4% more than the state benchmarks. It could be inferred that the factors relating to the increase can be attributed to the increase in the population of GTC that are 65 and older, as well as, the group of persons age 65 and older are most affected by this problem.

6. Data to Support According to the data from the Census Bureau between 2000 and the study performed from 2006 to 2008 Grand Traverse County population of those 65 years and older experienced a 21.36 percent increase or about 12.82 percent more increase than the National Benchmarks (MDCH, 2009).

7. Data to Support Review of the an ambulatory care sensitive condition data for the age group of 65 and older shows Grand Traverse County increased by 33.1% while the state benchmark increased by 30.7% (MDCH, 2009).

8. Data to Support It is estimated that by the year 2020 one-third of Grand Traverse County residents will be senior citizens (Grand Traverse County).

9. Data to Support “The condition (FTT) affects 5 to 35 percent of community- dwelling older adults, 25 to 40 percent of nursing home residents, and 50 to 60 percent of hospitalized veterans” (Robertson & Montagnini, 2004).

10. Data to Support “In 2007, more than 21,700 Americans died as a result of falls and more than 7.9 million were injured by a fall including over 1.8 million older adults who had a fall- related injury that resulted in an emergency room visit. Falls are the leading cause of injury-related deaths among older adults 73 and older and the second leading cause of death from ages 60- 72” (National Safety Council, n.d., para. 1).

11. Data to Support “Why fall prevention is important. Falls are a major threat to the health and independence of older adults, people aged 65 and older. Each year in the United States, nearly one-third of older adults experience a fall” (CDC, 2008, p. 6).

12. Data to Support Fall injuries accounted for 38.5 percent of the unintentional injuries for those ages 65 and older for Grand Traverse County in 2007 (Michigan Department of Community Health, 2009).

13. Health Interventions Exercise Program – Exercise is the only intervention that by itself reduces falls among older adults. – Exercises can improve mobility, strength, and balance Review your Medications with your Physician Check vision Check hearing http://www.cdc.gov/HomeandRecreationalSafety/images/CDC_Guide-a.pdf

14. Senior Center Topics for Education We will have seniors at the community center sign up for an in home evaluation. Education will be provided which looks for factors that put elderly at risk for Falls that could be remedied. Traverse City Senior Center

15. Senior Center Topics for Education We will have seniors at the community center sign up for an in home evaluation and education which looks for factors that put elderly at risk for falls that could be remedied: Outside lighting and nightlights near bed, hallways, stairs, and bathroom Throw rugs removed Safety when using new medications Keep telephone wires out of the way, have phone on bed stand and end table to prevent running for the phone. Wear rubber-soled shoes so you don't slip Put salt or kitty litter on icy sidewalks. Wear low-heeled shoes Do not walk in socks, stockings, or slippers Be sure stairs are well lit and have rails on both sides Put grab bars on bathroom walls near tub, shower, and toilet Use a nonskid bath mat in the shower or tub Keep a flashlight next to your bed

16. Senior Center Activities Perform an Elderly Mobility Scale to pre- determine safety Have clients watch video at local senior center on safety of rugs Have clients watch video at local senior center regarding fall prevention Have clients take the Fall Prevention Checklist (http://www.mnsafetycouncil.org/seniorsafe/ falls/index.cfm)http://www.mnsafetycouncil.org/seniorsafe/ falls/index.cfm Provide walkers, canes, and other assistive devices to those in need.

17. Loan Closet Commission on Aging Equipment, such as wheelchairs, walkers, commodes, and bath benches are loaned to senior citizens in Grand Traverse County

18. Home safety assessment and home modification Safety Bars Stair Rails

19. Client Outcomes The elderly population will be able to: continue at their highest level of functioning identify hazardous items in the home that contribute to falls name items that can help them to maneuver more safely identify medication that can contribute to falls. verbalize knowledge of postural hypotension and to get up slowly demonstrate the correct use of their walker or cane. They will also take pre test, watch fall prevention video, and take post test to evaluate their knowledge

20. Evaluation Evaluate participants 30 days after risk reduction education. Determine if risk reduction was taken. Have client take pre test, watch fall prevention video, and take post test to evaluate their knowledge Evaluate trends in ACS data Trends should show less hospitalization for Accidents (falls).

21. PLEASE TAKE 5 MINUTES TO VIEW THIS VIDEO ON FALL PREVENTION HTTP://WWW.YOUTUBE.COM/WATCH?V=JQQ GJPOFIO0&FEATURE=RELATED Fall Prevention Video

22. References Administration on Aging, 010) A profile of older Americans, 2009. Retrieved March 6, 2010 from http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2009/16.aspxhttp://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2009/16.aspx CDC. (2008). In Nation Center for Injury Prevention & Control (Eds.), Fall Prevention (Falls 2008, pp. 1-100). Retrieved April 1, 2010, from CDC Web site: http:/​/​www.cdc.gov/​HomeandRecreationalSafety/​images/​CDC_Guidea.pdf Grand Traverse County. Retrieved March 07, 2010, Retrieved March 07, 2010 from http://www.co.grand- traverse.mi.us/Page1492.aspx?PageMode=View&ContainerPageDefID=1531&PageletZo ne=1Munson Medical Center Senior Services. MDCH. (April 3, 2009). Ambulatory Care Sensitive Conditions (ACSC 1991 & 2002-2007). Retrieved March 4, 2010, from Michigan Department of Community Health Web site: http://www.mdch.state.mi.us/pha/osr/chi/hosp/frame.html http://www.mdch.state.mi.us/pha/osr/chi/hosp/frame.html Minnesota Safety Council. (2009). Fall Prevention Checklist. Retrieved March 28, 2010, from http://www.mnsafetycouncil.org/seniorsafe/falls/index.cfm http://www.mnsafetycouncil.org/seniorsafe/falls/index.cfm Murphy, D., and Cleveland, M. (2006, April 1). Falls: A preventable geriatric syndrome. Aging Matters

23. References Michigan Department of Community Health. (2009, June 22). Unintentional Fatal Injuries, 2002 -2007. Retrieved from MDCH Web site: http://www.mdch.state.mi.us/pha/osr/chi/fatal/frame/html http://www.mdch.state.mi.us/pha/osr/chi/fatal/frame/html National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). (2009, May). Fast Facts: What are ways to prevent falls and related fractures. Retrieved March 28, 2010, from http://www.niams.nih.gov/HealthInfo/Bone/Osteoporosis/Fracture/preventfall s_ff.asp# http://www.niams.nih.gov/HealthInfo/Bone/Osteoporosis/Fracture/preventfall s_ff.asp# National Safety Council. (n.d.). Protecting Ourselves from Slips, Trips and Falls. Retrieved April 2, 2010, from National Safety Council Web site: http://www.ncs.org/safety_home/Resources/Pages/Falls.aspx http://www.ncs.org/safety_home/Resources/Pages/Falls.aspx Ness,K., and Gurneu, J. (2001). Screening for risk of falls in the elderly in a community health fair setting: A feasible study. Issues on Aging, 24 (2). Robertson, R., & Montagnini, M. (2004, July 15). Geriatric failure to thrive. American Family Physician, 70(2), 248, 257. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15291092?dopt=Abstract http://www.ncbi.nlm.nih.gov/pubmed/15291092?dopt=Abstract Zeischegg P. (2010, February 03). Fall prevention balance and your brain. The Union. Retrieved April 4, 2010 from http://www.theunion.com