Authors: Colleen M. Casey, Ph.D., medical director, Providence Senior Health
Jamie Caulley, DPT, clinical liaison, Providence Senior Health
While there are many steps older adults can take to reduce their risk of falling, there also is much we can do as health care providers, along with our teams, to help our older patients understand and prevent the risk of falls.
According to the National Institutes of Health, more than 1 in 4 people ages 65 or older fall each year. The numbers are even more troubling in Oregon, at about 1 in 3 people. The risk of falling — and fall-related problems — rises with age. However, many falls can be prevented.
Awareness: Education and screening
Individual screenings
The first step in raising awareness can come through routine fall risk screening.
More than 46,000 older adults, ages 65+, were screened for fall risk last year at Providence Medical Group clinics in Oregon, constituting 52% of PMG’s total older adult patients.
Individual clinic screening rates, using the CDC’s STEADI (STopping Elderly Accidents Deaths and Injuries) self-assessment tool, can be found here on the Senior Health Fall Risk Management Sharepoint site (can be viewed only by Providence clinicians). Each year, roughly one-third of older adults who are screened in our clinics are considered to be at high risk to fall, meaning they had a STEADI score of 4 or more out of 14 possible.
Conversations about fall risk interventions often require behavior change, either in lifestyle (e.g., exercise, footwear or home safety/supports) or risky behaviors (e.g., high-risk medications, alcohol use). For patients at lower risk, there may be only one or two changes to make, such as adding tai chi to their walking routine or using nightlights. For someone at higher risk to fall, multiple risk factors can be at play and may require a more long-term approach over multiple visits and conversations.
Therefore, learning how we can talk about falls, (can be viewed only by Providence clinicians) as well as connecting fall risk education and interventions to what matter to the patient, are important.
Education
In addition to conversations with their health care team, patients and community members can attend one of Providence’s Staying Healthy and On Your Feet (available only to Providence clinicians) educational events, which focus on simple steps older adults can take to reduce their risk of an unnecessary fall. Providence Senior Health sponsors events throughout the year, but two events will occur during the week of National Fall Prevention Awareness.
These two upcoming events are free:
- Thursday, Sept. 21, 1 p.m.-3 p.m., Portland Covenant Church, northeast Portland
- Saturday, Sept. 22, 10 a.m. to noon, June Key Delta Community Center in north Portland
For more details about these community education events: Providence.org/ORFallClasses
Below is a recording of the class that can be shared with patients or community members:
https://www.youtube.com/watch?reload=9&v=A3k293TQF6k&feature=youtu.be
Action: Assessment, intervention and routine management
To help providers and care teams keep track of when a patient’s fall risk screening is due and decide on next steps for assessment and intervention, the Healthy Planet score card was released in Epic last year.
This tool highlights the three recommended priority assessment and intervention (Providence providers only) next steps when a STEADI score is positive for high fall risk. These priority interventions include attention to gait instability, evaluation of orthostatics and hypotension, and review of a patient’s medication list for high-risk medications. Interventions such as physical therapy and adjusting medications should be tailored based on what matters most to the patient.
Three Providence system smartphrases were developed to correlate with the Healthy Planet build for documenting interventions:
- .fallriskplan, to be used during a visit to document a conversation about fall risk, including a fall risk history and the recommended interventions
- .fallrisklowavs, after visit summary (AVS) instructions for patients screened at low risk to fall
- .fallriskpriorityavs, AVS instructions for patients screened at high risk, focusing on the three priority areas
As we head into Fall Prevention Awareness Week, we encourage you to think about how you and your care teams can move from awareness to action by:
- Using the tools available in Epic or on the Senior Health Fall Risk Management site
- Understanding your patient’s specific fall risk level and fall risk factors using screening algorithms and work flows
- Having meaningful conversations with older patients and their families about fall risk, what matters and behavior modification
Colleen M. Casey, Ph.D., ANP-BC, CNS, is medical director of Providence Senior Health and the Bain-Krantz Chair of Geriatric Medicine, Providence Oregon.
Jamie Caulley, DPT, is clinical liaison with Providence Senior Health and Northeast Rehabilitation, Providence Oregon
For more information
Falls Prevention Awareness Week Toolkit (ncoa.org) has resources for patients and providers, including educational handouts, videos and promotional materials around fall prevention and National Fall Prevention Awareness.
STEADI - Older Adult Fall Prevention | CDC includes background on the fall risk screening tool that we use from STEADI, as well as in-depth training and information on the STEADI initiative itself.
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