UW Health Serves as Pioneer with Falls Prevention Program
Falling is not an inevitable part of aging, but it is growing problem with potentially dire consequences.
According to the Center for Disease Control, in 2007 nearly 16,000 older adults died as a result of a fall, and more than half of those were due to traumatic brain injuries. In Wisconsin, falls are one of the leading causes of death for individuals over 65.
Injuries resulting from falls also carry a significant price. More than $19 billion is spent nationally each year for treating injuries from falls and the long-term care that is often necessary as a result. With increasing numbers of aging baby boomers, falls have become a major health concern.
A primary cause of falls in seniors is leg weakness, along with side effects from medications and poor vision.
UW Health has been a pioneer in falls prevention, having lead research to identify and implement effective falls prevention programs across Wisconsin.
Effective falls prevention programs are community based, multidisciplinary programs that involve health professionals, social workers, case managers, and others.
Research into developing effective falls prevention programs at UW began in 2000 with physical therapist Teresa Shea and Jane Mahoney, MD, associate professor with the University of Wisconsin-Madison School of Medicine and Public Health.
Shea and Mahoney worked together in the UW Health's Geriatric Falls Clinic. They explored with the Wisconsin Department of Health and Family Services if regional falls clinics could be set up. "It was difficult to support however, because the falls clinic is multidisciplinary and time intensive with two to three hour evaluations," Shea says.
Shea and Dr. Mahoney developed a program to cross train physical therapists, occupational therapists and nurses to bring the evaluation tools of the falls clinic into people's homes. They evaluated this program as a pilot in five Wisconsin counties.
They were awarded a grant by the state of Wisconsin to study this further in one of the counties. Shea explained that the evaluation consisted of reviewing medication, evaluating thinking and memory problems, assessing how the patient moves about his environment safely, as well as balance and walking tests and visual and neurological screening. Then recommendations were given to the older adult, family and their primary physician. Assistance was given in getting referrals. Follow up was provided with monthly phone calls for one year.
Through the three-year study the researchers saw approximately 350 patients in Kenosha County that were randomized, either getting comprehensive evaluation or just a home safety evaluation.
"We saw significant improvements and a decrease in falls with individuals who had mild thinking problems and a live-in caregiver. The total study group had a decrease in nursing home stay but overall we did not have a decrease in falls," explains Shea.
The key to an effective falls prevention program, according to Shea, is identifying the population and tailoring the intervention programs to that population. An example would be to recommend the Stepping On program for seniors who are at risk of falling but do not have memory or thinking problems.
Currently Dr. Robert Przybelski is the medical director of the UW Health's Geriatric Falls Clinic. The clinic is intended for complex patients for whom a physician is looking for an additional geriatric physician's consultation for their patient. Patients are referred to the clinic by their primary care physician or other specialty consulting physicians such as neurologists.
Typically an evaluation examines patients' medication, their vision, neurological condition, muscle and joints, appropriate footwear, and how they move about in the home and community setting.
"You need to examine a variety of issues," comments Shea, "because different factors may be causing the falls."
She uses the example that someone who has depth perception problems may fall because they are tripping. Exercises won't help because their joints and muscles are fine. Instead, they need to learn ways to interact with their environment more safely,
Patients at the Falls Clinic receive written recommendations, as do their physicians. Typically there will be 10 to 21 different recommendations for patients to follow.
Recommendations for all falls prevention programs focus on helping seniors identify potential problem areas and develop strategies to overcome them. Among the strategies are:
- Balance and leg strength exercises
- Gait training and evaluation of appropriate assistive device
- Ensuring medical providers are aware of the prescription and over the counter medicines seniors are taking, and modifying medications as they are able to decrease the risk of falls
- Ensuring seniors have eye exams every one or two years to identify any eye diseases they may compromise vision
- Home safety including a few of the following recommendations:
- Increasing the lighting in the home so it is easier to see the edges of tables and furniture
- Removing any rugs or other objects that might easily cause someone to trip
- Using a grab tool instead of standing on a stool or stooping to get something
- Placing grab bars strategically throughout the home, including in the bathroom, near the bed and stairs
If the patient's physician does not feel a comprehensive multidisciplinary consultation in the Geriatric Falls Clinic is necessary, they can refer the patient directly to physical therapy at UW Health Middleton Rehabilitation Clinic for falls prevention strategies. At the clinic, the patient would receive a physical therapy evaluation identifying falls risk factors and an individualized treatment plan.
Many falls often go unreported because people are embarrassed or are afraid their lives might be restricted as a result. Injuries are a significant concern because they are not always obvious and easily overlooked. Seniors may already have some cognitive impairment, making it extremely difficult to diagnose a traumatic brain injury. And adults are more likely to be asymptomatic, with no headaches or pressure sensation that might suggest something is wrong.
There are extensive resources available to physicians and their patients to help identify and prevent falls.
The Wisconsin Falls Initiative and the Dane County Task Force on Falls Prevention are two of the primary groups helping to implement programs across the state. In Dane County there is also a falls help line through the United Way available by calling 2-1-1.
Nationally, a few of the organizations are the National Institute of Health, CDC Injury Prevention Center, and the Falls Free Coalition through the National Council on Aging.
Further research funded by the CDC is being conducted by Dr. Mahoney and Shea to bring the Stepping On falls program nationwide. Most important to any falls prevention program, however, is the need to ensure that a senior's independence, dignity and quality of life are preserved.