Falls%20in%20Minnesota:%20Facts%20on%20Prevalence,%20Impact%20and%20Effective%20Prevention

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Falls in Minnesota Facts on Prevalence, Impact
and Effective Prevention

• Kari Benson, Minnesota Board on Aging
• Heather Day, Minnesota Department of Health
• Pam Van Zyl York, Minnesota Department of Health

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Falls in Minnesota Age Disabilities
Odyssey Duluth, MN August 20, 2007

• Heather Day, RN, MPH
• Minnesota Department of Health

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Falls leading cause of serious injury

• Mortality
• Major Trauma
• SCI
• TBI
• Hospitalized
• ED-treated

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Leading Causes of Injury Deathin Minnesota

• 1) Motor vehicle crashes
• 2) Unintentional Falls
• 3) Self-inflicted Firearm
• 4) Self-inflicted Poisoning

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Roesler J, Kinde M, Gaichas A, Fraser C, Phillips
M The epidemiology of trauma in Minnesota.
Minnesota Medicine 88(1)42-5, 2005.
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Leading Causes of Hospitalized Injury Among
Persons 65Minnesota, 1998 - 2005

• 1) Unintentional Falls (66,149)
• 2) MV Traffic Crash Occupants (3,677)
• 3) Unintentional Poisoning (1,884)
• 4) Overexertion (1,531)
• 5) Struck By / Against (1,192)

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Leading Causes of ED-treated Injury Among Persons
65 Minnesota, 1998 - 2005

• 1) Unintentional Falls (98,610)
• 2) Cut / Pierce (12,059)
• 3) Struck By / Against (11,252)
• 4) MV Traffic Crash Occupants (10,483)
• 5) Overexertion (7,717)

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Leading Injuries

• MVC leading cause of fatal injury
• Falls leading cause of serious injury
• Firearms most controversial injury
• Alcohol most common modifiable RF
• CNS most disability
• Violence
• Suicide/SIH
• Interpersonal

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Falls are heterogeneous

• Ladder
• Sports
• Work
• Slip/trip same level
• Mechanical vs. organic

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Minnesotas Rates are highMinnesotas Rates
are increasing
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Unintentional Fall Death Rates,United States and
Minnesota,1988-1998
Rates are Age-Adjusted to US 1940 Standard
Population.
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Unintentional Fall Death Rates,United States and
Minnesota,1999-2004
Rates are Age-Adjusted to US 2000 Standard
Population.
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Unintentional Fall MortalityAge 70
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Nonfatal Hospital-Treated Falls by Month
of Admission, 65Minnesota, 1998-2005
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Nonfatal Hospital-Treated Falls by Type and Month
of Admission, 65Minnesota, 1998-2005
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Of the 5 leading causesunintentional injury!
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Percentage Change in Death Rates for the Leading
Causes of Unintentional Injury, by Mechanism of
Injury United States,
1999-2004
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Unintentional Fall Death Rates Among Persons Age
65,United States and Minnesota, 1999-2004
Rates are Age-Adjusted to US 2000 Standard
Population.
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Unintentional Fall Nonfatal Hospitalization
Rates United States and Minnesota,
1998-2005
Rates are Age-Adjusted to US 2000 Standard
Population.
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Rates are highest in eldersFalls in Elders
Drive Overall Rates
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Unintentional Fall Nonfatal Hospitalization
RatesMinnesota, 1998-2005
Rates are Age-Adjusted to US 2000 Standard
Population.
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Unintentional Fall Nonfatal Hospitalization
Rates, 0-59Minnesota, 1998-2005
Rates are Age-Adjusted to US 2000 Standard
Population.
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Unintentional Fall Nonfatal Hospitalization
Rates, 50Minnesota, 1998-2005
Rates are Age-Adjusted to US 2000 Standard
Population.
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Total Acute Care Charges Associated with Nonfatal
Falls Among Persons 65Minnesota, 1998-2005

• Hospital Charges 1,022,083,080
• Range 83.9 million to 162.1 million per year
• ED Charges 106,255,555
• Range 5.8 million to 20.4 million per year

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Nonfatal Falls Among Persons 65Hip Fracture
and TBIMinnesota, 1998-2005

• Hip Fracture N 24,969
• 24,381 hospitalizations
• 1,488 ED visits
• Total charges 61.1 million
• TBI N 13,931
• 5,281 hospitalizations
• 8,649 ED visits
• Total charges 207.9 million

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Whats next

• Continued Analysis of Hospital Discharge data
• New V code V15.88 History of Falls
• Collection of hospital TBI elder falls data
• Body position
• Factors / activity at time of fall
• Height
• Location
• Time of day
• Use of anticoagulant or antiplatelet medication
• Comorbid health conditions

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Whats next

• Mandatory E-coding by CMS
• Translation of Science into Practice
• Medicare Reimbursement for fall prevention

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Falls Prevention

• Pam Van Zyl York, MPH, PhD, RD, LN
• Minnesota Department of Health

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Falls Prevention and Chronic Disease Management

• Keys to chronic disease management include
  regular physical activity, medication management,
  education and healthy eating
• 80 of those over 65 years have 1 or more chronic
  condition, 65 have multiple chronic conditions
• Those with impaired strength, mobility, balance
  and endurance are twice as likely to fall as
  healthier persons
• Those with more chronic conditions are more
  likely to die or sustain more serious injury when
  they fall

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Chronic Disease in Minnesotans 65 yrs

• Age related macular degeneration - Approx. 25
  (nationally)
• Alzheimers Disease - 13 (nationally)
• Arthritis - 53
• Diabetes - 13
• Heart Disease 6
• Stroke - 3
• Osteoporosis 14.4

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Key Elements of a Falls Prevention Intervention

• Education
• Exercise to increase lower-body strength and
  balance
• Home and environment assessment and modification
• Medication review and modification
• Vision evaluation and correction
• Support for self-management of risk factors and
  fear
• Nutritional considerations?

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Falls Injury Prevention Model Points of
Intervention Continuum
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Falls Injury Prevention Model Points of
Intervention Continuum
Primary and Secondary Prevention through
evidence-based interventions for falls and
chronic disease
Emergency medical services, primary care and
acute care
Safety promotion and increasing awareness among
individuals, communities and providers
Rehabilitation services
Home and medical support in the community
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MN Falls Prevention Initiative

• MN Board on Aging, Dept of Health and Dept of
  Human Services
• October 2005 3-year planning grant from U.S.
  Administration on Aging
• Convening a broad range of public and private
  partners at the state, regional and local levels
  to implement a statewide coordinated
  evidence-based falls prevention initiative.

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MN Falls Prevention Initiative

• The Vision
• Older Minnesotans will have fewer falls and
  fall-related injuries, maximizing their
  independence and quality of life.

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MN Falls Prevention InitiativeObjectives

1. Increase awareness of prevalence and risk factors
   for falls.
2. Increase assessment of fall risk.
3. Increase availability of evidence-based
   interventions statewide.
4. Increase access to these interventions.
5. Enhance quality assurance efforts related to
   falls prevention.

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Call to Action

• Articulates state plan for falls prevention and
  commitment of partners to work together
• Provides framework for action by professionals
  and community partnerships

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MN Falls Prevention Website

• Developed through collaborative effort of state
  partners
• Goal to make it easy to take action to prevent
  falls
• Consumer and Professional Sections
• Evidence-based Recommendations

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Contact Information

• Pam Van Zyl York Minnesota Department of
  Health, Division of Health Promotion and Chronic
  Disease pam.york_at_health.state.mn.us

• Kari Benson
• State Project Manager Minnesota Board on Aging
  kari.benson_at_state.mn.us