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Mary Ellen Kullman, Archstone Foundation

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Title: Mary Ellen Kullman, Archstone Foundation


1
Fall Prevention Making a Difference Through
Collaboration
  • Mary Ellen Kullman, Archstone Foundation
  • (Bonita) Lynn Beattie, The National Council on
    the Aging
  • Patricia Adkins, Home Safety Council
  • Debra Rose, California State University,
    Fullerton
  • Don Grantt, Administration on Aging (Respondent)

Health Promotion Institute Best Practices in
Health Promotion 2006
2
Evolution of the California Stop Falls Initiative
Mary Ellen Kullman, M.P.H. Vice
President Archstone Foundation kullman_at_archstone.o
rg
3
Evolution of the California Stop Falls Initiative
  • Isolated Projects Addressing Individual Risk
    Factors
  • Convening of a Small Group of Projects
  • Rand Meta Analysis Supports Multi-factorial
    Approach
  • Recognition that We Can Do Better by Working
    Across Silos and Collaborating

4
Evolution of the California Stop Falls Initiative
  • Formation of a Statewide Planning Group
  • Linking Partners Across the State and Nationally
  • Build the Evidence Base White Paper Development
  • Statewide Blueprint Development Process

5
Evolution of the California Stop Falls Initiative
  • Participation in National Action Plan and Falls
    Free Coalition
  • Formation of the Fall Prevention Center of
    Excellence
  • StopFalls California Coalition
  • California Fall Prevention Projects RFP
  • Model Project Development

6
Progress Through Collaboration
Bonita Lynn Beattie, PT, MPT, MHA Center for
Healthy Aging The National Council on the
Aging bonita.beattie_at_ncoa.org
7
What Do We Know Works?
  • Multifactorial nature of falls and fall related
    injuries demands a collaborative effort
  • Multifactorial intervention strategies, that
    identify and modulate an older adults risk
    factors, are particularly effective in lowering
    fall rates in high risk groups.

8
Falls FreeTM National Action Plan
  • National Falls Free Summit
  • 2 day invitational meeting of 58 national
    organizations, professional associations, and
    federal agencies
  • Through consensus process developed and published
    National Action Plan
  • 36 strategies and action steps to reduce falls in
    older adults

9
Organized Around Risk Factor Management ? for
which there is evidence of effectiveness
  • Physical Mobility
  • Home Safety
  • Medications Management
  • Environmental Safety
  • and cross-cutting issues

10
Falls FreeTM Coalition
  • Falls FreeTM Coalition loosely formalized and
    charged with rolling out the National Action Plan
  • National organizations, professional
    associations, federal agencies, and state
    coalitions working together to affect meaningful
    change

11
Falls FreeTM Coalition Initiatives
  • Presentations, media messages, journal articles,
    interviews, and NPR pieces
  • Falls FreeTM bimonthly Electronic-news
  • Advocacy Workgroup, Legislative Update S. 1531
    Keeping Seniors Safe from Falls Act of 2005
    http//www.healthyagingprograms.com/resources/S20
    153120fact20sheet.doc
  • State Coalitions forming to address fall
    prevention
  • Community collaborative projects forming to
    address local needs

12
Other Coalition Initiatives
  • Center of Excellence for Fall Prevention
    initiative to enhance programs and build
    community coalitions
  • Professional associations developing
    collaboratively developing tools and resources
  • American Geriatrics Society revision of clinical
    guidelines
  • CMS Clarifying Code  V15.88 History of Fall

13
Still More Initiatives
  • Research
  • ASPE LTC study on home modifications
  • NCIPC funded dissemination study, UNC a state
    program in Minnesota U of Wisconsin study of a
    comprehensive program with individual assessments
  • AoA funded projects Matter of Balance,
    Medication Management Model, Evidence-Based Fall
    Prevention Program in Senior Centers
  • Inclusion of fall prevention indicators in the
    CDC 2006 State of Aging and Health Report

14
Vision for Collaborative Action
  • Building community capacity and infrastructure
    through collaboration. Researchers, planners,
    health care, public health, and aging all working
    together to
  • Spread the message that falling is not inevitable
    and there are proven interventions
  • Provide integrated programs and services that
    address the fall risks in homes communities

Multifactorial nature of falls demands a
collaborative effort
15
Resources on the CD ROM
  • Archstone Foundation
  • Pre-conference White Papers
  • California State Conference Proceedings
  • Archstone Foundation/Center of Excellence RFP
  • Falls Free
  • National Action Plan
  • Research Review Papers
  • Issues of E-Newsletters
  • Home Safety Council
  • State of Home Safety

16
Resources
  • Center for Healthy Aging www.healthyagingprograms.
    org
  • Falls Free Electronic News
  • Center of Excellence for Fall Prevention
    www.stopfalls.org
  • National Resource Center on Supportive Housing
    and Home Modification
    www.homemods.org

17
Resources
  • National Center for Patient Safety Falls Toolkit
    www.patientsafety.gov/SafetyTopics/fallstoolkit/i
    ndex.html
  • Home Safety Council State of Home Safety
    Facts about safety in the home http//homesafetyco
    uncil.org/state_of_home_safety/sohs_2004_p017.pdf
  • National Institute on Aging, AgePage Preventing
    Falls and Fractures http//www.niapublications.org
    /agepages/PDFs/Preventing_Falls_and_Fractures.pdf

18
Program Tools
  • National Center on Injury Prevention and
  • Control A Tool Kit To Prevent Senior Falls
    www.cdc.gov/ncipc/pub-res/toolkit/toolkit.htm
  • American Geriatrics Society Falls in Older
  • Adults Management in Primary Practice
    www.americangeriatrics.org/education/falls.shtml

19
Programs
  • A Matter of Balance
  • Partnership for Healthy Aging www.aoa.gov/prof/ev
    idence/SMaine.pdf
  • Safe Steps Program
  • Home Safety Council www.homesafetycouncil.org/ex
    pert_network/en_safesteps_w001.aspx
  • Remembering When A Fire and Fall Prevention
    Program for Older Adults from the National Fire
    Protection Association http//www.nfpa.org/index.a
    sp

20
Programs
  • HEROES Program, Temple University
    www.temple.edu/older_adult
  • FallPROOF! A Comprehensive Balance and Mobility
    Training Program www.exrx.net/Store/HK/Fallproof.h
    tml
  • National Center for Safe Aging www.safeaging.org/m
    odel/default.asp

21
Falls FreeTM Coalition Public Policy Workgroup
and Federal Legislation
Patricia H. Adkins, MBA Chief Operating
Officer Home Safety Council patricia.adkins_at_homes
afetycouncil.org
22
Successful Collaborations at the Federal Level
  • Clear, Common Goals
  • Leadership
  • Resources
  • Communication
  • Unified Message
  • Success?!?

23
Falls Free National Action Plan Clear, Common
Goals
  • Strategy 5
  • Develop a public policy agenda to promote falls
    prevention at the national, state, and local
    levels
  • Action Step 6
  • Create model legislation for use by states and
    local communities

24
Falls Free Public Policy Workgroup Leadership
  • The Public Policy Workgroup was formed from the
    Falls Free Coalition membership
  • Who
  • The National Council on the Aging
  • Home Safety Council
  • National Safety Council

25
Falls Free Public Policy Workgroup Resources
  • Staff
  • Expertise
  • Experience
  • Networks

26
Falls Free Public Policy Workgroup Communication
  • Decision making
  • Working behind the scenes
  • Room for flexibility
  • Staying in touch

27
Falls Free Public Policy WorkgroupUnified
Message Unified Group
  • Unified Message
  • 60-Second Speech
  • One-Page Fact Sheet
  • Supporting Data
  • Joint Letters
  • Unified Group
  • Organizations Membership
  • State Coalitions

28
Falls Free Public Policy Workgroup Success ?!?
  • Celebrate the victories!
  • (big and small)

29
Federal Legislation
  • U.S. Senate
  • S. 1531 Keeping Seniors Safe from Falls Act of
    2005
  • Introduced July 28, 2005
  • Introduced by Sen. Michael Enzi (R-WY) and Sen.
    Barbara
  • Mikulski (D-MD), plus five additional Senate
    cosponsors
  • Authorizes 72 million for FY06-09
  • U.S. House of Representatives
  • Legislation will be introduced by Rep. Frank
    Pallone
  • (D-NJ) and Rep. Ralph Hall (R-TX)
  • House legislation incorporates elements from the
  • National Action Plan
  • House bill authorizes 105 million for FY06-09

30
Federal Legislation
History of the fall prevention legislation
  • The Elder Fall Prevention Act was first
    introduced in
  • the House of Representatives during the 107th
    Congress
  • by Rep. Frank Pallone (D-NJ)
  • A Senate companion bill was not introduced
  • The bill died in committee
  • The Elder Fall Prevention Act was introduced in
    the Senate during the 108th Congress by Sen.
    Michael Enzi (R-WY) and Sen. Barbara Mikulski
    (D-MD)
  • A House companion bill was not introduced
  • The bill died in committee

31
Federal Legislation
Current status of the fall prevention legislation
  • During the 109th Congress, Sen. Enzi and
    Mikulski
  • re-introduced the legislation with a new
    title, The
  • Keeping Seniors Safe from Falls Act of 2005
  • The legislation authorized funding for fall
  • prevention initiatives
  • A House companion bill is close to introduction
    with
  • specific language taken directly from the
    National
  • Action Plan

32
Falls Free Making a Difference Through
Collaboration
  • Increased knowledge and expertise
  • Increased resources
  • Strength in numbers and the ability to leverage
    support
  • Credibility and visibility
  • Activity on multiple fronts increases the
    potential
  • for success

33
Falls Free
Library of Congress (resource for tracking
legislation) http//thomas.loc.gov
Home Safety Council www.homesafetycouncil.org
34
Translating Research into Practice The
California Adventure!
  • Debra J. Rose, PhD
  • Co-Director
  • Center for Successful Aging
  • California State University, Fullerton
  • and
  • Fall Prevention Center of Excellence
  • University of Southern California


35
Defining a Best Practice
  • A technique or methodology that, through
    experience and research, has proven to reliably
    lead to a desired outcome.

36
Fall Prevention Strategies
  • Fall Risk Assessments and Medication Management
  • Physical Activity that specifically targets
    strength, balance, and endurance
  • Environmental modifications in home and community

37
Fall Risk Assessments
  • Shown to lower fall risk by 18 and mean number
    of falls by 43
  • Includes
  • Balance and gait testing
  • Neurological function
  • Medication review
  • Fall Circumstances
  • Individualized fall risk reduction plan with
    follow-up

38
Medication Management
  • Reviewing and modifying medications can reduce
    fall rates
  • Reducing number and type
  • effective
  • Benzodiazepines
  • Antidepressants
  • Sedatives/hypnotics

39
Medication Management
  • Gradual withdrawal of psychoactive drugs
    particularly effective BUT long-term compliance
    is a problem.
  • Successful programs will need a strong counseling
    component to improve compliance.
  • Most effective when part of an interdisciplinary
    and multi-component approach.
  • Medication use perhaps the most preventable or
    reversible risk factor associated with falls.

40
Physical Activity
  • Stand-alone physical activity interventions that
    target fall-related risk factors, lower fall risk
    by 12 and number of falls by 192
  • Different types found to be effective Tai Chi,
    balance and gait training, resistance training
  • Different settings studied Home, community.
  • Different levels of risk studied
  • Different approaches used - Group versus
    individually tailored home exercise programs

41
Physical Activity Programs
  • Successful programs
  • Target balance, gait, and strength
  • Are moderate in intensity or progress from
    low-to-moderate intensity
  • Are implemented by well-trained instructors with
    knowledge of common age-associated performance
    limitations
  • Are acceptable and of sufficient frequency and
    duration based on level of fall risk
  • Foster self-regulatory skills, self-monitoring of
    progress and self-reinforcement.

42
Environmental Modification
  • No evidence that it is effective as a stand-alone
    intervention
  • Most effective when assessments done by an OT and
    when focused on high risk groups.
  • Included as a component of successful
    multi-component interventions conducted with
    recurrent fallers.

43
Home Modification Strategies
  • Includes
  • Removing hazards
  • Adding special features or assistive devices
  • Moving furniture
  • Changing where activities occur
  • Renovating or changing structure of home

44
Environmental Modifications
  • Successful programs
  • Include financial or manual assistance
  • Hire trained health care professionals (OTs) to
    perform initial assessments
  • Target older adults who are ready for change
    (e.g., recent fall, increased understanding of
    risk)
  • Are combined with education and counseling about
    how to decrease risk

45
FPCE Mission.
  • Establish fall prevention as a key public health
    priority in California
  • Create effective and sustainable fall prevention
    programs
  • Create systems for fall prevention

www.stopfalls.org
46
There is NO One-Size-Fits-All Fall Prevention
Program
47
Model Projects
  • To be designed, implemented, and evaluated by
    FPCE in
  • Senior centers, retirement communities, and/or
    Adult Day Care and Health Care settings
  • Across different levels of fall risk
  • Program Expansion Grants
  • Expand on one or more existing components
  • Reviewed by FPCE and Archstone Foundation Staff
  • Technical assistance, grant monitoring, and
    external review of funded proposals by FPCE
  • Funding period is 18 months

48
Purpose of Model Projects
  • Study how best to combine the three core
    components of fall prevention
  • In different real-world environments
  • Via different service providers
  • Across different levels of fall risk

49
Desired Outcomes?
  • Process
  • Better understanding of barriers to
    implementation and sustainability
  • Problem-solving strategies used to overcome
    barriers
  • Internal mechanisms used to link components
  • Recommendations for program modifications from
    providers and recipients of services based on
    respective experiences

50
Desired Outcomes?
  • Product
  • Efficacy of program components in lowering fall
    risk, improving overall physical and
    psychological fxn, behavior change.
  • Effective and User-Friendly Evaluation packages.

51
Desired Outcomes?
  • Product
  • Training and Program Implementation Manuals and
    related resources
  • Replicable Best Practice Fall Prevention
    Programs

52
Current Progress?
  • Finalizing funding recommendations for program
    expansion and coalition-building grants (4-8 in
    each category)
  • Selecting model project sites
  • Pilot project at single site
  • Randomized clinical controlled trials at multiple
    sites
  • Finalizing assessment tools (processes
    and product) to be used to evaluate
    program efficacy

53
Thank You!
www.stopfalls.org
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