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StandUp for Senior Independence SUSI

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John J. Gerlach Center for Senior Health. 614-566-4225. blackbl_at_ohiohealth.com ... Hospital Gerlach Center for Senior Health developed a placemat with fall ... – PowerPoint PPT presentation

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Title: StandUp for Senior Independence SUSI


1
Stand-Up for Senior Independence(SUSI)
  • Lea Blackburn, LISW, ACSW
  • Riverside Methodist Hospital
  • John J. Gerlach Center for Senior Health
  • 614-566-4225
  • blackbl_at_ohiohealth.com

2
SUSI Funded By
  • Ohio Department of Public Safety
  • Division of EMS
  • HB 138 Special Projects
  • Columbus Foundation

3
Needs Evidence
  • According to Columbus Fire Department over 90 of
    the personal assist runs are related to patient
    falls.
  • During 6 month period EMS personnel have
    responded to 585 personal assist runs.
  • Annual cost of 438,750
  • Takes EMS unit out of service

4
Needs Evidence
  • According to CDC
  • every hour an older adult dies as the result of a
    fall
  • in 1998, more than 9,600 persons 65 and older
    died from fall related injuries, making falls the
    leading cause of death among this age group
  • 60 of all deaths involve individuals over the
    age of 75
  • 30-35 of people 65 fall each year
  • 20 of falls cause serious injury

5
Frailty / Falls Relationship
  • Frailty is defined by a constellation of symptoms
    including weight loss, weakness, fatigue,
    inactivity due to food intake. An illness or
    trauma such as a fall can trigger the
    acceleration of frailty.
  • Leading to loss of independent function

6
GOAL
  • An older adult who has experienced a fall (not
    resulting in a fracture) will effectively
    implement environment modifications and
    individual behavior changes to prevent ongoing
    frequent falls and thus remain independent.

7
STUDY POPULATION
  • Community-dwelling elders aged 70 or greater, who
    have experienced 2 falls requiring an emergency
    squad response within a 30 day period of time.
  • Changed the age criteria to 60
  • 119 initial home visits for assessment of
    eligibility.
  • 40 total subjects met the research criteria.

8
Exclusion Criteria
  • Fall was due to exacerbation of chronic medical
    condition including, but not limited to, a
    spontaneous fracture due to osteoporosis.
  • Prior diagnosis of dementia and under care of
    physician
  • Prior diagnosis of depression and under care of
    physician

9
Objectives
  • The referral program will reduce the likelihood
    of falling among community-dwelling elders who
    have previously have fallen at least twice within
    30 days, as demonstrated by a fall rate which is
    significantly above the baseline rate among this
    group.

10
Study Variables
  • demographic characteristics
  • home environment and living arrangements
  • circumstances location to the fall
  • baseline and follow-up functional status
  • co-morbiditys
  • Clinical assessment results
  • depression
  • dementia
  • nutrition
  • home environment
  • Added the CAGE (Alcohol screening)

11
Study Variables
  • follow-up after clinical recommendations
  • 1 month by phone
  • 3 months by phone
  • 6 month home visit
  • occurrence of falls during study period
  • hospital admissions during the study period and
    reason for admission

12
Collaborating Partners
  • Columbus Fire Department
  • Community Public Health Professionals

13
Study Design
  • This is a cohort study, which uses historical
    data to measure the level of success of the SUSI
    program.
  • A randomized trial would provide the best
    evidence for evaluating SUSI, it is not a
    practical design.

14
Study Begins with
  • Referral for clinical assessment from CFD or
    Public Health Professional

15
Clinical Assessments
  • Depression screening - Geriatric Depression Scale
    (GDS)
  • Dementia Screening - Folstein 3MS Mental Status
    Exam
  • Nutrition Screening - 1991 Nutrition Screening
    Initiative Level 1
  • Home Environment Screening
  • Alcohol screening (CAGE)
  • Health Status Questionnaire

16
Screened to Suggest Risk
  • Educated by the Project Coordinator
  • Coordinator will communicate with Primary
    Physician regarding the baseline information.
  • Coordinator with consent (and prescription if
    appropriate) from PCP will arrange PT, OT,
    Dietician or Home Medical Equipment

17
Baseline Location Reason for FallSubject fell
2x within 30 days
  • Most Frequent Location of Fall
  • Living Room / Den
  • Kitchen
  • Qualitative reasons given
  • Lost balance while reaching
  • Legs gave out
  • Turned around too quick

18
of Falls at 180 days
19
Results n40
  • 12.8 screened positive for depression
  • 57 screened positive for dementia
  • 100 required home environment changes
  • 47.5 screened positive for nutrition deficit
  • 32.5 required a dietician referral
  • 80 required a Physical Therapy referral
  • 286 visits for 28 subjects
  • 25 required Occupational Therapy
  • 89 visits for 1 subjects

20
Qualitative Results
  • I feel like there is hope
  • Dentures were too loose, broken hearing aide,
    depressed and needs bathroom equipment
  • referred to OSU dental clinic for dentures
  • referred to Cols Speech Hearing for new aide
  • referred to home modification company to install
    grab bars
  • Ordered PT OT
  • I know why I fell
  • denying need for help

21
Qualitative Results
  • I can simply ask my doctor for an OT / PT
    evaluation?
  • Ill do anything to stay in my own home.
  • Im just too old
  • Therapy will come to my home?
  • Medicare covers PT / OT evaluation and
    treatment?

22
Case Example
  • 89 year old male has fallen 3x within 30 days.
  • Assessment result needs
  • Depressed,
  • Dietary needs
  • Home Modifications
  • dx with macular degeneration

23
Case Example
  • Outcomes
  • PCP addressed overall health including depression
  • dietician
  • counselor
  • Home modifications - grab bars, shower drain,
    removed carpets
  • medic alert system
  • meals on wheels
  • homemaker and home health aid
  • services for visually impaired came to home and
    provided gadgets to allow to read again
  • Physical Therapy 3x wk for 6 weeks improve gait
    and balance.
  • No falls for 125 days

24
Conclusions
  • Falling is not a result of a single factor it is
    a combination of some or all of the following
    factors
  • Dementia
  • Over the age of 80
  • Reaching for items in kitchen or living room
  • Currently receiving some form of caregiver
    support.

25
Variables that Directly Correlate with a Decrease
in Falls
  • Improvement in Depression
  • 71 improvement in GDS
  • Improvement in Nutritional Status
  • 55 improvement
  • Home Modifications
  • Carpets removed 45.9
  • Grab bars added 40.5
  • Home Medical Equipment 32

26
Additional finding
  • There was no statistical significance between
    co-morbidities and falling.

27
Qualitative Information with Significance
  • Lack of communication about falls to their
    primary physician or family.
  • Subjects stated they knew why they had fallen.
  • Subjects are afraid they will fall again.
  • A statistically significant number of physicians
    were unaware that Medicare part B will cover OT
    or PT in the home with a prescription regarding
    fall risk.

28
Recommendations
  • Education for EMS and health care providers.
  • Education for the older adult and their family.
  • Riverside Hospital Gerlach Center for Senior
    Health developed a placemat with fall prevention
    strategies for EMS to take to older adults home
    or health care providers to distribute.
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