THE EVOLUTION OF SENIORS FALLS PREVENTION IN BRITISH COLUMBIA

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THE EVOLUTION OF SENIORS FALLS PREVENTION IN
BRITISH COLUMBIA

• Dr. Vicky Scott, Lillian Baaske, Dorry Smith,
  Tessa Graham, Dr. Elaine Gallagher, Dr. Ian Pike,
  Matt Herman Mike Vanderbeck

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B.C. Seniors

• Those 65 account for 13.7 of the B.C.
  population
• 1995 to 2004 population 65 rose from 475,300 to
  574,400 (21 increase)
• 2004 to 2010, number of seniors is expected to
  grow by another 17 to 672,000
• Between 2001 to 2021 the average age in B.C. will
  increase from 38.2 to 42.6 years

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Outline

• Laying the Groundwork
• Policy Considerations
• Environmental Scan in B.C.
• Translation of Research to Practice
• The Interior Health Authority Experience

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Laying the Groundwork for B.C.s Success

• 15 years of sustained collaboration
• Champions positioned to support and influence
• Recognition of opportunities and timing
• Shared vision and commitment
• Leadership
• Strategic investment of limited resources
• Strategic multi-sectoral partnerships
• Involve the right people in decisions, including
  those affected by the problem
• Respect for roles and responsibilities

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Essential Questions for Falls Prevention Planning

• What is the nature and magnitude of the problem
  in your region?
• What policies do you need to support prevention?
• Who should be involved in prevention?
• Who is at risk for falls and injuries?
• What are the best prevention strategies?
• How will you know if the strategies work?
• How will prevention efforts be sustained?

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Falls Injury Prevention Planning
Scott et al., 2005. Evolution of Seniors Falls
Prevention in British Columbia
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Policy Considerations

• Action on falls did not happen overnight
• Important ingredients policy decisions,
  champions, evidence, opportunities and timing
• Collaborative jurisdictional action on aging the
  context

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Policy Considerations

• Key policy and documents commissioned/released
  by F/P/T Ministers
• Evidence led to action and engagement of experts
  and those affected by the problem
• Commitment to injury prevention and falls was
  built over time
• Nationally unique partnership between Health
  Canada and Veterans Affairs launched in 2001

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Policy Considerations

• Continued federal/provincial/regional
  collaboration following the HC/VAC program
• Critical mass of individuals involved at
  different levels in the issue developed state of
  readiness to act
• Environment created to support further
  collaboration
• Development and release of the Environmental
  Scan Seniors and Veterans Falls Prevention
  Initiatives in B.C. 2005
• Establishment and support of BC Falls Prevention
  Coalition 2005

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Overview of Activities

• Ottawa Charter (1986)
• National Framework on Aging (1998)
• BC Office for Injury Prevention (OIP) focus
  0-24 years
• Deputy PHO created BCIRPU focus on all ages
  (1997)
• BC Summit on Falls Prevention (1998)
• F/P/T Ministers of Health and Safety and Security
  Working Group (SSWG) (1999) Seniors injury
  seen as priority
• F/P/T Advisory Committee on Population Health -
  Sub-committee of Public Health Falls Among
  Elderly seen as priority

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Activities Continued

• OIP and B.C. Office for Seniors jointly created
  Falls Prevention Specialist position (2001)
• Veterans Affairs and Health Canada Falls
  Initiative (2001-2004)
• Special PHO report on Falls and Injuries among
  the Elderly (2004)
• Partnership with Knowledge Network for social
  marketing of falls prevention (2004)
• BC Falls Prevention Coalition (2005)

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B.C. Research History

• Scope of the problem
• Risk factor evidence
• Prevention evidence
• Capacity building
• Sustainability
• Dissemination

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Scope of the Problem

• First profiled as a serious issue in B.C. in 1989
  at an Inter-ministerial Committee on Aging
• MOH led a provincial meeting on fall-related
  hospitalizations (Dr. Bob Fisk, 1990)
• 1st RCT on falls in B.C. Head Over Heels
  (Gallagher Brunt, 1991)
• Health Canada funded the STEPS project on falls
  in public places (Gallagher Scott, 1994)
• Mortality and Morbidity of Falls in B.C. (Scott
  Gallagher, 1997 )

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Risk Factors Prevention

• U.Vic Risk factors for falls and injuries among
  frail community seniors (Scott Gallagher, 2000)
• Population Health/BCIRPU Stepping In Fall
  Prevention in LTC (Scott et al., 2003)
• BCIRPU EDISS Reports on Fall Injury in Emergency
  Dept. (2004) SAIL Pilot and RCT (Scott et
  al., 2004/2005)
• UBC Risk reduction for women with osteoporosis
  (Lui-Ambrose Kahn, 2003) Strength Balance in
  Reducing Falls (Donaldson Kahn, 2005) Fall
  Risk for Women with Visual Impairment (Szabo
  Kahn, 2006) ED Fall Outcomes (Salter, 2004)
• SFU Biomechanics of Falls Hip Fractures
  (Robinovitch, 2005) Floor Stiffness Risk of
  Hip Fracture (Laing, 2003-)
• Other Paramedics for Early Intervention of Falls
  (Robinson, 2004) OT Falls Assessment (Dixon,
  2004) Centre for Hip Health (Oxland, 2006)

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Capacity Building, Sustainability Dissemination

• F/P/T Systematic Review of Best Practice in
  Falls Prevention (2000)
• F/P/T National Inventory of Falls Prevention
  (2000)
• BCIRPU Economic Burden of Unintentional Injury
  in B.C. (Smartrisk, 2001) Unintentional
  Fall-related Injury and Deaths Trends, Patterns
  Projections (BCIRPU, 2002)
• MOH/BCIRPU Prevention of Falls Injury Among
  the Ederly PHO Report
• PHAC/MOH Environmental Scan Seniors Veterans
  Falls Prevention Initiatives in B.C.

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Fall-related Hospital Rates per 1,000 by
Provinces and Territories, 1998/99 2002/03,
Ages 65
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Environmental Scan

• Environmental Scan of Seniors and Veterans Falls
  Prevention Initiatives
• Dr. Vicky Scott, Senior Advisor on Falls
  Prevention, BCIRPU
• Dr. Elaine Gallagher, Professor, UVic School of
  Nursing
• Dr. Mariana Brussoni, Associate Director, BCIRPU
• Kristine Votova, Doctoral Student, University of
  Victoria
• Dorry Smith, Researcher, BCIRPU

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Purpose and Background

• Why falls?
• 85 of all injuries to the elderly
• 180 million in direct health costs (BC,1998)
• Why a falls inventory?
• Reflect changes since the previous scan (Scott,
  Dukeshire, Gallagher, Scanlan, 2001)
• Aid practitioners/researchers to better
  understand critical factors
• End result prevent falls, promote networking and
  contribute to a collective effort currently
  underway in the province to reduce falls and
  injuries among older persons

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Methods of Data Collection

• Epidemiological data
• Vital Statistics (mortality)
• Ministry of Health (hospital separation)
• Inventory data
• Province-wide survey of seniors falls prevention
  initiatives
• Critical factors of success
• In-depth interviews with successful programs

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Results

• 116 completed inventories submitted
• Nine-fold increase in reported initiatives
• Initiatives categorized
• Policy
• Research
• Practice

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Results

• Community/Pre-Frail and Well-Elderly (32)
• LTC/Frail and Cognitively Impaired Elderly (30)
• Acute Care/Geriatric Rehab Services (5)
• Cross-Site (11)
• Research (11)
• Policy (8)
• Private Providers (3)

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Information Provided in the Scan

• Initiatives descriptive information
• Key findings of critical factors of success
• Recommendations to healthcare settings and
  providers
• Indexes of tables

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Translating Research to Practice

• Evidence-based
• Applicable
• Affordable
• Effective
• Sustainable

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Evidence to Practice Example

• The Interior Health Authority experience
• 1995 Researchers bring the issue of falls to the
  region
• 2000 North Okanagan Health Region (NOHR)
  planners were alarmed at the high rate of falls
  for their Health Area

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Evidence to Action

• Partnerships formed
• Communities buy-in
• Three year funding received from HCVAC

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Climate for Change

• Four health areas merge in 2000 creating a
  climate change
• New health region holds Population Health
  Conference in 2002 and Falls Program is showcased
  
• Aging Population Higher Falls Numbers

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Pop Health Jump Starts Falls Focus

• Champions were identified
• Project funds were strategically dispersed
• Strategic Plan was drafted
• Falls Prevention Manager appointed by Population
  Health to provide leadership and support of
  regional efforts

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Building Capacity

• Created inventory with BCIRPU
• Hired BCIRPU to produce a comprehensive falls
  report
• Identified and supported falls pilots in each
  sector and health area based on sound
  research/best practices
• Working with Municipal Councils, community groups
  and seniors to develop partnership to address
  local fall issues

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Action to Practice

• Internal
• Residential Falls Program
• Acute Care Project
• Community Health Care Workers Project
• External
• Safe Communities falls prevention program

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Challenges

• Constant change
• Compliance (Forms)
• Reliable real time internal data
• Developing universal reporting systems
• Sustaining the programs beyond the project phase

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Next Steps in Interior Health

• Mandatory Performance Management indicators
• Across sector falls reports
• Hand over clinical piece to Performance
  Management
• Will expand focus to include assisted living and
  well seniors in the community

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What we have learned in B.C.

• It takes time
• Need the evidence
• Need the right partners
• Need to integrate prevention into policy and
  practice
• Need to evaluate and disseminate
• Need to build sustainability in from the start
• Need to celebrate your successes

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Next Steps for B.C.

• CFPC national standardized training B.C.
  climate created opportunity to do this
• Accountability by HAs and Professionals
• Regional performance indicators
• Setting-specific practice indicators
• BCFPC
• Monitoring and supporting
• Priority setting
• Disseminating

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Questions?

• Thank You!
• Merci!