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Fall Prevention for Seniors from Research to Community Programs

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30-35% of people 65 fall each year1. Those who fall are 2-3 times more likely to fall again2 ... 1. American Geriatrics Society, JAGS, 2001. 2. Lord SR, JAGS, 2003 ... – PowerPoint PPT presentation

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Title: Fall Prevention for Seniors from Research to Community Programs


1
Fall Prevention for Seniors from Research to
Community Programs
Judy A. Stevens, Ph.D. National Center for
Injury Prevention Control Centers for Disease
Control Prevention
  • NASHIA Conference
  • September 10, 2008

2
Introduction
  • 30-35 of people 65 fall each year1
  • Those who fall are 2-3 times more likely to fall
    again2
  • 10-20 of falls cause serious injuries3

__________ 1. Hornbrook, Gerontologist, 1994
Hausdorff, Arch Phys Med Rehab, 2001 2.
Tinetti, New Eng J Med, 1988 Teno, JAGS,1990 3.
Sterling, J Trauma-Inj Infection Critical Care,
2001
3
Public Health Model
Translate Disseminate
Develop Test Interventions
Identify Risk Factors
Define Problem
4
Public Health Model
Translate Disseminate
Develop Test Interventions
Identify Risk Factors
Define Problem
5
Data Sources
  • Vital Records
  • National Electronic Injury Surveillance System
    All Injury Program (NEISS AIP)

6
WISQARSTM (Web-based Injury Statistics Query and
Reporting System)
  • Interactive database system
  • Provides customized reports of fatal nonfatal
    injury data

www.cdc.gov/injury
7
Leading Causes of Unintentional Injury Death
Among People 65, 2005
Total 36,800 deaths
N 15,800
__________ NCHS, Vital Records, 2005
8
2005 15,800 Fatal Fall Injuries
  • 50 Traumatic brain injury
  • 30 Lower extremity
  • 8 Torso
  • 3 Other head/neck
  • 9 Other

___________ Thomas KE, J Safety Res, 2008
Stevens JA, Inj Prev, 2006
9
Trends in Age-Adjusted Fall Death Rates Men
Women 65, 2000-2005
31
Men
Women
40
___________ NCHS, Vital Records, 2005
10
Leading Causes of Nonfatal Unintentional Injuries
Among People 65, 2005
Total 2.9 million injuries
N1.8 million
__________ NEISS-AIP, 2005
11
2005 1.8 Million Nonfatal Fall Injuries
  • 27 Upper extremity
  • 27 Lower extremity
  • 15 Torso
  • 19 Other head/neck
  • 4 Traumatic brain injury
  • 8 Other

___________ Stevens JA, Inj Prev, 2006
12
Impact
  • Economic
  • Quality of life

13
Economic Impact
  • In 2000, cost of fatal fall injuries among people
    65
  • Total 19 billion
  • Fatal falls 0.2 billion
  • Nonfatal injuries 19 billion
  • ___________
  • Stevens JA, Inj Prev, 2006

14
Quality of Life
  • 20 - 36 fear falling1
  • 20 die within a year after hip fracture2
  • 25 in a nursing home one year later3

___________ 1. Vellas BJ, Age Aging, 1997
Friedman SM, JAGS, 2002 2. Lu-Yao GL, AJPH,
1994 3. Magaziner, J Gerontology Medical
Sciences, 2000
15
Public Health Model
Translate Disseminate
Develop Test Interventions
Identify Risk Factors
Define Problem
16
Fall Risk Factors
  • Biological
  • Behavioral
  • Environmental

__________ V. Scott, 2000
17
Biological Factors
  • Not Modifiable
  • Older age
  • Female
  • Chronic diseases
  • Mentally impaired
  • Modifiable
  • Muscle weakness
  • Gait balance problems
  • Poor vision

18
Behavioral Factors
  • Risky behaviors
  • 4 medications
  • Psychoactive medications
  • Inactivity

19
Environmental Factors
  • Modifiable
  • Clutter tripping hazards
  • No stair railings or grab bars
  • Poor lighting
  • Not Easily Modifiable
  • Cold temperatures
  • Uneven pavement
  • Poorly designed public spaces

20
Public Health Model
Translate Disseminate
Develop Test Interventions
Identify Risk Factors
Define Problem
21
Elements of Effective Interventions
  • Individualized assessment1
  • Exercise for balance strength2
  • Medication management3
  • Improve vision4
  • Home safety5
  • ___________
  • 1. American Geriatrics Society, JAGS, 2001
  • 2. Lord SR, JAGS, 2003
  • 3. Cumming RG, Drugs Aging, 1998 Ray W, Topics
    in Geriatric Rehab, 1990
  • 4. Lord SR, JAGS 2001
  • 5. Day L, BMJ 2002 Gill TM, APHA, 1999

22
Public Health Model
Translate Disseminate
Develop Test Interventions
Identify Risk Factors
Define Problem
23
Translate proven interventions into programs
24
Tai ChiMoving for Better Balance
  • RCT showed Tai Chi participants had 55 fewer
    falls
  • Dr. Fuzhong Li translated 6-month intervention
    into a 12 week program

25
Moving for Better Balance (Cont)
  • Program held in senior centers
  • 1-hour classes twice a week for 12 weeks
  • Follow-up 12 weeks after last class
  • Developing a multi-media program package for
    organizations

26
Stepping On
  • RCT showed Stepping On participants had 31
    fewer falls
  • Dr. Jane Mahoney is translating Australian
    program for the U.S.
  • Maintain fidelity to the original program

27
Stepping On (cont)
  • Uses adult learning principles in a group setting
    to
  • Increase awareness of fall risk
  • Build self-confidence in fall risk situations
  • Encourage decision-making
  • Promote behavior change

28
Stepping On (cont)
  • 2-hour classes once a week for 7 weeks
  • Exercises for balance, strength mobility
  • Review medications
  • Vision screening
  • Safe footwear
  • Home modification

29
CDC Resources for Organizations Preventing
Falls What Works
  • Provides detailed information about 14 fall
    interventions
  • Interventions tested in RCTs shown to reduce
    falls

30
Preventing Falls How to Develop Community-based
Fall Prevention Programs
  • Defines key elements
  • Provides guidelines on program planning,
    development, implementation evaluation
  • www.cdc.gov/ncipc/preventingfalls

31
Resources for Seniors Caregivers
  • Fall prevention brochure
  • Home safety checklist

www.cdc.gov/ncipc/duip/fallsmaterial.htmBrochures
32
Next Steps
  • Need to translate more proven interventions into
    new community programs
  • Need to disseminate promote widespread adoption
    of these evidenced-based fall prevention programs

33
In Conclusion…
  • Falls significantly affect seniors health
    quality of life
  • We can prevent falls through evidenced-based
    programs

34
Thank You!
jas2_at_cdc.gov
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