Fall Prevention for Seniors from Research to Community Programs

1
Fall Prevention for Seniorsfrom 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

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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
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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)

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WISQARSTM (Web-based Injury Statistics Query and
Reporting System)

• Interactive database system
• Provides customized reports of fatal nonfatal
  injury data

www.cdc.gov/injury
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Leading Causes of Unintentional Injury Death
Among People 65, 2005
Total 36,800 deaths
N 15,800
__________ NCHS, Vital Records, 2005
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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
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Trends in Age-Adjusted Fall Death Rates Men
Women 65, 2000-2005
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Men
Women
40
___________ NCHS, Vital Records, 2005
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Leading Causes of Nonfatal Unintentional Injuries
Among People 65, 2005
Total 2.9 million injuries
N1.8 million
__________ NEISS-AIP, 2005
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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
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Impact

• Economic
• Quality of life

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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

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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
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Public Health Model
Translate Disseminate
Develop Test Interventions
Identify Risk Factors
Define Problem
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Fall Risk Factors

• Biological
• Behavioral
• Environmental

__________ V. Scott, 2000
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Biological Factors

• Not Modifiable
• Older age
• Female
• Chronic diseases
• Mentally impaired

• Modifiable
• Muscle weakness
• Gait balance problems
• Poor vision

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Behavioral Factors

• Risky behaviors
• 4 medications
• Psychoactive medications
• Inactivity

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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

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Public Health Model
Translate Disseminate
Develop Test Interventions
Identify Risk Factors
Define Problem
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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

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Public Health Model
Translate Disseminate
Develop Test Interventions
Identify Risk Factors
Define Problem
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Translate proven interventions into programs
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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

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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

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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

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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

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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

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CDC Resources for OrganizationsPreventing
Falls What Works

• Provides detailed information about 14 fall
  interventions
• Interventions tested in RCTs shown to reduce
  falls

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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

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Resources for Seniors Caregivers

• Fall prevention brochure
• Home safety checklist

www.cdc.gov/ncipc/duip/fallsmaterial.htmBrochures
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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

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In Conclusion

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

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Thank You!
jas2_at_cdc.gov