Tuesday, January 3, 2012

STAY ON YOUR FEET (SOYF) preventing falls in seniors

Healthcare does more research and ignores most of it as well. This is a statement I used to make about education, when I wrote about those issues. As editor of a couple of teacher publications, I found that much research was done in the field, but these research papers were buried in a raft of publications.

Individual teachers should be held accountable by their principals to ensure that they are up-to-date on best practices. The same is true in the field of healthcare.
We know what works: integrated practices, prevention, interventions, direct services, and monitoring.
One of the best interventions I am familiar with was the Cardiovascular Health Awareness Program (CHAPprogram.ca) in which blood pressure clinics, held across the province, educated individuals in taking responsibility for their cardiovascular health issues. I worked on this, and it was quite successful at teaching seniors to take responsibility for their cardiovascular health!

How do we translate research into best practices?
It is hard to convince individual seniors at home about their risks. I tried to intervene with my parents. My father had a brain tumour removed, and while shaky on his feet, he didn't want to use his walker.

It is hard encouraging an administrator of an institution (Retirement Home or long-term care) to read recent research, implement change, and retrain staff. Especially, those homes run by a for-profit with head office in the USA. And this is where the system breaks down. Conferences and publications can illuminate these interventions, but it is up to the individual nurse manager, director of care, case manager, physician, to educate their clients.

Through the Canadian Best Practices Portal healthcare agencies across Canada can access best practices. We need not invent the wheel across this nation. In fact, this is an international issue.
It is based on an Australian study: R Volpe and J Lewko (2006) Stay on Your Feet. Preventing Neurotrauma: A casebook of evidence based best practices.

This Australian portal provides much information on preventing falls. With most of the caregiving in institutions being undertaken by for-profit organisations, delivered by personal support workers (PSW) with minimal education and training (a 14-module certificate), we must ensure that we deliver  the best care we can. Preventing Falls in Older Adults Project: Stay active, stay independent, stay on your feet Research Report [PDF].

Falls can lead to a reduction in mobility as well as in participation in activities of daily living, restricted social interaction and in higher levels of dependency and care. We know the ramifications of hospitalisation for seniors. Preventing falls is a difficult one.

What I find interesting is the conclusion of the widely touted study:
"The main finding of the research project, was that neither a community awareness-raising plus community action /development; NOR an increased availability of group physical activity opportunities, in themselves, substantially improve falls risk factors or decrease the rate of fallsrelated injury. There was a minor and non-specific statistically significant improvement in some of the risk factors for falls within the two populations studied. There was no significant improvement in falls-related injury. The project did provide valuable knowledge that can be translated into practical application both within, and through, Government and community based systems and practices.

The Australian study states:
  • one in 4 (26.8%) people 65+ years, in the community, experience a fall in any 12 month period
  • one in 2 need medical treatment following the fall.
  • 1 out of 4 people who fall restrict their usual activities fear of falling again.

  • in 2008: 850 hospital admissions to specialized trauma facilities in 2008
  • about one-fifth (20%) of all severe injury admissions
  • falls in seniors increased by 20% over the five-year period from 2004. 
  • more than half of these falls (57%) happened at home
  • severe injuries to the head or spine in 87%
  • falls accounted for 71% of major injury hospitalizations
  • Men were more likely to be hospitalized after a fall than women
  • number of falls increased as age did, peaking at age 72 for men and 86 for women
  • between 2004 and 2008, the number of severe injury hospitalizations in trauma centres for falls among all ages increased 16% (from 1,359 to 1,577).
For anyone who works with seniors, we knew the huge impact falls have on an aged population. A Muskoka Moose FM article quotes the Executive Director of The Friends, Marliese Gause, who says that on average in Parry Sound, there are 22 calls per month to EMS related to falls, with most being women. (Cottage Country's city of Parry Sound has a year-round population of 18,000.)

What are the causes of falls? 
The causes of falls?
  • medication, e.g., delirium
  • lack of physical activity, poor muscle tone
  • frailty
  • osteoporosis
  • obesity
  • mobility issues
  • environmental issues: clutter, slippery carpets, stairs or slipping, tripping or stumbling
  • poor, unsafe footwear
  • vision issues, lack of visual acuity.
North Bay's Rising Stars perform
This Cottage Country Now article reported that this local singing group put together an amusing Diner's Club concert, warning about the risks of fall for seniors. Rising Stars were performing for the Belvedere Heights Community Support Services Diner's Club. They helps seniors by providing volunteers who assist with senior visits, Meals on Wheels, congregated dining: diner's club, and transportation. What a great idea!

The solutions?
  • exercise programs
  • walking programs
  • physiotherapy
  • getting seniors together for education, socialisation
  • modifying the environment: home, institution; ramps, rails, walkers
  • monitoring medications 
  • home support: transportation, Meals on Wheels, case manager 
  • supportive living facilities.

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