Demographic and Self-Report Measures and Cognitive Screening for Falls Risk Assessment

Demographic and Self-Report Measures  and Cognitive Screening for Falls Risk Assessment

By Kristin T. Wright, SPT, ATC, CSCS, OLY

Background:

My interest in falls risk assessment has been on-going specifically for the last two years.  I have always had fun interacting and treating older patients as it seems they are always very gracious for our help, they can make great improvements, and they have so many great stories to tell.  In my second year of PT school, I had the opportunity to serve the residents of Tyrrell County, NC by joining my fellow classmates and other programs within UNC, on a service learning trip to eastern North Caroling.  Prior to this trip, I took advantage of UNC’s free OTAGO training certification as I knew we would be adventuring out on home visits and providing falls risk assessments at the local senior center. This program put me in a great position to assess their risk and provide exercise programs for them to try.  In addition, my second clinical rotation was with the PACE (Program for All-Inclusive Care for the Elderly) program, which is a national program established to provide care to older populations with chronic health needs.  It is here, that I really got involved in falls risk assessment and prevention strategies.  We would assess participants on a daily basis for their falls risk and I saw first-hand the devastating effects falls can have on our older community members.  In the past year, I continued this interest by volunteering at a number of CHAMP (Community Health and Mobility Partnership) events within North Carolina where we would assess community members for their falls risk and provide fall prevention interventions. This capstone project is a module that provides community members and healthcare providers with resources on how to assess for falls risk in terms of demographic and self-report measures and cognitive screening tools.

Statement of Need:

For older adults, falls are a very scary event which can have disastrous consequences. Falls are one of the leading causes of injury and death among the elderly. Fall related events account for over $50 billion dollars in medical costs each year.¹ Undoubtedly, there is a need to decrease falls within our communities.  This project will strive to fulfill a need within the CHAMP program, as well as providing community health care professionals with falls risk assessment education materials. First, this project will serve as a part of a series of educational training modules designed to train healthcare professionals and students who would like to volunteer within the CHAMP program.  Secondly, this module will serve as a general educational module where healthcare professionals can access this information online to learn about common falls risk assessment measures and screens and how to implement them within their community.

Overview of Project:

There are many risk factors that contribute to falls, including but not limited to: low balance confidence, cognitive impairment, depression, and low physical activity levels.  Research has shown that a multifaceted fall prevention approach works best in preventing and reducing fall rates.² This project focuses on the factors listed above, which provide a portion of a multifaceted approach to creating and implementing a falls risk assessment program in order to decrease falls within our community dwelling older adult populations.  The online educational module describes proper administration techniques for many different self-report measures and cognitive screens, which are commonly used in falls risk assessments.  A post-module evaluation was also created to assess retention and for use in continuing education.  An annotated bibliography was produced which highlights the main sources used in this project as well as providing the users with additional resources to peruse.

Products:

Links to the products can be found here:

Demographic and Self-Report Measures and Cognitive Screening for Falls Risk Assessment – Online Training Module

Post Module Evaluation (Qualtrics Survey)

Post Module Evaluation (PDF)

Annotated Bibliography of Primary Sources (PDF)

Associated Work:

In the fall term of 2017 for our Evidence Based Practice II course, I completed a critically appraised topic (CAT) on interventions which may decrease a person’s fear of falling in order to reduce their falls risk.  This paper can be found here.

In addition to my project, fellow classmates Carly Bernadotte, SPT, and Anthony Augliera, SPT completed modules which explore “Falls Risk Assessment and Intervention in Community-Dwelling Older Adults” and “Physical Performance Tests for Falls Risk Assessment”. While each of these modules are separate from one another, together they provide a multifaceted approach to falls risk assessment and intervention.  I would encourage readers to view their pages found here and here.

Evaluation:

Throughout this project I received helpful and constructive feedback from my advisor Dr. Vicki Mercer and my committee members, Dr. Carolyn Vincent, PT, DPT and Dr. Courtney Hall, PT, PhD.  My committee members were given a general evaluation form to provide candid feedback about the strengths and weaknesses of the presentation and where they felt revisions could be made.  My classmates Carly Bernadotte, SPT and Anthony Augliera, SPT, also provided insight and recommendations on how to improve this project and allow it to mesh well with other similar projects.  For those who will be using the module as training for the CHAMP program, or for those who wish to test their retention of the information, there is also a post-module evaluation which can be found in the products section or here.

Reflection on this Project:

This was a great project to work on and I feel it will serve a real need within our communities.  As we become healthcare providers here in a few short months, we must realize that we can have such a positive impact on our community.  We are not only trying to improve the health of our patients by treating their chief complaint, but by treating them in a holistic manner so as to improve their life as a whole and encourage them to live safely within their environment.  This project brought to light the complexity of patient care and the many dimensions that need to be addressed with each patient interaction.  As I began this project I never thought I would have an inclination towards truly starting a program within my community.  After having completed this project, I learned so much about program implementation, communication and cooperation among volunteers, providers, and community members, and that anything is possible if you put your mind to it.  I now have a true interest in implementing a community based falls assessment, prevention, and intervention program sometime in the future.

Acknowledgements:

First and foremost, I would like to acknowledge the tireless efforts of Dr. Vick Mercer PT, PhD. She has to be one of the busiest people I know, yet without fail she continued to provide constructive and effective feedback in a timely manner (no matter if it was 1am!).  This project would not have been possible without her help and guidance.  Thank you!

My classmates Carly Bernadotte, SPT and Anthony Augliera, SPT also stood as a sounding board on many, many, occasions and made sure this project was a success.

Dr. Carolyn Vincent PT, DPT, for her positivity and leadership. Dr. Vincent was my clinical instructor at PACE during my second rotation which sparked an overall interest in geriatrics and falls assessment and prevention strategies.  She provided wonderful feedback and suggestions for improving this project and I thank her for her time and effort in making this a success.

Thank you to Dr. Courtney Hall PT, PhD, for taking time out of her busy schedule to provide comments and opinions for a student she only knows through email.

I would also like to thank Martha Zimmerman MEd, PT, for providing the needed training while at the CHAMP events and for her support and direction during filming.

There were two community members who took time out of their lives to help with the production of our videos.  Their patience, positivity, and willingness to help will not be forgotten.  Thank you!

And last, but not least, Erica Rothman and her team with Nightlight Video Productions. It was a joy working with you all, the videos and narration are wonderful and I would recommend your business to anyone!

References:

1. Centers for Disease Control and Prevention. Home and Recreational Safety. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html. Last updated February 10, 2017. Accessed April 2018.
2. Day LM. Fall prevention programs for community-dwelling older people should primarily target a multifactorial intervention rather than exercise as a single intervention. J Am Geriatr Soc. 2013;61(2):284-285.

Image received from: https://psnet.ahrq.gov/webmm/case/324/raise-the-bar