Falls Risk Assessment and Intervention in Community-Dwelling Older Adults

Falls Risk Assessment and Intervention in Community-Dwelling Older Adults

Carly Bernadotte, SPT

Background

During PT school, I have found one of my interests to be working with the geriatric population. Personally, I find this population very rewarding to work with. The older adult population is growing at remarkable speed.  Adults over 65 make up 15.2% of the total population in the country, a mere 49.2 million people, and this is continuing to grow¹. With these numbers, most clinicians will encounter working with older adults. Additionally, as the numbers grow, the problems of falls in older adults is becoming a bigger and more noticeable problem. Falls are the leading cause of fatal and non-fatal injuries among older adults. 1 in 4 adults every year will fall and 7 million will require medical treatment or restricted activity.

Due to this increasing problem, the CDC has created a program titled STEADI that provides health providers with tools needed to screen older adult patients who are at risk for falls, and then decide if they need further assessment or intervention². In addition to primary care providers initiating this service, community fall prevention programs have started to form. However, they are not abundant, especially in more rural areas. Rural areas are where these programs could have the most benefit, as there are less providers overall, as well as less community activity programs.

CHAMP is comprehensive community-based fall prevention program that began in western North Carolina. This program includes screening older adults for various fall risks, assessing their physical capabilities, and providing intervention based off the results. The program uses the evidence-based Otago Exercise program as intervention for increasing strength and balance. This program has helped many older adults gain confidence in their balance and stay active.

Project Overview

Due to the great need for these types of programs, Dr. Vicki Mercer had the vision to create educational modules that would train interdisciplinary health professionals including faculty, clinicians, and students who provide services and volunteer for CHAMP. This would allow more volunteers to be trained and available to volunteer at CHAMP. In addition, these modules can also be used for health professionals who are looking to begin their own community fall prevention program in an area where CHAMP does not already exist.

My classmates, Anthony Aguilera, Kristin Wright, and I worked on creating modules that covered Fall Risk Assessment and Intervention for Community Dwelling Older Adults, CHAMP Intake Procedures, and Physical Performance Testing. Before preparing the module, I became Otago certified and attended several CHAMP events to volunteer and gain understanding of how the program worked. My module serves as an overview of identifying those who are at a risk for falling and the intervention that will decrease their risk. My project also outlines the structure of CHAMP, detailing what should be included in any comprehensive fall-prevention program.

Statement of Need

With the information stated above, the problem of falls in older adults is clear. What is not as clear, is how health professional can address this problem. The CDC has certainly begun to address the problem with creating STEADI. However, when looking at a large health system, only 40% of providers asked their older adult patients if they had had a fall in the last year³. Comprehensive fall prevention programs, like CHAMP serve the need of screening older adults and identifying who is at fall risks. This is even more important in more rural communities where access to a provider may not be as readily available. My presentation is designed for all health care providers. It serves a need of awareness by presenting the problem of falls and how to intervene for providers that may not think they have an important role in the screening process. Additionally, it serves the need of training volunteers for CHAMP, so that more patients can be seen. It also serves the need of what to include in a comprehensive fall prevention program, for those in communities who don’t have one and would like to start one, but are not sure what to include.

Products

I have turned my presentation into a narrated Voicethread for online access to various health professionals and students. I have also included a post-module evaluation to make sure learners are truly getting the main points of the presentation and grasp the material. Finally, I also have an annotated bibliography of sources that I used in creating the presentation.

Voicethread

Post-Module Evaluation (Qualtrics link)

Post-Module Evaluation (PDF)

Evaluation Answers (PDF)

Annotated Bibliography 

 

Associated Products

As my presentation included information about intervention, I wanted to have current research on intervention for older adults at risk for falls involved in my capstone. I complete a CAT that evaluated the question: “In a 75-year-old female with a high risk of falls, is a group-based balance exercise class more effective than individual based balance exercise routine for decreasing falls?” Overall, the research showed that neither intervention was more effective than the other for decreasing falls. Providers should recommend exercise intervention based on patient preferences and what they are most likely to do.

Critically Appraised Topic- Falls Risk Intervention

Additionally, I have linked below two of my classmates presentations. All 3 of our presentations were intended to be modules together to get a true understanding of all of the parts to a comprehensive falls prevention program.

Intake and Self Report Measures for Fall Risk Assessment

Physical Performance Tests for Falls Risk Assessment

 

Evaluation and Reflection

Throughout this process, I have received frequent feedback on my presentation from my capstone advisor, Dr. Vicki Mercer, as well as my capstone committee, Gabrielle Scronce, DPT and Martha Zimmerman, PT. I have also received feedback from my classmates, Anthony and Kristin, as we worked on these presentations to be cohesive with one another. Thanks to this group’s consistent feedback I was able to have some evaluation on my project before it was complete and I could still make improvements to it. While these projects were not yet turned into the modules intended, and therefore real feedback about the interaction of them was not possible, I created this post-module survey could also be included in the final product when health professionals are watching this to be trained for CHAMP.

Working as part of a team and trying to produce a product with a lot of moving parts was challenging at times, however, I feel that I gained invaluable experience in learning how to collaborate with others and reach out to those who are not in my immediate program. We were able to obtain high quality videos that fit into our presentations to make them more engaging and give a better idea of how CHAMP and it’s components really work. Personally, I got to learn so much about what goes into creating learning modules and filming. I have a much greater appreciation for these sorts of learning tools now than I did before. I believe that I did achieve my goal of becoming much more knowledgeable about older adult fall prevention programs, and feel confident that I could assist a startup of one, or start one in my own community. I also feel confident that I could educate other health professionals on the importance of their role of being involved in screening for older adults who are at risk for falling. I believe this knowledge and awareness will be very useful to me as a PT working in the clinic. I will be able to use these skills to achieve some of my professional goals of being involved in my community and working with older adults. I also believe this has put me in a better position to advocate for older adult patients, especially to other health care providers. I have come to realize that I could be in the position to make them aware of this need of screening and that these types of programs may be available for their patients in the community. Overall, I am pleased with the knowledge and skills I have gained during this process, what this team and I were able to accomplish, and my presentation overall.

Acknowledgements 

First and foremost, I would like to thank my capstone advisor, Dr. Vicki Mercer, for her vision and constant guidance. She was always in contact to answer my questions and review my work, no matter what time of day! She was also an instrumental part of us being able to access the resources we had.

Second, I would like to recognize my classmates, Anthony Augliera and Kristin Wright. We all went through this unknown process together and I could not have done it without our teamwork and support for each other!

I would also like to thank my committee members, Gabrielle Scronce and Martha Zimmerman. Both of their insight and being consistent volunteers at CHAMP made them invaluable members to my committee. They both gave extremely helpful feedback to my presentation and evaluation.

Finally,  I want to thank Erica Rothman and her team at Night Light Video for working with all of us to produce these amazing high quality videos that are featured in our presentations. I would also like to thank the volunteers in the videos for their time and kindness throughout filming.

 

Resources

1. The Nation’s Older Population Is Still Growing, Census Bureau Reports. Available at: https://www.census.gov/newsroom/press-releases/2017/cb17-100.html. Accessed April 17, 2018.
2. Make STEADI Part of Your Medical Practice | STEADI – Older Adult Fall Prevention | CDC Injury Center. Available at: https://www.cdc.gov/steadi/index.html. Accessed April 17, 2018.
3. Smith ML, Stevens JA, Ehrenreich H, et al. Healthcare providers’ perceptions and self-reported fall prevention practices: findings from a large new york health system. Front Public Health 2015;3:17. doi:10.3389/fpubh.2015.00017.

 

image source: https://khn.org/topics/aging/