Fall prevention and resources for seniors In 2008, fall related events comprised 17.4% of EMS responses among persons 65 years and older. Approximately one-third of community-dwelling persons older than 65 years of age fall each year, most commonly in the home setting, with 10 to 15% of these events resulting in serious injury. Half of these serious injuries are fractures. For elderly persons who suffer hip fracture, half require hospital discharge to a nursing home and more than a quarter die in the year following injury. Falls also have more subtle adverse consequences; resulting in self-imposed limitations and a decline of functional ability and quality of life.A recent review of fall prevention interventions recommends that successful fall prevention programs are those that consider health screening of at risk elderly people, followed by interventions which are targeted at both intrinsic and environmental risk factors of individual patients (Gillespie et al. 2000). Stevens and Olson (2000) add that prevention strategies which include a multifaceted approach with both behavioral and environmental components are most necessary. Important elements include education and skill building to increase knowledge about fall risk factors, exercise to improve strength and balance, home modifications to reduce fall hazards and medication assessment to minimize side-effects.
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One Step Ahead Fall Prevention Program
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| Video: The Good News About Fall Prevention from the Seattle Pacific University. |
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Falls are a major cause of injury and result in substantial morbidity and even mortality. Two of the strongest risk factors for falls are older age and prior history of falls. As part of the One Step Ahead Fall Prevention Program, King County EMS in conjunction with local Fire Departments have collaborated to identify and intervene with those at highest risk in the community. The EMS Division screens 9-1-1 calls to identify older adults who have required EMS care for a fall. The majority of the participants come from the Medical Incident Report Forms, however quite a few are also referred by healthcare professionals that have assessed their patients and meet our criteria which include over 65 years old, independent living, at risk for a fall or has fallen in the past 6 months, not in subsidized housing, retirement facilities and nursing homes, no dementia and Alzheimer's, and be ambulatory. This program enables an efficient and directed approach to identify those persons living in the community who are at the highest risk of serious injury due to falls. Once high-risk persons have been identified, they are offered a multi-pronged, no-cost approach to reduce their individual risk and receive follow-up to assure that their fall risks are being addressed. The One Step Ahead Fall Prevention Program has had an increasing role over time. In 2008, the program enrolled 113 persons, nearly double the average number compared to prior years, and the 2009 enrollment is on pace to exceed 2008 participation. The average age of participants is about 80, two-thirds are women, and about half live alone. Participants come from all parts of King County and have a variety of backgrounds based on the profile of past occupations, income, and race. The challenge to successfully prevent the next fall is to identify which specific risk factors each individual may have. For example, a fall may be due to environmental risks such as uneven carpets or a slippery tub, a patient's physical limitations such as poor vision or weak leg strength, or treatments provided to the patient to manage chronic health conditions that cause side effects, such as some therapies for poor sleep or high blood pressure. The most successful fall prevention strategies match the risk profile to specific interventions so that the individual receives a personal program. Therefore, the Falls Prevention Program meets with each participant in their home to identify the exact set of risk factors and design a prevention action plan. The falls prevention specialist evaluates the individual's physical balance and strength, surveys the home for fall hazards, and reviews medical conditions and medications treatments in order to customize the action plan. Our specialist works with the individual to help coordinate fall prevention care. For example, in a third of individuals the specialist arranges for safety equipment to be installed around the home to reduce risk. This equipment includes grab bars for the bathroom, improved lighting, and repositioning or even removal of carpets. Another example is the use of optimal footwear so that individuals wear supportive well-fitting shoes that enhance rather than detract from balance. A final example is letter of communication, sent upon approval of the participant, to their personal physician. The letter explains the Fall Prevention program and details the findings of the evaluation so that the physician may consider if other medical management might also help prevent additional falls. A core component of each specific intervention is providing education to the participant so that the decrease in risk can be sustainable. The Program has been a large success among the participants. There is a very high level of participant satisfaction based on surveys. Moreover, follow-up indicates a relatively low risk of repeat falls when compared to national averages in this high-risk group. Should you know someone who is at high risk for a fall or has fallen, please feel free to call 206-263-8544 for more information on the One Step Ahead Fall Prevention Program.
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