Around and Around We GoFalls in Elderly

Presented By: Anna Moses - RN,BSN,CCRN,CENEastern Maine Medical Center

Heather HarrimanEastern Maine Medical Center

Angela LufkinGentiva Home Healthcare

Lisa DunningEastern Area Agency on Aging

Around and Around We GoFalls in Elderly

Anna Moses RN,BSN,CCRN,CEN

Trauma Coordinator

Eastern Maine Medical Center

• Falls are a major contributing factor to elderly admissions to hospitals annually– In 2013 201 admissions for falls resulting in

serious/multiple injuries for persons age 65 and older.• this # does not include surface level falls with hip

fracture

Statistics

• 2.5 million non-fatal falls in 2013– Greater than 734,000 of these were admitted

to hospitals• Medical costs in excess of $34 BILLION• 1 in 3 older adults fall each year, with less

than half of these talk about it with their Primary Care Physician

• For many people that fall, even if no serious injury, a fear of falling develops

The Problem

• 2.5 million non-fatal falls in 2013– Greater than 734,000 of these were admitted

to hospitals• Medical costs in excess of $34 BILLION• 1 in 3 older adults fall each year, with less

than half of these talk about it with their Primary Care Physician

• For many people that fall, even if no serious injury, a fear of falling develops

The Problem

• 2.5 million non-fatal falls in 2013– Greater than 734,000 of these were admitted

to hospitals• Medical costs in excess of $34 BILLION• 1 in 3 older adults fall each year, with less

than half of these talk about it with their Primary Care Physician

• For many people that fall, even if no serious injury, a fear of falling develops

The Problem

• 2.5 million non-fatal falls in 2013– Greater than 734,000 of these were admitted

to hospitals• Medical costs in excess of $34 BILLION• 1 in 3 older adults fall each year, with less

than half of these talk about it with PCP• For many people that fall, even if no

serious injury, a fear of falling develops

The Problem

• Education is key• Programs to assist in decreasing the risk

– STEADI Toolkit– Bone Builders– Matter of Balance– Gentiva: Safe Strides

What Do We Do to Stop the Falling?

An Adventure

• 75 yr old Female, fell down cellar stairs at 3am while going to the bathroom.

• Arrives to ER at 6am via EMS, was found by husband at 5am when he awoke.

• Mary is alert, but somewhat confused. Head laceration, c/o pain in R thigh, R chest

Mary

• Mary it is discovered has a mild concussion, 4 fractured ribs on the Right, and a Right Hip Fracture.

• What are the possible contributing factors to Mary’s fall?

• What is the possible follow up/ treatment plan?

Mary

• Over the next few days Mary is recovering after surgery to fix her hip, and aggressive pulmonary toileting for her rib fractures.

• A PT/OT evaluation is ordered to find her baseline for ambulation and self-care

Physical Rehabilitation

Physical Rehabilitation

Heather Harriman PT, MS

Eastern Maine Medical Center

• The next morning Mary is met by Physical Therapy (PT) and Occupational Therapy (OT) who go through a baseline evaluation with her.– From those evaluations it is determined that

Mary would benefit from a brief stay in Rehab and then likely home with further therapy services.

PT/OT Evaluations

Evaluations will look at:

Prior Level of Function

Household Set Up

Bathroom Set Up

Supports in place

Cognition

Vision/Hearing

Acute Evaluations

Also addressed:

Vital signs

ROM

Strength

Self Care

Bed mobility

Transfers

Gait

Post-concussive assessment

Evaluations

Meeting with care management

Review of the medical status

Ensure nursing goals have been met

Different levels of rehab options

Patient input

Liaisons from the accepting facility

Discharge planning

• When Mary gets to Rehab she will undergo another set of evaluations by the therapists at that facility.– included here is a formal walking assessment– strength– bed mobility– balance assessment– estimation of her length of stay

Rehabilitation

Mary will work with PT and OT on a regular basis to progress toward her goals.

The “team” will meet to discuss discharge dates and equipment needs.

They will discuss transition to home and equipment and further therapy needs.

PT will work with Mary using a device on level surfaces, stairs and outside if appropriate. They will work on car transfers.

OT will address bathing/dressing and cooking tasks in the kitchen. They will also follow her cognition to ensure the symptoms of the concussion resolve.

Rehabilitation

• Once Mary meets her therapy goals she will transition to home. – Can this person safely return to home?– Do they need a home health referral for

PT/OT and/or nursing care?– Does a home evaluation need to be

completed?– Does she have the equipment she needs? – Have safety recommendations and

reasonable adaptations been done to the home?

Transition to Home

Home Healthcare after falling

Angela LufkinGentiva Home Health

Home Healthcare after falling

Angela LufkinGentiva Home Health

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REWIND

■ Verification of insurance

Communication with Hospital and patient prior to discharge

■ Disciplines ordered

■ Confirmation of discharge date

■ Location in which services will be provided

■ Visit from the liaison at hospital to confirm hhc ordered

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Opening to Services

■ Review of Hospital orders

■ Next day Start of Care

■ Home Safety Evaluation

■ Medication Reconciliation

■ Development of the plan of care

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Physical Therapy

■ Perform time up and go

Dig deeper to determine strengths and weaknesses

■ Evaluation of transfers and balance

■ Evaluation of strength and flexibility

■ Measure gait speed and observe gait patterns

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Physical Therapy Continued

I. Vestibular

II. Somatosensory

III. Vision

IV. Musculoskeletal

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Occupational Therapy

■ Home modifications

■ ADLs

■ Adaptive Equipment

■ Energy Conservation

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Nursing

■ Pain Management

■ Wound care

■ Disease state training

■ Diet and Hydration

Total Team effort

■ Communication with PCP

■ Communication with each other

■ Communication with family

■ Preparing for discharge from

services

Around and Around we go FallsLisa Dunning, Health Programs Manager

Eastern Area Agency on Aging

Time out!

• What if we had prevented Mary’s fall?• Let’s say Mary shared her concerns about

balance with her healthcare provider.• Her well-informed provider instantly opened

up www.eaaa.org and sent a HIPPA compliant referral to EAAA for a Falls Risk Assessment.

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Click HERE!

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Print any of these for

your consumer to take home.

Once Mary is connected with EAAA, she participates in an in-home Falls Risk Assessment. This includes:• Personal and medical questionnaire,

including fall history• Medication usage• Home environment and safety• 3 physical tests: visual acuity screening,

functional reach, and a 10’ timed up and go

This information is used to generate a Falls Risk Assessment Score Report, which is the beginning of the education process. Mary is empowered to make changes to improve her risk of falling.

Mary reviewed her results and was empowered to make some changes in herself and her home to improve her balance and overall well-being.

EAAA Health

Programs

Falls Risk Assessments

Balancing Act

Matter of Balance

Senior Strength

Walk with Ease ®

Tai Chi

Yoga

Walk Strong

Fitness Fun

Functional Fitness & Wellness

Living Well

Linedancing & more!

• Falls Risk Assessment

• Balancing Act

• Matter of Balance

• Senior Strength

• Finally got her eyeglass prescription updated (because she saved $ on her drugs)

•All prescriptions at one pharmacy•Reduced risk of drug interactions

•Reduced cost by assigning Mary to

the correct formulary

• Bathroom grab bars

• Handrails on interior AND exterior stairways

• Fixed the light switch outside her bedroom

• Tack down her loose carpet

EZ Fix Program

Benefits Checkup

Health Programs

Outside Referrals

There is no wrong door…

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Contact information:

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Anna Moses - RN,BSN,CCRN,CENTrauma CoordinatorEastern Maine Medical Centeramoses@emh.org(207) 973-7920

Angela LufkinMaine Market ManagerGentiva Home HealthcareAngela.Lufkin@gentiva.com(207) 990-9000

Lisa DunningHealth Programs ManagerEastern Area Agency on Agingldunning@eaaa.org(207) 941-2865