Pulling It All Together: Preventing and Managing …...Pulling It All Together: Preventing and...

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Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging

Making Our Vision A Reality

Pulling It All Together: Preventing and Managing Chronic

Diseases and Reducing Falls Risk

(Bonita) Lynn Beattie, MPT, MHA, PT

April 2015

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Historical Perspective

http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/healthy_aging_aag_508.pdf

AKA



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Discuss how chronic conditions can

increase the risk of falling in older

adults and persons with disabilities

Discuss how fall injuries can

exacerbate or precipitate chronic

conditions

Discuss how you and your organization

can enfold CDSME, fall prevention and

physical activity programs into more

effective healthy aging strategies

Objectives

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Approximately 92% of older adults have at least one chronic disease, and 77%

have at least two. Four chronic diseases—heart disease, cancer, stroke, and

diabetes—cause almost two-thirds of all deaths each year.

According to the Centers for Disease Control and Prevention, chronic diseases—

such as heart disease, stroke, cancer, diabetes, obesity, and arthritis—are among

the most common, costly, and preventable of all health problems.

Select Chronic Conditions

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Falls Affect 1 in 3 Every Year

One out of three older adults (those aged 65 or

older) falls each year1 but less than half talk to

their healthcare providers about it.

Among older adults, falls are the leading cause

of both fatal and nonfatal injuries.

In 2013, 2.5 million nonfatal falls among older

adults were treated in emergency departments

and more than 734,000 of these patients were

hospitalized.

In 2013, the direct medical costs of falls,

adjusted for inflation, were $34 billion. From Alaska Injury Prevention Guide

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Chronic Conditions and Falls

In older adults, predisposing fall risk factors

include:

lower extremity weakness

generalized de-conditioning and poor

endurance, musculoskeletal stiffness and

rigidity

slow reaction time to perturbations in balance,

and slow walking speed

The presence of these risk factors in older adults

with chronic conditions and/or functional

disabilities increases their risk for fall-related

injuries because of their limited reserves and

their fragility (California Blueprint for Falls Prevention,

2003).

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Risk Factor Relative Risk

Muscle weakness 4.9

Balance problems 3.2

Gait problems 3.0

Poor vision 2.8

Limited mobility 2.5

Cognitive impairment 2.4

Functional limitations 2.0

Postural hypotension 1.9

Fa

lls R

isk

Rubenstein, Age & Aging, 2006

Leading Fall Risk Factors

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Research Is Strong

The research is strong that both directly and indirectly most chronic

conditions significantly increase risk of falling.

functional limitations and disabilities

chronic pain

sensory deprivations

vision effects; depression, and

balance and gait disturbances

It is estimated that chronic diseases may account for 30% of falls

through direct effects of the disease and indirect effects, such as

reduced physical activity, muscle weakness, and poor balance. Lawlor, et. al. 2003

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Research Is Strong

Diabetes Number of Medications

Paresthesia

Poor walking performance

Reduced cognitive functioning

de Mettelinge, et. al. 2013

Women with

diabetes

contributor to slower walking

speed, decreased balance,

substandard lower extremity

function

Increased rates of known fall risk

factors

Women With Diabetes: Quality of Health

Care, 2004-2005 U.S. Department of

Health and Human Services, AHRQ

Schwartz, et. al. 2002

Stroke, TBI About one-half of fatal falls

among older adults are due to

TBI.

Stevens JA, 2006

Lower limb

arthritis

Deficits in neuromuscular

systems: muscular strength, knee

proprioception, and standing

balance

Sturnieks, et. al. 2004

Chronic pain Pain contributes to functional

decline and muscle weakness, is

associated with mobility

limitations, interference with daily

activities

Leveille, et. al. 2009

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Fall-related Outcomes

Linked to physical and functional declines,

depression, social isolation, loss of

independence

Exacerbation of chronic pain

Linked to pneumonia, exacerbation of COPD,

Fear: may lead older people to avoid activities

such as walking, shopping, or taking part in

social activities

Falls are the most common cause of traumatic brain injuries (TBI).

The most common are fractures of the spine, hip, forearm, leg, ankle,

pelvis, upper arm, and hand.

NH Task Force on Falls: Each cane represents someone who died from a fall.

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CDSME - Stanford Suite of Programs

Chronic Disease Self-Management - English and

Spanish

Diabetes Self-Management - English and Spanish

Arthritis Self-Management

Chronic Pain Self-Management

Cancer: Thriving and Surviving

Positive Self-Management Program for HIV

A Building Better Caregivers Workshop; Caregivers

Workshop

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How Does CDSME Contribute?

Promotes better self-management of chronic conditions including:

techniques to deal with problems such as frustration, fatigue, pain and

isolation

appropriate exercise for maintaining and improving strength, flexibility,

and endurance

appropriate use of medications

communicating effectively with family, friends, and health

professionals

nutrition, decision making, and

how to evaluate new treatments

Reinforces behavior change strategies

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Healthy Aging and Physical Activity

“Eighty percent of the health

problems once associated with

aging are now thought to be

preventable or postponable if

person keeps fit” Alexander Leaf, MD, Harvard Medical School (1921-2013)

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How Do Physical Activity Programs Contribute?

Helps maintain the ability to live independently and reduces the risk of falling and

fracturing bones.

Reduces the risk of dying from coronary heart disease and of developing high blood

pressure, colon cancer, and diabetes.

Can help reduce blood pressure in some people with hypertension.

Helps people with chronic, disabling conditions improve

their stamina and muscle strength.

Reduces symptoms of anxiety and depression and

fosters improvements in mood and feelings of well-being.

Helps maintain healthy bones, muscles, and joints.

Helps control joint swelling and pain associated with

arthritis.

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Putting the Pieces Together

Among your many challenges, how to integrate the

contributions of many existing programs to affect a community

model of falls prevention. HEALTHY AGING

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To Put a Face on the Numbers…the New 90

2011: the US Census estimated there

were 50 million adults age 65+ in the

population with 1.9 million aged 90+

(nonagenarians).

Continuum of risk

• Multiple chronic conditions

• Medications

• Functional losses

• Attitude/engagement

• Level of cognition

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Program Integration Offers Many Advantages

Recruitment

• At risk participants

• Partners

• Organizations

Referral

Reinforcement of behavior change

Implementation of a more

comprehensive approach

Expanding participation to include

family and caregivers

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Will it Make a Real Difference?

The outcomes:

more effective management of chronic

disease manifestations

promotion of an informed, educated and

supported consumer

could include a reduction in the growing

number of injuries among older adults,

especially falls and falls-related injuries

and deaths in this vulnerable population

Healthy Aging

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Growing Public Health Issue – FPAD 2014

Vermont partners distributed many

products associated with falls

prevention, such as pill boxes and pill

cutters, nightlights, and keychain

flashlights, and educated seniors

about medication management

strategies. Go4Life booklets were also

widely distributed to help seniors make

lifestyle changes. Champlain Valley

Agency on Aging (CVAA) in partnership

with Addison County Home Health and

Porter Hospital shared information on

the Chronic Disease Self-Management

programs available in the community.

http://patienteducation.stanford.edu/programs/cdsmp.html



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Falls Prevention Programs in Seattle-King County

Falls Prevention Programs in Seattle-King County were key to the awareness

activities:

Matter of Balance: Managing Concerns About Falls

Fall Prevention Clinic at Harborview, UW Medicine

HomeStretch

Living Well With Chronic Conditions (Chronic Disease Self-Management Program)

One Step Ahead Fall Prevention Program (King County EMS)

Project Enhance (Enhance Fitness and Enhance Wellness)

In addition, Tai Chi: Moving for Better Balance (now known as Tai Ji Quan: Moving

for Better Balance) and Stay Active and Independent for Life (SAIL) were

promoted.

http://www.seniorservices.org/wellnessphysicalactivities/HealthWellnessPrograms/AMatterofBalance.aspx

http://www.uwmedicine.org/patient-care/our-services/find-a-clinic/pages/clinic.aspx?clinicid=479

http://www.agingkingcounty.org/healthy_aging.htm#homestretch

http://www.agingkingcounty.org/livingwell/default.htm

http://www.kingcounty.gov/healthservices/health/ems/community/falls.aspx

http://www.seniorservices.org/wellnessphysicalactivities/Home.aspx

http://tjqmbb.org/

http://www.doh.wa.gov/Portals/1/Documents/2900/346068-SAILGuide.pdf

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Promote Education and Awareness

8th Annual US Senate Proclamation:

Take a Stand to Prevent Falls

Fall Prevention Awareness Day

September 23, 2015

September is Active Aging Month, Healthy Aging Month,

and Senior Center Month

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Increase Healthy Aging Messaging

Older Americans Month (May)

Healthy Vision Month (May)

Healthy Aging Month (Sept)

Disease awareness months

(arthritis, diabetes, heart, etc.)

Medicare open enrollment

Obesity prevention initiatives

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Pulling It All Together: Preventing and Managing …...Pulling It All Together: Preventing and...

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