Fall Prevention in Canada: Epidemiological and Program Update

Fall Prevention in Canada:
Epidemiological and Program
Update
Vicky Scott, PhD, RN
Senior Advisor, Fall & Injury
Prevention, BCIRPU and MHLS;
Director, Centre of Excellence on
Mobility, Fall Prevention & Injury in
Aging (CEMFIA)

Acknowledgements
Ministry of Healthy Living and
Sport
• Matt Herman
• Alison Sum
• Lori Wagar
CEMFIA
• Karim Kahn
• Heather McKay
• Steve Robinovitch
• Maureen Ashe
• Fabio Feldman
BCIRPU
• Ian Pike
• Sarah Elliott
• Hansdeep Bawa
• Fahra Rajabali
• Dorry Smith
BC Fall & Injury Prevention
Coalition: professional
organizations, policy, research and
practice, including RHA leads:
• Merry-Jo Levers
• Tom McLeod
• Kelly Wilson
• Cheryl Leia/Tanya Dunn
• Fabio Feldman
CFPEC
• Anne Higginson
• Ginette Assline
• Julian Young
• Provincial/Territorial Leads
• CFPC Participants
Funders
• MHLS; PHAC; CIHR; MSHRF;
RHAs; U.S. CDC; etc.
2

Public Health Approach to Fall Prevention
Approach
Public Health Approach
Program
Planning
Steps
Defining the
Problem
Identifying
Risk Factors
Examining
Best Practices
Implementing
the Program
Evaluating
the Program
Population
Acute/Rehab
LTC
Residential
Community
(services)
Community
(no services)
Strategies
& Actions
Data
Sources
Assessment
Tools
Evidence/
Guidelines
Knowledge
to Action
Evaluation
Tools
Social &
Policy
Context
Older Persons, Families, Care Providers, Policy Makers of Procedures,
Accreditation Standards and Legislation
3

DEFINING THE PROBLEM
4

Canadian Fall Facts
• Account for 8.5% of all
hospitalizations for seniors
• Account for 85% of all
injury related
hospitalizations for seniors
• 53,545 hospitalizations
each year
• $2 billion annually or
almost $500 per senior per
year (SMARTRISK, 2009)
5

Hip Fracture Hospitalizations, 65+,
2008/09
• 95% of hip fractures
r/t a fall
• Hip fractures
account for 38% fallrelated
hospitalizations
• Hip fracture rates
lowest in the
Territories; highest in
NL
11

Length of Stay: Falls vs Other
• Acute days: 70%
longer for fallrelated
injuries vs
all other
• ALC days:
average of 6.5
days for falls vs 2
days for all other
12

Data Issues
•Lack of reporting by settings, regions
and provinces
•Under reporting of falls and fall
injuries
•Inconsistency in analysis, e.g., CIHI
data:
– Separation-based analysis VERSUS
– Episode-based analysis
13

Sources of Data

Definition of a Fall
•Unintentionally coming to rest on the
ground or other lower level with or
without an injury

RISK ASSESSMENT
16

American/British Geriatric Society
Guidelines, 2009
17

ABGS Risk Factors
• History of falls
• Medications
• Gait, balance and mobility
• Visual acuity
• Other neurological impairments
• Muscle strength
• Heart rate and rhythm
• Postural hypotension
• Feet and footwear
• Environmental hazards
18

Risk Assessment Tool Selection
•Valid and reliable:
– strong predictive validity among the population
of interest
– Consistent findings across repeated prospective
tests
•Appropriate for setting
– Affordable and easy to use
– Includes clear instructions; training
requirements; equipment needs; recommended
‘cut
cut-off
off’ scores

EXAMINING BEST PRACTICES
20

Major Fall Prevention Studies
Topic
Mobility, balance, musculoskeletal
Risk factors for injurious falls
Effectiveness/cost effectiveness
Hip protector compliance
Fall prevention in LTC
Neurocognitive impairments
Fallers in ED
Clinical/economic factors
Exercise
Institution/Location
Sunnybrook ON; U. Quebec;
McMasters; UBC; U. Manitoba
VCH Research Institute, BC
VCH Research Institute, BC; FHA,
BC
FHA, BC
Simon Fraser U., BC
VCH Research Institute, BC
UBC
VCH Research Institute, BC
UBC
21

BEEEACH Prevention Model
Education
Equipment
Health
Management
Behaviour
Change
Environment
Clothing and
Footwear
Activity

IMPLEMENTING THE PROGRAM
23

Collaboration
• Canadian Fall Prevention Education Collaborative
• Centre of Excellence on Mobility, Fall Prevention &
Injury in Aging (CEMFIA)
• BCIRPU and other Injury Prevention Centres
• International Collaboration:
– U.S. CDC
– California FP Centre of Excellence
– U.S. Falls Free Coalition
– Falls and Balance Research Group, NSW
– ProFANE
– World Health Organization
24

Program Examples
•Canadian Falls Prevention Curriculum
•Finding Balance Alberta
•Nova Scotia FP Network
•Fall Prevention Mobile Clinics
•Strategies and Actions for
Independent Living: FP in Home Care
•Promoting Active Living: FP in Assisted
Living
26

PAL Guidelines
• Collaboratively
developed and tested
for validity and
feasibility
• Disseminated to each
ALR in BC
Copies available at:
www.qpbooks.ca or call 1
800 663-6105
6105

EVALUATING THE PROGRAM
28

PHAC FP Inventories
•2000: 58 programs
•2003: 123 programs
•2005: 195 programs
•2010: 232 and counting
29

Canadian Accreditation Standards
On June 25, 2008, Accreditation Canada implemented the Required
Organizational Practice under Patient Safety Area #6, to reduce the risk
of injuries resulting from client falls, through the following:
• Implement and evaluate a fall prevention strategy
to minimize the impact of client falls.
• Tests for compliance
– The team has implemented a fall prevention strategy.
– The strategy identifies the population(s) at risk for falls.
– The strategy addresses the specific needs of the
populations at risk for falls.
– The team evaluates the fall prevention strategy on an
ongoing basis to identify trends, causes and degree of
injury.
– The team uses the evaluation information to make
improvements to its fall prevention strategy.
30

Baseline – Can We Do Better?
Fall-related hospitalizations for seniors:
•808,671 acute bed days each year
•327,424 ALC bed days, including 219,374
days waiting to get into residential care
•fill the equivalent of 15 two hundred bed
hospitals each year
•one senior hospitalized every 10
minutes
31

Thank you!
And remember…
Falls can be
prevented.
Except falling in love.