Mary Ellen Kullman, Archstone Foundation

1
Fall Prevention Making a Difference Through
Collaboration

• Mary Ellen Kullman, Archstone Foundation
• (Bonita) Lynn Beattie, The National Council on
  the Aging
• Patricia Adkins, Home Safety Council
• Debra Rose, California State University,
  Fullerton
• Don Grantt, Administration on Aging (Respondent)

Health Promotion Institute Best Practices in
Health Promotion 2006
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Evolution of the California Stop Falls Initiative
Mary Ellen Kullman, M.P.H. Vice
President Archstone Foundation kullman_at_archstone.o
rg
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Evolution of the California Stop Falls Initiative

• Isolated Projects Addressing Individual Risk
  Factors
• Convening of a Small Group of Projects
• Rand Meta Analysis Supports Multi-factorial
  Approach
• Recognition that We Can Do Better by Working
  Across Silos and Collaborating

4
Evolution of the California Stop Falls Initiative

• Formation of a Statewide Planning Group
• Linking Partners Across the State and Nationally
• Build the Evidence Base White Paper Development
• Statewide Blueprint Development Process

5
Evolution of the California Stop Falls Initiative

• Participation in National Action Plan and Falls
  Free Coalition
• Formation of the Fall Prevention Center of
  Excellence
• StopFalls California Coalition
• California Fall Prevention Projects RFP
• Model Project Development

6
Progress Through Collaboration
Bonita Lynn Beattie, PT, MPT, MHA Center for
Healthy Aging The National Council on the
Aging bonita.beattie_at_ncoa.org
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What Do We Know Works?

• Multifactorial nature of falls and fall related
  injuries demands a collaborative effort
• Multifactorial intervention strategies, that
  identify and modulate an older adults risk
  factors, are particularly effective in lowering
  fall rates in high risk groups.

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Falls FreeTM National Action Plan

• National Falls Free Summit
• 2 day invitational meeting of 58 national
  organizations, professional associations, and
  federal agencies
• Through consensus process developed and published
  National Action Plan
• 36 strategies and action steps to reduce falls in
  older adults

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Organized Around Risk Factor Management ? for
which there is evidence of effectiveness

• Physical Mobility
• Home Safety
• Medications Management
• Environmental Safety
• and cross-cutting issues

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Falls FreeTM Coalition

• Falls FreeTM Coalition loosely formalized and
  charged with rolling out the National Action Plan
• National organizations, professional
  associations, federal agencies, and state
  coalitions working together to affect meaningful
  change

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Falls FreeTM Coalition Initiatives

• Presentations, media messages, journal articles,
  interviews, and NPR pieces
• Falls FreeTM bimonthly Electronic-news
• Advocacy Workgroup, Legislative Update S. 1531
  Keeping Seniors Safe from Falls Act of 2005
  http//www.healthyagingprograms.com/resources/S20
  153120fact20sheet.doc
• State Coalitions forming to address fall
  prevention
• Community collaborative projects forming to
  address local needs

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Other Coalition Initiatives

• Center of Excellence for Fall Prevention
  initiative to enhance programs and build
  community coalitions
• Professional associations developing
  collaboratively developing tools and resources
• American Geriatrics Society revision of clinical
  guidelines
• CMS Clarifying Code  V15.88 History of Fall

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Still More Initiatives

• Research
• ASPE LTC study on home modifications
• NCIPC funded dissemination study, UNC a state
  program in Minnesota U of Wisconsin study of a
  comprehensive program with individual assessments
• AoA funded projects Matter of Balance,
  Medication Management Model, Evidence-Based Fall
  Prevention Program in Senior Centers
• Inclusion of fall prevention indicators in the
  CDC 2006 State of Aging and Health Report

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Vision for Collaborative Action

• Building community capacity and infrastructure
  through collaboration. Researchers, planners,
  health care, public health, and aging all working
  together to
• Spread the message that falling is not inevitable
  and there are proven interventions
• Provide integrated programs and services that
  address the fall risks in homes communities

Multifactorial nature of falls demands a
collaborative effort
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Resources on the CD ROM

• Archstone Foundation
• Pre-conference White Papers
• California State Conference Proceedings
• Archstone Foundation/Center of Excellence RFP
• Falls Free
• National Action Plan
• Research Review Papers
• Issues of E-Newsletters
• Home Safety Council
• State of Home Safety

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Resources

• Center for Healthy Aging www.healthyagingprograms.
  org
• Falls Free Electronic News
• Center of Excellence for Fall Prevention
  www.stopfalls.org
• National Resource Center on Supportive Housing
  and Home Modification
  www.homemods.org

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Resources

• National Center for Patient Safety Falls Toolkit
  www.patientsafety.gov/SafetyTopics/fallstoolkit/i
  ndex.html
• Home Safety Council State of Home Safety
  Facts about safety in the home http//homesafetyco
  uncil.org/state_of_home_safety/sohs_2004_p017.pdf
• National Institute on Aging, AgePage Preventing
  Falls and Fractures http//www.niapublications.org
  /agepages/PDFs/Preventing_Falls_and_Fractures.pdf

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Program Tools

• National Center on Injury Prevention and
• Control A Tool Kit To Prevent Senior Falls
  www.cdc.gov/ncipc/pub-res/toolkit/toolkit.htm
• American Geriatrics Society Falls in Older
• Adults Management in Primary Practice
  www.americangeriatrics.org/education/falls.shtml

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Programs

• A Matter of Balance
• Partnership for Healthy Aging www.aoa.gov/prof/ev
  idence/SMaine.pdf
• Safe Steps Program
• Home Safety Council www.homesafetycouncil.org/ex
  pert_network/en_safesteps_w001.aspx
• Remembering When A Fire and Fall Prevention
  Program for Older Adults from the National Fire
  Protection Association http//www.nfpa.org/index.a
  sp

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Programs

• HEROES Program, Temple University
  www.temple.edu/older_adult
• FallPROOF! A Comprehensive Balance and Mobility
  Training Program www.exrx.net/Store/HK/Fallproof.h
  tml
• National Center for Safe Aging www.safeaging.org/m
  odel/default.asp

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Falls FreeTM Coalition Public Policy Workgroup
and Federal Legislation
Patricia H. Adkins, MBA Chief Operating
Officer Home Safety Council patricia.adkins_at_homes
afetycouncil.org
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Successful Collaborations at the Federal Level

• Clear, Common Goals
• Leadership
• Resources
• Communication
• Unified Message
• Success?!?

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Falls Free National Action Plan Clear, Common
Goals

• Strategy 5
• Develop a public policy agenda to promote falls
  prevention at the national, state, and local
  levels
• Action Step 6
• Create model legislation for use by states and
  local communities

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Falls Free Public Policy Workgroup Leadership

• The Public Policy Workgroup was formed from the
  Falls Free Coalition membership
• Who
• The National Council on the Aging
• Home Safety Council
• National Safety Council

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Falls Free Public Policy Workgroup Resources

• Staff
• Expertise
• Experience
• Networks

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Falls Free Public Policy Workgroup Communication

• Decision making
• Working behind the scenes
• Room for flexibility
• Staying in touch

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Falls Free Public Policy WorkgroupUnified
Message Unified Group

• Unified Message
• 60-Second Speech
• One-Page Fact Sheet
• Supporting Data
• Joint Letters
• Unified Group
• Organizations Membership
• State Coalitions

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Falls Free Public Policy Workgroup Success ?!?

• Celebrate the victories!
• (big and small)

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Federal Legislation

• U.S. Senate
• S. 1531 Keeping Seniors Safe from Falls Act of
  2005
• Introduced July 28, 2005
• Introduced by Sen. Michael Enzi (R-WY) and Sen.
  Barbara
• Mikulski (D-MD), plus five additional Senate
  cosponsors
• Authorizes 72 million for FY06-09

• U.S. House of Representatives
• Legislation will be introduced by Rep. Frank
  Pallone
• (D-NJ) and Rep. Ralph Hall (R-TX)
• House legislation incorporates elements from the
  
• National Action Plan
• House bill authorizes 105 million for FY06-09

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Federal Legislation
History of the fall prevention legislation

• The Elder Fall Prevention Act was first
  introduced in
• the House of Representatives during the 107th
  Congress
• by Rep. Frank Pallone (D-NJ)
• A Senate companion bill was not introduced
• The bill died in committee
• The Elder Fall Prevention Act was introduced in
  the Senate during the 108th Congress by Sen.
  Michael Enzi (R-WY) and Sen. Barbara Mikulski
  (D-MD)
• A House companion bill was not introduced
• The bill died in committee

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Federal Legislation
Current status of the fall prevention legislation

• During the 109th Congress, Sen. Enzi and
  Mikulski
• re-introduced the legislation with a new
  title, The
• Keeping Seniors Safe from Falls Act of 2005
• The legislation authorized funding for fall
• prevention initiatives
• A House companion bill is close to introduction
  with
• specific language taken directly from the
  National
• Action Plan

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Falls Free Making a Difference Through
Collaboration

• Increased knowledge and expertise
• Increased resources
• Strength in numbers and the ability to leverage
  support
• Credibility and visibility
• Activity on multiple fronts increases the
  potential
• for success

33
Falls Free
Library of Congress (resource for tracking
legislation) http//thomas.loc.gov
Home Safety Council www.homesafetycouncil.org
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Translating Research into Practice The
California Adventure!

• Debra J. Rose, PhD
• Co-Director
• Center for Successful Aging
• California State University, Fullerton
• and
• Fall Prevention Center of Excellence
• University of Southern California

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Defining a Best Practice

• A technique or methodology that, through
  experience and research, has proven to reliably
  lead to a desired outcome.

36
Fall Prevention Strategies

• Fall Risk Assessments and Medication Management
• Physical Activity that specifically targets
  strength, balance, and endurance
• Environmental modifications in home and community

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Fall Risk Assessments

• Shown to lower fall risk by 18 and mean number
  of falls by 43
• Includes
• Balance and gait testing
• Neurological function
• Medication review
• Fall Circumstances
• Individualized fall risk reduction plan with
  follow-up

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Medication Management

• Reviewing and modifying medications can reduce
  fall rates
• Reducing number and type
• effective
• Benzodiazepines
• Antidepressants
• Sedatives/hypnotics

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Medication Management

• Gradual withdrawal of psychoactive drugs
  particularly effective BUT long-term compliance
  is a problem.
• Successful programs will need a strong counseling
  component to improve compliance.
• Most effective when part of an interdisciplinary
  and multi-component approach.
• Medication use perhaps the most preventable or
  reversible risk factor associated with falls.

40
Physical Activity

• Stand-alone physical activity interventions that
  target fall-related risk factors, lower fall risk
  by 12 and number of falls by 192
• Different types found to be effective Tai Chi,
  balance and gait training, resistance training
• Different settings studied Home, community.
• Different levels of risk studied
• Different approaches used - Group versus
  individually tailored home exercise programs

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Physical Activity Programs

• Successful programs
• Target balance, gait, and strength
• Are moderate in intensity or progress from
  low-to-moderate intensity
• Are implemented by well-trained instructors with
  knowledge of common age-associated performance
  limitations
• Are acceptable and of sufficient frequency and
  duration based on level of fall risk
• Foster self-regulatory skills, self-monitoring of
  progress and self-reinforcement.

42
Environmental Modification

• No evidence that it is effective as a stand-alone
  intervention
• Most effective when assessments done by an OT and
  when focused on high risk groups.
• Included as a component of successful
  multi-component interventions conducted with
  recurrent fallers.

43
Home Modification Strategies

• Includes
• Removing hazards
• Adding special features or assistive devices
• Moving furniture
• Changing where activities occur
• Renovating or changing structure of home

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Environmental Modifications

• Successful programs
• Include financial or manual assistance
• Hire trained health care professionals (OTs) to
  perform initial assessments
• Target older adults who are ready for change
  (e.g., recent fall, increased understanding of
  risk)
• Are combined with education and counseling about
  how to decrease risk

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FPCE Mission.

• Establish fall prevention as a key public health
  priority in California
• Create effective and sustainable fall prevention
  programs
• Create systems for fall prevention

www.stopfalls.org
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There is NO One-Size-Fits-All Fall Prevention
Program
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Model Projects

• To be designed, implemented, and evaluated by
  FPCE in
• Senior centers, retirement communities, and/or
  Adult Day Care and Health Care settings
• Across different levels of fall risk
• Program Expansion Grants
• Expand on one or more existing components
• Reviewed by FPCE and Archstone Foundation Staff
• Technical assistance, grant monitoring, and
  external review of funded proposals by FPCE
• Funding period is 18 months

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Purpose of Model Projects

• Study how best to combine the three core
  components of fall prevention
• In different real-world environments
• Via different service providers
• Across different levels of fall risk

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Desired Outcomes?

• Process
• Better understanding of barriers to
  implementation and sustainability
• Problem-solving strategies used to overcome
  barriers
• Internal mechanisms used to link components
• Recommendations for program modifications from
  providers and recipients of services based on
  respective experiences

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Desired Outcomes?

• Product
• Efficacy of program components in lowering fall
  risk, improving overall physical and
  psychological fxn, behavior change.
• Effective and User-Friendly Evaluation packages.

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Desired Outcomes?

• Product
• Training and Program Implementation Manuals and
  related resources
• Replicable Best Practice Fall Prevention
  Programs

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Current Progress?

• Finalizing funding recommendations for program
  expansion and coalition-building grants (4-8 in
  each category)
• Selecting model project sites
• Pilot project at single site
• Randomized clinical controlled trials at multiple
  sites
• Finalizing assessment tools (processes
  and product) to be used to evaluate
  program efficacy

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Thank You!
www.stopfalls.org