Stepping On - PowerPoint Presentation

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Stepping On

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Stepping

On:

Building Confidence and ReducingFalls in Older Adults

Your Name and Info Here

The FCNN Stepping On Program is supported, in part, by a Live Well at Home grant from Minnesota Department of Human Services. Slide2

Unintentional Fall Death RatesSlide3

Leading Causes of Death

Source: CDC webinar on STEADI: April, 2013Slide4

Clinical Ramifications of Falls

Clinical Ramifications of Falls1 out of every 4

people, 65 years & over fall each year.

More than 95% of hip fractures are caused by falling, usually by falling sideways.Falls are the most common cause of traumatic brain injuries (TBI).

Every

11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.Source: CDC, STEADI: October, 2016 and NCOA Falls Prevention Facts, 2016Slide5

Ramifications of Falls

Ramifications of FallsAdjusted for inflation, the direct medical costs for fall injuries are

$31 billion annually.

 Hospital costs account for two-thirds of the total.The average hospital cost for a fall injury is over $30,000.The financial toll for older adult falls is expected to increase as the population ages and may reach

$67.7 billion by 2020.

Source: CDC, STEADI: October, 2016 and NCOA Falls Prevention Facts, 2016Slide6

Increase in Falls

Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling. 

Source: CDC webinar on STEADI: Oct, 2016Slide7

Difference between Men and Women

Why the difference between men and women?

Men may have lower nonfatal fall injury rates due to better lower body strength, and women are more

likely to have osteoporosis

Source: CDC webinar on STEADI: April, 2013Slide8

Reasons for Increase in Fall Death Rates

Possible Reasons for Increases in Fall Death Rates:

Aging population

Living with chronic diseases (diabetes, arthritis, CVD)AnticoagulantsSource: CDC webinar on STEADI: April, 2013Slide9

MN Falls Statistics

MN Falls Statistics

In Minnesota, falls are the

leading cause of injury related death and injuries

requiring hospitalization or treatment, with the vast majority of these occurring among older adultsFalls contribute significantly to depression, loss of mobility, and loss of functional independence among older adults

Minnesota has the fifth highest death rate for unintentional falls in the United StatesFactors contributing to falls include decreased lower body strength, balance, and endurance; complications from chronic conditions; use of medications; weakened vision; and unsafe home and community conditionsMinnesota Department of Health, 2012Slide10

Stepping On: A Group-Based Multifactorial Intervention

Developed in Australia by Dr. Lindy Clemson and Megan Swann, Occupational Therapists

Participants were age 70+, fell in last year or had concern about falling, were community-dwelling older adultsThe Program:7 weekly sessions + 1 home visit + 1 booster sessionGoal was to improve self-efficacy, encourage behavioral change, reduce falls

Program was led by an Occupational Therapist

Results showed a 31% reduction in falls; RR = 0.69 (0.5 to 0.96) Clemson, 2004Slide11

Adherence at 14 Months After Completing Stepping On

Program exercises

59%

Home visit recommendations

70%

More program subjects had a vision check up

p=0.002

No change in total medications taken

p=0.55

Program participants were less likely to start taking a new psychotropic drug

p=0.04Slide12

Where it Began:

Wisconsin Experience with Stepping On

2006 - Funding from Wisconsin Partnership Program to Kenosha County Division of Aging Services to disseminate Stepping On in 5 counties

Developed 2-1/2 day training program (now 3 days)Added co-leader based on Chronic Disease Self Management Program, preferably an elderly peer leader who took the class and benefitted from itDid not restrict to leaders with health professional degrees only, i.e. OT, PT, RNSlide13

Results of Stepping On

Dissemination in Wisconsin

Five Years of Data Collection / Research showed:

35% decrease in falls pre-post (using initial, 6 month post and 12 month post surveys)Decrease of 22 Emergency Department visits due to falls (11.7% reduction)

Translated to a savings of $39,468 Slide14

Settings Where Stepping On

is Delivered

Senior center

LibraryHospital and clinicCongregate meal siteSenior apartment complexChurch meeting areaVarious community meeting areas/hallsADRC/aging unitSlide15

Implementation Structure

Train the Trainer Model

Faculty Trainer, Master Trainer = Health professional (OT, PT, RN, MD)

Leaders = any professional working with older adultsPeer Leaders = any older person 60+ who has completed the program, is comfortable sharing in a group setting and who believes that falls are preventable and benefitted from the class.

Faculty

Trainers

Master Trainers

Leaders and Peer LeadersSlide16

Stepping On Participant

The Stepping On Falls Prevention program is ideal for older adults who:

Are at risk of falling for a number of

reasons

Have had a fall in the past year, or have a fear of

fallingWalk independently, may use a cane indoors or out, or a walker for outdoor use onlyAre cognitively intactLive in their own home or other independent living facilityAre able to speak conversational English or the language in which the group is being facilitated.Slide17

What is Stepping On?

Small-group sessions of 2 hours eachBalance and strength exercises each class – based on the Otago exercise program

Discussion sessions with invited experts:

Starting exercise, getting out and about safelyPhysical therapistEnvironmental safetyPolice officer, or community safety expertVision screens, coping with low visionLow vision expertMedication reviewPharmacistSlide18

Stepping On -

Overview of Sessions:

Building trust, risk appraisal, introduce balance and strength exercises

Review exercises, moving about safely

Home hazardsCommunity safety and safe footwear Vision and fallsBone healthMedication managementSleep alternativesMobility mastery experiencesSafe bus and train travelHome visitBooster session Slide19

Stepping On Program

Improving self-efficacy to change behavior by:Telling storiesDiscussion using prevention framework

Doing “homework”

Using multiple modalities to learn (videos, brainstorm, handouts, display table)Personalizing information to accomplish personal goalsSlide20

Balance and Strength Exercises

During the first two sessions, the physical therapist helps participants to learn all exercisesLater sessions do sampling of exercises based on participants input

Homework: balance and strength exercises are practiced at home and recorded. Balance exercises completed daily, strength exercises completed

3x/weekProgress the exercises as able during sessions and at home by increasing repetitions, adding weight, reducing supportIn each session, workshop facilitator leads a discussion on barriers and facilitators to implementing exercises at homeSlide21

ExercisesSlide22

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Modifiable Risk Factors

Modifiable Risk Factors

Intrinsic

Biological

Leg weakness

Mobility problems

problems with balance

Poor vision

Problems with gait

Medical conditions

Intrinsic

Behavioral

Psychoactive meds

4+ meds

Risky behaviors

Inactivity

Change in mental state

Extrinsic

Environmental

Clutter and tripping hazards

No stair railing or grip bars

Poor lighting

Assistive devices

Footwear

The more risk factors, the increased chance for a fall.

Also, the interaction between risk factors can increase falls

.

Judy Stevens, April 2013

Source: CDC webinar on STEADI: April, 2013Slide23

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The Preventive Framework Adapted for Reflecting on Stories About Safety Strategies:

1. Why did this work/not work and what are some other things that could work?

2. Which way works best for you?

3. How can you make this happen?

4. Are there any barriers to making it happen?5. How can you keep this happening?Slide24

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Home Visit and Booster

- Not just a home safety check

- Individual follow-up

- Safety strategies

- Referrals- Review exercises- Remind about Booster Session- Review progress- What are you using-what have you changed- Review and practice exercises- Review Key IssuesSlide25

Findings from Focus Groups

Former participants:

Enjoyed program overall

Felt it was useful for the exercises, information, resourcesLearned from each other and made changes in their behavior and surroundings Former leaders:Enjoyed leading itFelt prior experience in group facilitation was importantRealized that using the “Preventive Framework” to facilitate discussion among participants made the program work and helped participants make changes in their livesSlide26

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Questions?

Thank You!

The FCNN Stepping On Program is supported, in part, by a Live Well at Home grant from Minnesota Department of Human Services.