Cheyenne McCravey MEd Secondary Falls Prevention Coordinator Adult Falls Prevention Program Epidemiology and Response Division New Mexico Department of Health Disclosure Statement Cheyenne McCravey does not have any relevant financial relationships with any commercial interests that cr ID: 754137
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Slide1
Building the Pathways to Falls Prevention
Cheyenne McCravey, M.Ed.Secondary Falls Prevention CoordinatorAdult Falls Prevention ProgramEpidemiology and Response DivisionNew Mexico Department of HealthSlide2
Disclosure Statement
Cheyenne McCravey does not have any relevant financial relationships with any commercial interests that creates a conflict of interest to affect CME content about products or services. Slide3
WHAT DO THE DATA SHOW?
New Mexico: 8th highest fall-related death rate in the U.S. Death rate for older adults is almost twice the U.S. rate. (WISQARS, 2016)
ibis.health.state.nm.usSlide4
Fall-Related Unintentional Injury Death Rate
Highest RatesDark GreenDark TealTurquoiseLight Green
Khaki Lowest Rates
ibis.health.state.nm.us (2012-2016)
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
in Adults age 65+ Slide5
Diabetes Connection to Falls
Threat of Neuropathy Loss of Sensation Reduced Muscle Tone Impaired Balance
Vision Problems
Damage to the Retina’s Blood Vessels
Cataracts
Glaucoma
Managing Blood Glucose
Drop in Blood Glucose “Feeling Woozy”
High BP Medications Disturb Balance
High BP Medications Weaken Bones
UC Berkeley Health and Wellness Alerts. Why Diabetes Raises Your Risk of Falling_Health After 50. November 3, 2017Slide6
WHAT IS BEING DONE?
1. Evaluate current approach to community fall prevention.
2. Develop strategies for effective change.
3. Mandate reporting of fall-related fracture as a reportable condition.
4. Prepare, report, and present the Task Force findings
back
to the legislature.
In 2014, the legislature passed
a law requiring NMDOH to establish a Statewide Community-Based Adult Falls Risk Awareness and Prevention Program.
(NM Stat 24-1-36)
Older Adult Falls Task ForceSlide7
Falls Program StructureSlide8
Program Reach
Extends over 25 counties210 certified instructors across 21 counties, including 21 tribal communitiesOver 600 older adults have participated in community-based primary preventionOver 960 older adults been seen in secondary prevention
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
LeaSlide9
Certifies community members as Master Trainers, coaches, or instructors in fall reduction practices to reduce fall-related deaths
and injuries.
Improves older adult physical activity, clinical intervention, and home safety modification using five evidence-based interventions.Provides falls prevention strategies to areas with low resources (healthcare facilities, providers, etc.)
Adult Falls Primary PreventionSlide10Slide11
By The Numbers
60 certified Tai Ji Quan instructors100 Matter of Balance Master Trainers and coaches50 instructors trained in Tai Chi for ArthritisOver 240 healthcare providers trained in OTAGOOver 500 individuals trained on the STEADI ToolkitSlide12
Improves quality of care for adults who experience a fracture due to a fall.
Connects hospitals in New Mexico to evidence-based interventions.
Tracks and monitors fracture patients through the hospital’s Fracture Liaison Service.
Adult Falls Secondary PreventionSlide13
Fracture Liaison Service (FLS)
A hospital best-practice prevention model -“The most effective secondary fracture intervention.” ∼30 % reduction in re-fractures at FLS compared to non-FLS hospital *Nakayama, A., Major, G., Holliday, E., Attia, J., & Bogduk, N. (2015). Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate. Osteoporosis International, 27(3), 873-879. doi:10.1007/s00198-015-3443-0A doctor or coordinator to provide: Bone (DXA) Scan and Vitamin D
Personalized treatment plan to prevent future fracturesGerald Champion Regional Medical Center implemented a FLS program in a pilot project with NMDOH
Osteoporosis Medication
Referral to Physical Therapy and Follow-Up CareSlide14
Bone health is not tested
Referred to physical therapy, but no follow-up takes place Health continues to decline Fear of falling increases
The Journey of an Older Adult Fall
Fear of falling
Less physical activity
Increased time indoors
Muscle strength and balance weakens
Vison deteriorates with age
Grace falls while gardening outdoors
Fall-related wrist fracture
Hospital without specialized fall-prevention services
Grace falls, yet again
Grace, age 78, high blood-pressure, reasonably healthy
Third fall leading to a major hip fracture
Doctors state she is too fragile to operate on
Grace spends three weeks in
hospice care before passing at age 82Slide15
The Adult Falls Prevention Program
Evidence-Based Interventions
Community partners trained as certified fall-prevention instructors
Instructors return
to their communities to
lead fall prevention classes
FLS hospital
Providers trained in the STEADI toolkit
Bone health is tested
Osteoporosis medication
An older adult falls
An older adult falls and suffers a hip fracture
Referred to a Physical Therapist trained in Otago
Referral System
Tai Chi for Arthritis
Tai Ji Quan
A Matter of Balance
STEADI Toolkit
OtagoSlide16
Paths To Health NM
Referral Website to Prevention ClassesDiabetes PreventionChronic Disease ManagementFall PreventionFor Public and Provider Use – HIPAA CompliantPathsToHealthNM.netSlide17
Instructors in Rural Communities
There are over 210 instructors specialized in fall prevention across 21 counties.
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
Population Density
Instructor Reach
Program ReachSlide18
Elder Falls in Tribal Communities
A recent survey of New Mexico tribes showed that 32% of American Indians age 65+ had at least one fall in the previous 3 months. (AASTEC TRIBAL BRFSS PROJECT, 2007-2014)
1 in 3 elders fell in the past 90 days
The unintentional death rate from falls is higher among American Indians from the U.S. Southwest than from other regions in the country.
(WISQARS, 2016)Slide19
Instructors in Tribal Communities
Certified instructors in 21 American Indian Tribes, Nations, and Pueblos.
Luna
Hidalgo
Grant
Bernalillo
Rio
Arriba
Cibola
De Baca
Colfax
Curry
Santa
Fe
Guadalupe
Otero
McKinley
Catron
Torrance
Doña Ana
Valencia
Quay
Taos
Eddy
Mora
San Juan
Los
Alamos
Sierra
San
Miguel
Harding
Chaves
Roosevelt
Union
Sandoval
Socorro
Lincoln
Lea
Ute Mountain
Navajo Nation
Zuni Pueblo
Ramah Navajo
Pueblo of Laguna
Tohjiillee
Zia Pueblo
Picuris
Kewa
/ Santo Domingo
Mescalero Apache
Tesuque Pueblo
Nambe Pueblo
Santa Ana Pueblo
Santa Clara Pueblo
San Felipe Pueblo
Jemez Pueblo
Jicarilla Apache
Ohkay
Owingeh
Sandia Pueblo
Taos Pueblo
San Ildefonso PuebloSlide20
Adult Falls Prevention Awareness Day
September 22 New Mexico Adults Falls
Prevention Coalition in Albuquerque, NM“The Champion Way 5K” at Gerald Champion Regional Medical Center in Alamogordo, NMSlide21
Thank you for partnering with us to lower the death rate in older adults due to falls across New Mexico.
Together we serve the people of New Mexico effectively in this joint mission.
Cheyenne McCravey, M.Ed.Secondary Falls Prevention CoordinatorAdult Falls Prevention ProgramEpidemiology and Response DivisionNew Mexico Department of Health
Cheyenne.McCravey@state.nm.us