Providers in the Loop: Preventing Falls across the Continuum of Care

By Carlos Muchiutti

Falls are a huge health problem plaguing the senior patient population, and they are often preventable. While falls most often occur at home, providers can help patients while they are still in the hospital take steps to avoid the falls that cause so many readmissions.

Currently, falls are the leading cause of injury and injury-related death among seniors, with a third of American adults age 65 and older suffering at least one fall each year (National Council on Aging, 2014). Unfortunately, the stats don’t stop there; a senior is treated for a fall-related injury every 14 seconds in America’s emergency departments. In 2013 alone, 2.5 million non-fatal falls among older adults were treated in emergency departments, and more than 734,000 of those patients were hospitalized (CDC, 2014b). Due in part to age-related vulnerabilities, including slow healing and preexisting chronic medical conditions, readmission rates are increased by the fact that those who fall are two to three times more likely to fall again (Philips Lifeline, 2012).

Without change, the situation will only get worse. The American population age 65 and older is expected to double by the year 2030, accounting for 19% of the population at that point (Administration on Aging, 2014). With costs associated with fatal and non-fatal injuries from falls now totaling $30 billion annually, the U.S. can expect to see significant fiscal consequences for individuals, their families, providers, insurers, and for the healthcare system overall, unless something is done (CDC, 2014b).

Reinforce Messages across the Health Continuum

During a time of massive reforms and financial pressures on the healthcare system, coordination across care teams is essential for meeting the fiscal and quality goals driven by new regulations. Much of the pressure of reform lands on providers, and seniors represent a huge target population in which improvements with far-reaching effects can be implemented. In addition to ongoing concern for their patients and the desire to improve care quality and population health, it’s in the financial best interest of providers to stay educated and fluent in falls prevention in order to work toward reducing readmissions.

Some core tenets of healthcare reform rely on improving care coordination. Fall prevention measures sometimes require blurring the lines between clinical and practical advice and acting in tandem with other care stakeholders, including patients and their families. Working together, care teams along the health continuum can help seniors safely make the transition from hospital to home, and from injury to health.

Start the Conversation to Stop the Fall Cycle

Clinicians can use discharge conversations to offer information and advice related to fall prevention to all senior patients and their families. While previously these conversations may have been delegated to other professionals and caregivers, such as social workers and home care providers, the reality is that the messages may have more impact when delivered in the hospital environment where there’s a fresh reminder of potential health consequences. In the new, coordinated health continuum, this chain of responsibility needs to be viewed as one in which everyone works together to reinforce messages of overall greater health and wellness.

By kicking off the conversation, clinicians begin a cycle of patient education and engagement that will help seniors stay healthy and out of the hospital. Important factors to address include medical issues, as well as lifestyle factors, which can be just as essential to reducing the risk of falls. By following a checklist, clinicians can ensure a consistent message is delivered, both during care and at discharge.

Address health issues associated with aging. As we age, reaction times decrease, reflexes become slower, balance declines, and sensory and vision problems set in. By being more aware of these deficiencies and how they interact and adjusting behavior to account for them, seniors can reduce the risk of falls associated with the typical signs of aging.

For example, many seniors experience foot problems: as aging feet grow wider, sole padding thins, skin becomes drier, and pain increases (California Podiatric Medical Association, 2013). Many of the necessary steps to better foot health can also help prevent falls. These include continuing to walk regularly, as well as wearing comfortable, well-fitted shoes that have good grip.

Provide recommendations for managing chronic conditions. Certain chronic conditions that are common among older Americans can greatly increase the risk of falls, especially when they require medications that have side effects such as dizziness or drowsiness. These include conditions such as low or high blood pressure, cardiovascular disease, and diabetes, to name a few. By informing seniors of the risks of these conditions and their medications, and how they interact, providers can help seniors prevent disease-related falls. This is especially important when adding new medications to the mix.  

Arthritis is a condition that clinicians should pay attention to when treating their elderly patients, as adults with arthritis are 2.5 times more likely to experience injuries after a fall. Arthritis is the most common disability in the U.S, impacting 52.5 million adults as of 2014 and expected to impact 67 million adults by 2030. It’s important for clinicians to urge their arthritic patients to be active, as research shows that exercise or physical therapy can help to reduce fall risk, but 44 percent of adults with arthritis report no leisure-time physical activity. Furthermore, 47 percent of U.S. adults with arthritis have at least one other disease or condition, increasing the possibility that conditions and their associated medications may interact to increase the risk of falls and other potential hazards (CDC, 2014a).

Assess lifestyle factors such as diet and exercise. By improving diet and exercise routines, seniors can improve their overall health and strength, helping to reduce the risk of falls.
Research shows that, over the age of 50, women should consume 1,800 calories daily, and men 2,200 to 2,400 calories (National Institute on Aging, 2015). However, 15.3 percent of the senior population faces the threat of hunger, and many seniors are malnourished (Gundersen & Ziliak, 2014). This is often due not to a lack of funds, but rather to the inability to access food or maintaining established food habits that do not provide the nutrients necessary to keep seniors healthy as they age. Providers should ask seniors about their diets and recommend solutions such as asking a family member to drive them to the grocery store once a week and helping them develop  a grocery list of nutrient-rich foods. There are also “meals-on-wheels” programs for seniors that ensure access to healthy food on a regular basis.

Exercising can help reduce falls by building muscle strength and increasing endurance, agility, and flexibility. It’s recommended that adults over the age of 65 perform strength-building exercises at least two days a week and get at least 150 minutes of aerobic exercise each week (CDC, 2014c). Depending on the patient’s condition, providers can recommend low-impact exercises such as yoga, swimming, light weight-lifting, and resistance training, many of which can be completed in the home or in the company of a loved one.

Finally, seniors should also be encouraged to think about cognitive or mental fitness. Studies have shown that cognitive exercises help to improve memory and attention (Housen et al., 2009). By participating in cognitive exercises, seniors can reduce confusion and other risk factors for falls.

Encourage seniors and families to assess risk factors in the home. Unsafe home features such as improper lighting, loose rugs, extension cords on the floor, unsteady step stools, and slippery surfaces can cause seniors to fall. By assessing these factors and making necessary changes, such as adding grab rails, seniors can greatly reduce the risk of falls. Many institutions offer checklists that providers can review with seniors and their caregivers as they assess risks in the home.

Providers can also suggest seniors consider changing habits such as getting out of bed too quickly or not sitting down to tie shoes. These adjustments can reduce the risk of hip injuries, which is very important. Falls are the cause of 95 percent of hip fractures, and one in five patients who break a hip die within a year (CDC, 2014b).

Recommend a plan for better medication adherence.  Older adults are twice as likely to come to emergency departments for adverse drug events, accounting for more than 177,000 emergency visits each year. They are also nearly seven times more likely to be hospitalized after an emergency visit (CDC, 2012). Many of these reactions are caused by preventable errors such as missed or doubled doses.

Providers should review medications, especially new medications and their side effects, such as increased risk of falls, at the time of discharge. Rather than simply providing caregivers with a medication management plan, providers can empower seniors to take charge of their own medication adherence using simple methods, such as using pill boxes or notes as reminders, or incorporating medications into a daily routine, such as brushing their teeth.

Share information about advances in technology. While some seniors may be resistant or nervous about the use of technology, many innovations can help them lead easier, happier lives. Providers should make sure seniors are aware of technologies that can help them manage their health and stay safe while living independently.  

In the area of medication adherence, technological advances such as electronic medication dispensers can provide audio reminders to dispense medications at pre-scheduled times. Seniors can also set alarm reminders on their phones and order medications using an online pharmacy to ensure that they never run out.

Another option that can provide peace of mind to both seniors and their families is adopting a medical alert service with automatic fall detection. Today’s seniors want to be active and independent, and a mobile medical alert service provides assurance to both seniors and their caregivers that they have access to 24/7 help on-the-go.

The Internet also provides excellent tools for seniors and caregivers. Loneliness and depression can impact seniors’ overall health, and when immobile due to age or to a falls-related injury, seniors can stay connected to friends and loved ones using social networks and technologies such as Skype and Facebook. Especially in situations involving distance, clinicians should encourage caregivers to use the Internet to stay connected to seniors, helping them stay on top of their health needs, lifting their spirits, and contributing to their overall health and well-being.

While each patient case is different, general education on falls is a necessary step in stopping this preventable issue plaguing the senior patient population. By initiating the conversation at the most acute and emergent moment of a health issue, providers can start the cycle of health and wellness education, ultimately improving patient care and engagement and creating building blocks needed for meeting healthcare reform-driven requirements in the shift toward value-based care.

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Carlos Muchiutti is the senior director for global product management for Philips Home Monitoring. For more than a decade with the Lifeline Medical Alert business, Muchiutti has focused on bringing technology-enabled solutions to seniors and their care providers. Additionally, he has played a lead role in delivering services that allow patients to be monitored remotely (in their homes) while providing clinicians the necessary tools to optimize care models. Muchiutti has more than 20 years of experience in information technology, consulting, and finance. He began his career in California’s Silicon Valley working in various start-ups providing technology solutions to Fortune 500 companies, including Genentech, Charles Schwab, Motorola, and AT&T.

References

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Centers for Disease Control and Prevention (CDC). (2014a). Arthritis: Meeting the challenge of living well. Centers for Disease Control and Prevention, Chronic Disease Prevention and Health Promotion. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/aag/arthritis.htm

Centers for Disease Control and Prevention (CDC). (2014b). Falls among older adults: An overview. Centers for Disease Control and Prevention Injury Center, Home and Recreational Safety. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

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