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Falls Prevention Planning in Champlain: Article 7

CME Certified Fall Prevention module

In a cross Canada review, there were few certified Fall Prevention programs targeted towards Primary Care physicians and their healthcare professional teams. Dr. Frank Molnar, Geriatrician, and his team have changed that! The Champlain Fall Prevention Steering Committee, Dr. Molnar and the Regional Geriatric Program of Eastern Ontario have worked together to deliver an interactive Fall Prevention module which utilizes the Champlain Fall Prevention tools. This online group learning program meets the certification criteria of the College of Family Physicians of Canada and has been certified by the University of Ottawa’s Office of Continuing Professional Development for up to 2 MainPro+ credits.

The sequential modules focus on education, client self-screening using the Staying Independent Checklist, and delivery of the appropriate and evidence-based follow up assessment and diagnosis to determine the root cause of the fall. Selecting the right intervention and referral is also covered in the module.

A complement to this CME program includes access for non-registered health care workers to an online PSW Fall Prevention module. It can be useful for volunteers, receptionists and other non-registered team members as it provides information to enable them to act as a coach and guide for their older clients and to understand the importance of self-screening and the use of the Staying Independent  Checklist as part of the Champlain Fall Prevention Algorithm.

These two modules are components of the Fall Prevention education framework to reinforce the delivery of the best practices in Fall Prevention across the continuum. Work is now being undertaken to provide other registered healthcare professionals with similar support,

All of these resources and the link to sign up for the CME module can be found through the www.stopfalls.ca website

Falls Prevention Planning in Champlain: Article 6 – Exercise Class Navigation Flow Chart: Evaluation

 

As described in our last article physical activity plays a very important role in Fall Prevention but it has often been complicated in the past, for seniors to find the class with the right fit for them to enable them to continue to participate. The purpose of developing the exercise class navigation tool was to make it easier for seniors to access LHIN funded exercise classes across the region. The Champlainhealthline.ca link  “Exercise Classes for Seniors” shows the “Which Exercise Class is Best for Me” flowchart and a list of the available classes in the senior’s locality.

The chart was launched nine months ago for Fall prevention month in November 2016 and the time has come to ask users what they think of it, and to understand whether it has achieved its purpose and what improvements can be made.

To do this a questionnaire has been developed and will be visible when seniors, family members, and caregivers as well as referrers use the Champlain Healthline at  www.champlainhealthline.ca

We would like to ask you as referrers and health care providers to give us your feedback as well as encouraging your patients and clients to complete the very short survey which can also be found here.

Thank you for your time and your help in making sure that the navigation chart is relevant and useful for seniors and their care providers alike.

Falls Risk Screening Research Project

Falls are a leading cause of injury among seniors. 20-30% of seniors (age 65+) experience one or more falls each year and 85% of seniors’ injury-related hospitalizations are due to falls.

The Champlain LHIN IMPACTT Centre is conducting a research project supported with Ontario Centres of Excellence funding from the MOHLTC Ontario Chief Innovation Strategist.

This project will ddetermine the value of a falls prediction model that leverages a new technology; QTUGTM and uses trained technicians (non-professionals such as personal support workers) to engage seniors that are normally not being actively screened for falls, and to identify those at higher risk of falling prior to their first fall.

If a senior has been identified with a moderate to very high falls risk, we are suggesting they take the handout materials and speak with their physician or other healthcare professionals to better understand what may be contributing to their risk of falls and what they can do to help prevent falls.

 What is QTUGTM?

The “Timed Up and Go” or TUG test is one tool that health professionals use during a falls assessment.  It consists of the person getting up from a chair walking 3 meters, turning around, walking back the 3 meters and sitting down while the professional monitors the time it takes, the gait, steadiness, etc.

The QTUGTM uses sensors worn on the shins (over clothing) and a hand-held tablet to track the person during the TUG test.  With proven qualitative input, analytical data and algorithms it produces a Falls Risk Score.

First, the person is asked a few questions about age, weight, height, recent falls, any problems with mobility, medications, blood pressure, dizziness and/or vision. The sensors and tablet then measure the time taken to stand, average stride time, average stride velocity, step time variability, time taken to turn, number of steps in turn and time to complete the test. The sensor information combined with the short falls questionnaire determines your risk of falling.

For more information contact the IMPACTT Centre.

Email: Judy Marshall-Brunke 

Tel: 613-745-8124, ext. 5879 | Toll Free: 1.800-538-0520

Falls Prevention Planning in Champlain: Article 5

Exercise Class Navigation Flow Chartexercise-class-in-action-1

Encouraging seniors to exercise and to be physically active is an important part of a fall prevention strategy. Exercise programs that promote balance training combined with strength and flexibility have been shown to be effective in significantly reducing falls and the injuries resulting from a fall.  LHIN funded exercise and Fall Prevention programs are available across the Champlain region, and different levels of programs for people of different abilities are provided.  However, determining which class is the right one is key to ensuring that participants gain maximum benefit from the class. Choosing the wrong level of class can be a lost opportunity to promote increased activity.

To simplify the choices and decisions for older adults, their families and health care providers, the Navigation Working Group of Champlain Fall Prevention Steering Committee has developed a flow chart. Each region has its own flow chart with local class details and contact information, but the descriptions for each level have been standardized across Champlain with consistent wording for each level of class.

 

Ottawa
Eastern Counties (Prescott Russell and Stormont, Dundas and Glengarry)
Renfrew County

List of locations (Renfrew County and District)

On the reverse of the chart is the Staying Independent Checklist and seniors are urged to complete this fall-risk screening tool, although it is not a determinant of exercise and activity levels. This screen is a key first step in the Champlain Fall Prevention Algorithm of Detection, Diagnosis and Intervention.  Primary care providers should encourage their older patients to complete the Staying Independent Checklist annually and to bring issues and concerns to the primary care team.

The exercise class flow chart will be launched in November 2016 (Fall Prevention month) and will be distributed to public health units, community support services, primary care providers and other agencies, to encourage seniors to choose an active lifestyle. The flow charts can be found on the www.stopfalls.ca website under the community resources tab, and also on the Champlainhealthline website , under the Exercise Classes for Seniors button, “Which Exercise Class for me?”

For more information contact:

Christine Bidmead 

Project Manager

Champlain Falls Prevention Strategy

Regional Geriatric Program of Eastern Ontario

email: cbidmead@toh.ca

Cell Phone 519 639 3000

Does balance training work?

two older women exercisingYes, according to this article which describes the effectiveness of a 2 year balance training program to prevent fall induced injuries in women at risk for falls.

This is one of the first randomized control trials to show a decrease in injuries from falls with an intensive exercise program. The participants also had a better perception of their overall physical health than the control group.

Exercise and Falls Prevention in Champlain

Fortunately there are exercise and fall prevention programs available in our region. For Ottawa residents, take a look at the Better Strength, Better Balance program with sessions starting in September.

Information on other exercise and falls prevention classes in the region is available on Champlainhealthline.ca.

Finally, your patients may be interested in these fun falls prevention videos from Ottawa Public Health.

Supporting Regional Excellence in Falls Prevention: A Progress Update

In this third article focusing on the Champlain Falls Prevention Strategy, we look at the six foundational pillars of the strategy and what progress was made towards advancing each one in 2014-2015.

The Champlain Regional Falls Prevention Strategy was planned with a system change approach in mind. Composed of six foundational pillars, the strategy was developed by a Steering committee made up of members from across health care sectors. During the 2014-2015 fiscal year work was undertaken to advance each pillar, with support to ensure that the plans were linked together strategically.

Pillar 1 – Public awareness and engagement

Increase awareness of the risk factors associated with falls and promote preventive measures to reduce the number and impact of falls on seniors in Champlain.

2014-15 progress:

Public health units in the region have adopted the use of the Staying Independent Checklist as a self-screening tool for older adults in the community. This is being aligned with the Champlain Falls Prevention algorithm. Working in conjunction with the Champlain LHIN, the units are implementing a communications plan from February to June 2015. Primary Care physicians received communications in the initial stages that included the Staying Independent Checklist and the Champlain Falls Prevention algorithm.

Pillar 2 – Detection, diagnosis and intervention

Ensure that robust, reliable tools and leading practices are used for the detection and diagnosis of falls- related conditions and risk factors. Ensure comprehensive identification of seniors across the aging continuum and tailored interventions that respond to the psychosocial, cognitive, environmental and behavioural needs of the patient.

2014-15 progress:

The Champlain Falls Prevention algorithm and Staying Independent Checklist were refined based on feedback received from December 2013 to March 2014. These tools are now available in French and English on the RGPEO and Champlain Healthline websites, and on the stopfalls.ca and arretonsleschutes.ca domains. They are now ready for use in the following nine community and primary care sites with education support for community teams provided by Public Health.

Over the past six months the following sites have received training and have begun using the tools in their health care practice settings.

  • Barry’s Bay Home Support services
  • Seven retirement homes in Ottawa, Renfrew and Eastern Counties
  • Primary Care Outreach teams at Seaway Valley CHC and Pinecrest Queensway CHC
  • Geriatric Assessment Clinic in Primary Care
  • EMS services in Eastern Counties
  • Renfrew County GEM Program

The Practice Solutions group has also completed work to integrate the Falls Prevention algorithm into the Electronic Medical Record.

Pillar 3 – Provider Best Practice

Ensure seniors receive coordinated care, based on evidence and leading practices around falls prevention and injury reduction.

2014-15 progress:

A Falls Prevention module for training Personal Support Workers (PSW) has been developed for use by Public Health Units. The module was used during the training of PSWs in the community and Retirement Homes in January and early February 2015. It may require further refinement based on feedback from these sessions. Public Health will be driving this initiative.

Registered health care professionals will receive education on the Checklist and algorithm as usage rolls out across the region.  An accredited online education module is in the early stages of development in conjunction with the University of Ottawa. This module will initially focus on the needs of physicians but will be developed with other health professionals in mind for the future.

Pillar 4 – Performance monitoring and evaluation

Support a Champlain fall prevention structure to implement, monitor and sustain quality practices and services across all sectors.

2014-15 progress and outcome:

A Logic Model for the Champlain Falls Prevention strategy has been developed with specific outcome measures to inform future directions for the Steering Committee. This tool supports the LHIN Scorecard targets for reducing Emergency Department visits and hospitalizations for falls-related conditions in seniors over 65 years old and for residents of Long-Term Care. A local marker to understand admissions to hospital for seniors with hip fracture will be included in the data to be collected.

Pillar 5 – System integration and navigation

Provide better system integration across sectors that deliver detection, diagnosis, interventions and supports related to falls prevention for seniors in Champlain. Coordinate care related to falls prevention that will simplify and allow better navigation of patients throughout the system.

2014-15 progress and outcome:

System navigation is a very complex and critical factor in ensuring that seniors access the programs and services that will best meet their needs. For the Falls Prevention Strategy, the Committee agreed to focus on the ability to navigate into and between the various exercise classes that are funded through the Champlain LHIN / MOHLTC and design a navigation process to facilitate access.

Pillar 6 – Advocacy

Ensure a voice at the patient, family, community and system level that will address systemic issues related to falls prevention.

2014-15 progress and outcome:

The issues and challenges related to falls and falls prevention that have been identified by the Committee were shared with the Champlain LHIN Board and Medical Officers of Health from the Public Health Units. In addition, presentations on falls prevention and the work of the Committee have been made to various other groups.

Article written by: Christine Bidmead (cbidmead@toh.on.ca), Project Manager, Champlain Falls Prevention Strategy

Why It Is Important to Have a Falls Prevention Plan in Champlain

Falls have a significant impact on individuals, families, society, and health care systems. Find out about what’s being done provincially and locally to prevent falls among the older adult population.

Falls facts

  • 1 in 3 seniors fall every year
    • Half of seniors who fall do so repeatedly
    • 1 in 4 falls result in injuries including sprains, fractures, and death
  • Falls are the leading contributor to overall injury costs in Canada and account for $6.2 billion or 31 per cent of total costs of all injuries (Smartrisk, 2009)
  • Falls cause more than 90 per cent of all hip fractures in the elderly and 20 per cent of seniors who suffer a hip fracture die within a year
  • A single hip fracture adds between $24,600 to $28,000 in direct health costs to the system. Almost half of people who sustain a hip fracture never recover fully
  • The mean length of stay for a falls-related injury is approximately 15 days (Scott, Wagar & Elliott, 2010)
  • In the Champlain region this is can be translated as:
    • 2,765 admissions of seniors from Emergency Department for falls in 2013
    • The equivalent of 41,475 bed days at a cost of $17.2 million
    • Average length of stay for a falls-related admission = 15 days
    • Cost per bed / day = $415 (50th percentile)
  • Falls are directly accountable for 40 per cent of all elderly admissions to nursing homes or long-term care facilities

What is being done to prevent falls?

Provincially

Many jurisdictions internationally have developed approaches to reduce the number of falls and research tells us that a reduction of between 6% and 33% of fall-related injuries can be achieved through coordinated, community-wide, multi-strategy fall prevention initiatives (McClure et al., 2005).

In Ontario a task force was convened and developed the Provincial Integrated Falls Prevention Framework and Tool kit which was introduced in 2011.

Locally

In 2012 the Champlain LHIN began to invest in the development of a regional Falls Prevention Strategy. This initiative is a partnership between the LHIN, the region’s four Public Health Units, the Regional Geriatric Program of Eastern Ontario (RGPEO), and primary and community health care providers. Primary Care and Public Health leaders co-chair the Champlain Falls Prevention Steering Committee, which draws membership from across all health care sectors.

The objective of the strategy is: To effectively reduce falls and the impact of falls on Champlain older adults through a coordinated, evidence-informed approach to falls prevention that builds on community-wide, inter-sectoral collaboration.

The feedback from an early 2013 survey of primary and community care providers made it clear that a standardized approach was wanted and required to support teams in these sectors to provide screening, assessment, and intervention in order to prevent falls in their senior populations. Coordination, use of standardized tools and communication, and access to up-to-date resources that are relevant and useful were all issues that were raised in the survey.

Next month’s article: Responding to the issues: What have we done so far?

Article written by: Jane Adams (janadams@toh.on.ca) and Christine Bidmead (cbidmead@toh.on.ca), Project Managers, Champlain Falls Prevention Strategy