The Regina QuAppelle Health Regions - Research _amp; Performance

							Shelly McEwen1, Erica Carleton2 & Dr. Shanthi Johnson3
                                 1Population  and Public Health Services,
                                    2Research  and Performance Support,
                                        Regina Qu’Appelle Health Region
                               3Faculty of Kinesiology and Health Studies

                                                     University of Regina
         Older Adult Falls
 Falls are a significant threat to the
  health, safety and independence of
  older adults resulting in high mortality
  and morbidity rates
 Current cost/burden
 Majority of falls happen to older adults
  within the community
 Numbers
     More than just numbers
 Athletes and Children
 Mild Falls very dangerous for older
  adults due to a combination of:
     High incidence of falls
     High injury susceptibility
      ○ High prevalence of clinical disease
      ○ Physiological age-related changes
      Risk Factors for Falls
 Biological/Medical, Behavioral,
  Environmental and Social/Economic
 Lack of knowledge
 Falls not seen as personally relevant
            Fall Prevention
 Cost effective strategy to reduce direct
  and indirect cost of falls
 Falls Predictable and Preventable
 Public Health Programs focus on
  reducing injury:
     Severity
     Frequency
     Impact
            Regional Priorities
   Fall Prevention
       In alignment with Ministry of Health and Safe
        Saskatchewan
       Development of Fall Prevention Strategy and
        implementation by 2012
              PPHS Approach
   Best Practice
     Multi-factorial, Multidisciplinary, Environmental,
      Health strategies
   Targeting High Risk Population
     Older adult, female, over 80, low socio-
      economic status, chronic health conditions,
      socially isolated
   Collaborative
     Older adults, Community, Business, Health
      Region
     Interprofessional
          Best Practice Team
   Community based multi-factorial
    interventions
     Included health professionals from
      ○ Nursing
      ○ Vision
      ○ Physical Therapy
      ○ Occupational Therapy
      ○ Kinesiology
      ○ Pharmacy
      ○ Nutrition
      ○ Podiatry
      ○ Social Work (Client Assessment)
        Value of Intercollaborative
                  Practice
   Separate and shared knowledge and skills
    synergistically influence client care

   Positive influence on:
       Population health and client care
       Access and wait times
       Communication, coordination of care and client safety
       Recruitment and retention of health care professionals
       Satisfaction among clients and health care professionals
       Health human resources


    Sources: Canadian Physiotherapy Association, Canadian Health Services Research Foundation, Centre for
        the Advancement of Interprofessional Education
                   Fall Clinics
   Population and Public Health Services
    (RQHR) clinic model development
     Model developed around an injury prevention
      approach in Victoria, Australia
   Clinics
     2 Pilot Clinics in Regina
     4 additional clinics (end of June 2011)
      Fall Clinics: Recruitment
   Targeted community dwelling elderly
    residents at high risk for falls

   Identified through an environmental scan
         Fall Clinics: Procedure
   Pre-clinic
       Engaging Community
       Education on fall prevention
       Appointment bookings
       Pre-clinic questionnaire
   Clinic procedure
     Clients saw all 9 health professionals
      o Fall risk factors were assessed (standardized testing)
      o Interventions & referrals were made
   Post-clinic
     Satisfaction questionnaire
     Clinic results forwarded to family physician
   Follow-up phone calls
     3 months (completed)
     6 months (in progress)
      Fall Clinic: Objectives
 Increase the knowledge and capacity of
  the clinic participants, to decrease their
  risk for falls
 Increase health system efficiency
  through inter-collaborative practice, both
  internally and externally
 Contribute to best practice and research
        Fall Clinics: Outcomes
   Incidences of falls
     12 months before clinic
     3 and 6 months following clinic
   Fall efficacy
     Activity Specific Balance Confidence Scale (ABC)
   Fall knowledge
     Falls Risk Behaviours and Perceptions Scale
   Fear of falling
   Health behaviour
     Physical Activity level
     Nutrition
   Referrals
      Results: Demographics
   66 clinic participants
     18 unable to provide follow-up at 3 months
 Average age of participants was 73
 Most participants were female (82%),
  with low socioeconomic status (63%) &
  less than a grade 12 education (73%)
              Results: Falls
   44% participants had fallen in the 12
    months prior to the clinics
     17% had fallen at the 3 month follow-up
 No significant difference in fall efficacy
 Significant decrease in fear of falling
  from baseline to 3 months
 Significant increase in fall knowledge
  from baseline to 3 months
    Results: Health Behaviours
   Exercise
     Significant increase in the subjective amount
     of physical activity participants completed
     at 3 months
   Nutrition
     49% made dietary changes to improve their
     nutrition at 3 months
           Results: Referrals
 All health professionals made a total of
  140 referrals
 The most commonly made referrals
  were to
     Podiatry (27)
     Vision (19)
     Family Doctor (18)
   Physical Therapy and Occupational
    Therapy made the most referrals (59)
                Conclusion
   The clinics were successful at
    increasing the knowledge and capacity
    of participants to minimize their risk for
    falls
     Significant improvement in fall knowledge
     Decreased fear of falling
     Increase in physical activity
                 Conclusion
   The clinics also enhanced inter-
    collaborative practice
     Delivery of the clinic by multiple disciplines
     Number of referrals
      ○ Wide variety of internal and external health
        resources
                 Conclusion
   The findings provide a model for best
    practice
     Can be integrated into future fall prevention
     programming, learning and practice
               Looking forward
   Increased Access to Falls Clinics
     Two in urban RQHR in June 2011
     Two planned in rural RQHR in Fall 2011

   Community Stepdown
     Environmental Fall Resource Kits
       ○ Shared with other health regions
       ○ MOH Sharepoint
     Physical Activity

   Knowledge Exchange and Translation
     Model of Clinics shared Provincially and Nationally
                Last Words
   Majority of older adult falls happen within
    the community (70%)
   Fall Clinics are one approach which older
    people with high levels of fall risk can be
    managed
   Prevention of falls for older adults involves
    multiple interventions
   Falls are predictable and preventable
   Fall Prevention: Cost Effective Strategy
Questions ???