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					 Fall Prevention: Making a Difference
 Through Collaboration

Mary Ellen Kullman, Archstone Foundation
(Bonita) Lynn Beattie, The National Council on the Aging
Patricia Adkins, Home Safety Council
Debra Rose, California State University, Fullerton
Don Grantt, Administration on Aging (Respondent)

                     Health Promotion Institute
               Best Practices in Health Promotion 2006
Evolution of the California Stop Falls
              Initiative



           Mary Ellen Kullman, M.P.H.
                 Vice President
             Archstone Foundation
            kullman@archstone.org
Evolution of the California Stop Falls
Initiative

   Isolated Projects Addressing Individual Risk Factors

   Convening of a Small Group of Projects

   Rand Meta Analysis Supports Multi-factorial
    Approach

   Recognition that We Can Do Better by Working
    Across Silos and Collaborating
Evolution of the California Stop Falls
Initiative

   Formation of a Statewide Planning Group

   Linking Partners Across the State and Nationally

   Build the Evidence Base – White Paper
    Development

   Statewide Blueprint Development Process
Evolution of the California Stop Falls
Initiative

   Participation in National Action Plan and Falls Free
    Coalition

   Formation of the Fall Prevention Center of
    Excellence

   StopFalls California Coalition

   California Fall Prevention Projects RFP

   Model Project Development
Progress Through Collaboration



    Bonita Lynn Beattie, PT, MPT, MHA
        Center for Healthy Aging
    The National Council on the Aging
        bonita.beattie@ncoa.org
What Do We Know Works?

   Multifactorial nature of falls
    and fall related injuries
    demands a collaborative
    effort
   Multifactorial intervention
    strategies, that identify and
    modulate an older adult’s
    risk factors, are particularly
    effective in lowering fall
    rates in high risk groups.
Falls FreeTM National Action Plan

   National Falls Free Summit
    2 day invitational meeting of
    58 national organizations,
    professional associations,
    and federal agencies

   Through consensus process
    developed and published
    National Action Plan
       36 strategies and action
        steps to reduce falls in older
        adults
Organized Around Risk Factor Management
  for which there is evidence of effectiveness

                   Physical Mobility
                     Home Safety

               Medications Management
                 Environmental Safety



                     and cross-cutting issues
Falls FreeTM Coalition

   Falls FreeTM Coalition loosely formalized and
    charged with rolling out the National Action Plan

   National organizations, professional associations,
    federal agencies, and state coalitions working
    together to affect meaningful change
Falls FreeTM Coalition Initiatives

   Presentations, media messages, journal articles,
    interviews, and NPR pieces
   Falls FreeTM bimonthly Electronic-news
   Advocacy Workgroup, Legislative Update: S. 1531
    Keeping Seniors Safe from Falls Act of 2005
    http://www.healthyagingprograms.com/resources/S%2
    01531%20fact%20sheet.doc

   State Coalitions forming to address fall prevention
   Community collaborative projects forming to
    address local needs
Other Coalition Initiatives

   Center of Excellence for Fall Prevention initiative
    to enhance programs and build community
    coalitions

   Professional associations developing collaboratively
    developing tools and resources

   American Geriatrics Society revision of clinical
    guidelines

   CMS Clarifying Code: V15.88 History of Fall
Still More Initiatives
   Research:
       ASPE LTC study on home modifications
       NCIPC funded dissemination study, UNC; a state
        program in Minnesota; U of Wisconsin study of a
        comprehensive program with individual assessments
       AoA funded projects: Matter of Balance, Medication
        Management Model, Evidence-Based Fall Prevention
        Program in Senior Centers
       Inclusion of fall prevention indicators in the CDC
        2006 State of Aging and Health Report
Vision for Collaborative Action

   Building community capacity
    and infrastructure through
    collaboration. Researchers,
    planners, health care, public
    health, and aging all working        Multifactorial nature
                                         of falls demands a
    together to                          collaborative effort
       Spread the message that
        falling is not inevitable and
        there are proven interventions
       Provide integrated programs
        and services that address the
        fall risks in homes &
        communities
Resources on the CD ROM
   Archstone Foundation
       Pre-conference White Papers
       California State Conference Proceedings
       Archstone Foundation/Center of Excellence RFP

   Falls Free
       National Action Plan
       Research Review Papers
       Issues of E-Newsletters

   Home Safety Council
       State of Home Safety
Resources

   Center for Healthy Aging
    www.healthyagingprograms.org
    Falls Free Electronic News

   Center of Excellence for Fall Prevention
    www.stopfalls.org


   National Resource Center on Supportive Housing
    and Home Modification
    www.homemods.org
Resources

   National Center for Patient Safety Falls Toolkit
    www.patientsafety.gov/SafetyTopics/fallstoolkit/index
    .html

   Home Safety Council: State of Home Safety
    Facts about safety in the home
    http://homesafetycouncil.org/state_of_home_safety/s
    ohs_2004_p017.pdf

   National Institute on Aging, AgePage: Preventing
    Falls and Fractures
    http://www.niapublications.org/agepages/PDFs/Preve
    nting_Falls_and_Fractures.pdf
Program Tools

   National Center on Injury Prevention and
    Control: A Tool Kit To Prevent Senior Falls
    www.cdc.gov/ncipc/pub-res/toolkit/toolkit.htm


   American Geriatrics Society: Falls in Older
    Adults Management in Primary Practice
    www.americangeriatrics.org/education/falls.shtml
Programs

   A Matter of Balance
    Partnership for Healthy Aging
    www.aoa.gov/prof/evidence/SMaine.pdf

   Safe Steps Program
    Home Safety Council
    www.homesafetycouncil.org/expert_network/en_safes
    teps_w001.aspx

   Remembering When: A Fire and Fall Prevention
    Program for Older Adults™ from the National Fire
    Protection Association
    http://www.nfpa.org/index.asp
Programs

   HEROES Program, Temple University
    www.temple.edu/older_adult


   FallPROOF! A Comprehensive Balance and Mobility
    Training Program
    www.exrx.net/Store/HK/Fallproof.html


   National Center for Safe Aging
    www.safeaging.org/model/default.asp
Falls FreeTM Coalition Public Policy
Workgroup and Federal Legislation



            Patricia H. Adkins, MBA
            Chief Operating Officer
             Home Safety Council

     patricia.adkins@homesafetycouncil.org
Successful Collaborations at the Federal
Level

   Clear, Common Goals

   Leadership

   Resources

   Communication

   Unified Message

   Success?!?
Falls Free National Action Plan
Clear, Common Goals

Strategy 5

  Develop a public policy agenda to promote falls
  prevention at the national, state, and local levels


Action Step 6

  Create model legislation for use by states and local
  communities
Falls Free Public Policy Workgroup
Leadership

The Public Policy Workgroup was formed from the
  Falls Free Coalition membership

Who
     The National Council on the Aging
     Home Safety Council
     National Safety Council
Falls Free Public Policy Workgroup
Resources

   Staff

   $$$

   Expertise

   Experience

   Networks
Falls Free Public Policy Workgroup
Communication

   Decision making

   Working behind the scenes

   Room for flexibility

   Staying in touch
Falls Free Public Policy Workgroup
Unified Message – Unified Group

Unified Message
   60-Second Speech

   One-Page Fact Sheet

   Supporting Data

   Joint Letters



Unified Group
     Organizations’ Membership
     State Coalitions
Falls Free Public Policy Workgroup
Success ?!?


        Celebrate the victories!
           (big and small)
Federal Legislation

       U.S. Senate
       • S. 1531 “Keeping Seniors Safe from Falls Act of 2005”
       • Introduced July 28, 2005
       • Introduced by Sen. Michael Enzi (R-WY) and Sen. Barbara
         Mikulski (D-MD), plus five additional Senate cosponsors
       • Authorizes $72 million for FY06-09


       U.S. House of Representatives
       • Legislation will be introduced by Rep. Frank Pallone
         (D-NJ) and Rep. Ralph Hall (R-TX)
       • House legislation incorporates elements from the
         National Action Plan
       • House bill authorizes $105 million for FY06-09
Federal Legislation
        History of the fall prevention legislation
        • “The Elder Fall Prevention Act” was first introduced in
          the House of Representatives during the 107th Congress
          by Rep. Frank Pallone (D-NJ)
            • A Senate companion bill was not introduced
            • The bill died in committee


        • “The Elder Fall Prevention Act” was introduced in the
          Senate during the 108th Congress by Sen. Michael Enzi (R-
          WY) and Sen. Barbara Mikulski (D-MD)
            • A House companion bill was not introduced
            • The bill died in committee
Federal Legislation
       Current status of the fall prevention
       legislation
         • During the 109th Congress, Sen. Enzi and Mikulski
           re-introduced the legislation with a new title, “The
           Keeping Seniors Safe from Falls Act of 2005”
            • The legislation authorized funding for fall
              prevention initiatives


         • A House companion bill is close to introduction with
           specific language taken directly from the National
           Action Plan
Falls Free
Making a Difference Through Collaboration

   Increased knowledge and expertise

   Increased resources

   Strength in numbers and the ability to leverage
    support

   Credibility and visibility

   Activity on multiple fronts increases the potential
    for success
Falls Free


                Library of Congress
         (resource for tracking legislation)
              http://thomas.loc.gov

               Home Safety Council
             www.homesafetycouncil.org
Translating Research into Practice:
   The California Adventure!


               Debra J. Rose, PhD
                   Co-Director
           Center for Successful Aging
      California State University, Fullerton
                       and
      Fall Prevention Center of Excellence
        University of Southern California
Defining a “ Best Practice”

   A technique or methodology
    that, through experience
    and research, has proven to
    reliably lead to a desired
    outcome.
Fall Prevention Strategies

   Fall Risk Assessments and Medication Management
   Physical Activity that specifically targets strength,
    balance, and endurance
   Environmental modifications in home and
    community
Fall Risk Assessments

Shown to lower fall risk by 18% and mean number of
  falls by 43%
   Includes:
       Balance and gait testing
       Neurological function
       Medication review
       Fall Circumstances

   Individualized fall risk reduction plan with follow-
    up
Medication Management

   Reviewing and modifying medications can reduce
    fall rates

   Reducing number and type
    effective
       Benzodiazepines
       Antidepressants
       Sedatives/hypnotics
Medication Management
   Gradual withdrawal of psychoactive
    drugs particularly effective BUT long-
    term compliance is a problem.
   Successful programs will need a
    strong counseling component to
    improve compliance.
   Most effective when part of an
    interdisciplinary and multi-
    component approach.
   Medication use perhaps the most
    preventable or reversible risk factor
    associated with falls.
Physical Activity

   Stand-alone physical activity
    interventions that target fall-
    related risk factors, lower fall risk
    by 12% and number of falls by 19%2

       Different types found to be
        effective – Tai Chi, balance and
        gait training, resistance training
       Different settings studied: Home,
        community.
       Different levels of risk studied
       Different approaches used - Group
        versus individually tailored home
        exercise programs
Physical Activity Programs

   Successful programs:
       Target balance, gait, and strength
       Are moderate in intensity or progress from low-to-
        moderate intensity
       Are implemented by well-trained instructors with
        knowledge of common age-associated performance
        limitations
       Are acceptable and of sufficient frequency and
        duration based on level of fall risk
       Foster self-regulatory skills, self-monitoring of
        progress and self-reinforcement.
Environmental Modification

   No evidence that it is effective
    as a stand-alone intervention
   Most effective when
    assessments done by an OT
    and when focused on high risk
    groups.
   Included as a component of
    successful multi-component
    interventions conducted with
    recurrent fallers.
Home Modification Strategies

   Includes:
       Removing hazards
       Adding special features or
        assistive devices
       Moving furniture
       Changing where activities
        occur
       Renovating or changing
        structure of home
Environmental Modifications

Successful programs:
     Include financial or manual assistance
     Hire trained health care professionals
      (OTs) to perform initial assessments
     Target older adults who are ready for
      change (e.g., recent fall, increased
      understanding of risk)
     Are combined with education and
      counseling about how to decrease risk
FPCE Mission……….

   Establish fall prevention as a
    key public health priority in
    California
   Create effective and
    sustainable fall prevention
    programs
   Create systems for fall
    prevention


    www.stopfalls.org
        “There is
           NO
     One-Size-Fits-All
Fall Prevention Program”
Model Projects

   To be designed, implemented, and evaluated by
    FPCE in
       Senior centers, retirement communities, and/or
        Adult Day Care and Health Care settings
       Across different levels of fall risk

   Program Expansion Grants:
       Expand on one or more existing components
       Reviewed by FPCE and Archstone Foundation Staff
       Technical assistance, grant monitoring, and external
        review of funded proposals by FPCE
       Funding period is 18 months
Purpose of Model Projects

   Study how best to combine the three core
    components of fall prevention
       In different “real-world” environments
       Via different service providers
       Across different levels of fall risk
Desired Outcomes?

   Process
       Better understanding of barriers to implementation
        and sustainability
       Problem-solving strategies used to overcome
        barriers
       Internal mechanisms used to link components
       Recommendations for program modifications from
        providers and recipients of services based on
        respective experiences
Desired Outcomes?

   Product
       Efficacy of program components in lowering fall
        risk, improving overall physical and psychological
        fxn, behavior change.

       Effective and User-Friendly Evaluation packages.
Desired Outcomes?

   Product
       Training and Program Implementation Manuals and
        related resources

       Replicable “Best Practice” Fall Prevention Programs
Current Progress?

   Finalizing funding recommendations for program
    expansion and coalition-building grants (4-8 in
    each category)
   Selecting model project sites
       Pilot project at single site
       Randomized clinical controlled trials at multiple
        sites
   Finalizing assessment tools (processes
    and product) to be used to evaluate
    program efficacy
  Thank You!




www.stopfalls.org