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A home health bulletin distributed to our physicians on September 27, 2008

A Prescription to Prevent Fall Injuries

Every year, one third of community-dwelling seniors experience an accidental fall.^1,2  This makes fall injuries the number one cause of injury deaths among seniors³ and the number one source of injury-related hospital admissions among seniors.⁴  Recent research has demonstrated that a multi-disciplinary fall prevention program under the general supervision of a physician can significantly modify the risk of fall injuries.^5-9  When patients are homebound, refer at risk seniors to AbleCare Home Health for a comprehensive, home-based fall prevention program. The home health services available through AbleCare can both prevent falls and lessen the severity of injuries when falls do occur.

Indications for a fall prevention program:

• A recent fall or history of falls
• Asymmetrical gait
• Low foot clearance
• Difficulty with the Timed Up & Go Test (15 seconds or greater)

A fall prevention program from AbleCare can include:

• The combined expertise of physical therapists, occupational therapists, and home health nurses
• Home safety assessment & modifications
• Gait training
• Balance training / proprioceptive rehabilitation
• Transfer training
• Strengthening (lower & upper extremities)
• ROM (lower & upper extremities)
• Training with ambulation devices
• Optimization of activities of daily living
• Customized home exercise plan
• Medication review (including medicine cabinet and pantry review)

The majority of fall injuries occur at home,¹⁰ so a home-based fall prevention program may prove the optimal intervention strategy.  A recent study including 360 community-dwelling, frail seniors found that home assessments reduced the incidence of falls by 37%.⁵  Future falls were most likely to be reduced among seniors who experienced a recent fall.  Researchers theorize that the recent fall made seniors more motivated to implement continuously at least one suggestion from the home assessment.  Gardner et al showed how an individually tailored, home-based training program reduced the incidence of falls among geriatric patients and moderated the severity of injuries.⁶ 

By the year 2020, the Centers for Disease Control expect the national cost of fall injuries to reach $43.8 billion (in current dollars) (CDC 2004).  With one third of seniors experiencing an accidental fall each year, doctors should expect that a significant percentage of their patients would qualify for fall prevention efforts.  On average, Medicare’s cost savings from preventing one fall injury justifies 11 home health episodes.  Referring patients for fall prevention saves money for Medicare while promoting the health and independence of your patients. 

Your Friendliest
Home Health Option

Your patients frequently write on satisfaction surveys that AbleCare caregivers feel like part of their family.  We feel the same way, and it shows.  AbleCare caregivers commonly pick up medications for patients, find community solutions to non-medical challenges at home, and are just plain caring and nice.  Embodying our caring hearts value is a requirement of all AbleCare team members.  You and your staff probably notice the difference, too.

References

1. Hausdorff JM, Rios DA, Edelber HK. “Gait variability and fall risk in community-living older adults: a 1-year prospective study.” Archives of Physical Medicine and Rehabilitation 2001; 82(8): 1050-6.
2. Hornbrook MC, Stevens VJ, Wingfield DJ, et al. “Preventing falls among community-dwelling older persons: Results from a randomized trial.” The Gerontologist 1994: 34(1): 16-23.
3. Murphy SL. Deaths: Fiinal data for 1998. National Vital Statistics Reports, vol. 48, no. 11. Hyattsville (MD): National Center for Health Statistics; 2000.
4. Alexander BH, Rivara FP, Wolf ME. “The cost and frequency of hospitalization for fall-related injuries in older adults.” American Journal of Public Health 1992; 82(7): 1020-3.
5. Nikolaus T, Bach M. “Preventing falls in community-dwelling frail older people using a home intervention teat (HIT): results from the randomized falls-HIT trial.” J Am Geriatr Soc March 2003; 51: 300-5.
6. Gardner MM; Buchner DM; Robertson MC, et al. “Practical implementation of an exercise-based falls prevention programme.” Age Ageing 2001; 30 (1): 77-83.
7. Province MA, Hadley EC, Hornbrock MC, Lipsitz LA, Mulrow CD, Ory MG, et. al. The effects of exercise on falls in elderly patients: A pre-planned meta-analysis of the FICSIT trials. Journal of the American Medical Association 1995;273:1341-7.
8. Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Annals of Internal Medicine 1994;121:442-51.
9. Judge JO, Lindsey C, Underwood M, Winsemius D. Balance improvements in older women: effects of exercise training. Physical Therapy 1993; 73(4):254-65.
10. Wilkins K. “Health care consequences of falls for seniors.” Health Reports 1999; 10 (4): 47-55.