Transcript The GP Data Model and Core Data Set

Falls prevention in the
elderly
Doris Young
Professor of General Practice
University of Melbourne
Greetings
from Australia
Falls- Size of problem
o Sixth leading cause of death in
older people
o Each year affects 30% of people
over 65 and 50% of over 80
o Repeated falls and half with
multiple falls
o Common cause for nursing home
Why prevent falls?
Lots of people fall:
At home
In hospitals & institutions
In public places
A range of injuries-most fractures due to
falls but not all falls lead to fractures
Can lead to:
Loss of confidence & Quality Of Life
greater disability, Death
(AN INTEGRAL PART OF GOOD
GERIATRIC CARE)
Risk factors
Intrinsic:
history of falls
CVA
Parkinson’s disease
visual status –
acuity, depth
perception
 hearing
 Gait-quad strength
 Balance-postural
sway








transfer ability
cognition
dizziness
sedentary
Extrinsic:
 Footwear
 Medication
 Environment
Falls assessment
o History of fall circumstances
o Medication history
o Assessment of acute or chronic
medical problems and mobility
levels
o Examination of vision, gait,
balance, lower extremity joint
function
o Neuro-mental status, muscle strength,
lower extremity peripheral nerves,
proprioception, reflexes, cortical,
extrapyramidal and cerebellar
functions
o CVS- heart rate, rhythm, postural pulse
and BP
o if appropriate, HR/ BP responses to
carotid sinus stimulation
Investigations
o FBE, U&E, TFTs,FBG,Vitamin B12
(often missed, muscle weakness
and peripheral neuropathy)
o MRI, CT (CNS),
o cardiac monitoring (for
antiarrythmics or pacemakers)
o vestibular testing rarely indicated
Management
Medication adjustment (numbers vs
types)
Improving gait and balance (tai chi)
o Improving postural BP, (medications,
stockings, getting out of bed slowly 20
sec-15 min)
o Muscle strength training
o Visual care
o Footwear-low heel, thin sole
o Modifying environmental hazards
(mats, lighting)
Evidence-based management
LOGIC
INPUT
1
Assessment
of falls risk
OUTPUT
2
Falls
prevention
Expert
Server
C ar e Pr o vid e rs ;
Med ica l:g en e ra l, ge r iatr ic s, r eh a bilita tio n
Allie d he a lth : Pha r ma c is t, Nu r se , Oc c up a tion a l Th er a pis t,
N utr itito n ist, Phy s ioth er a p is t,Op to me tr is t, Sp e ec h the r ap is t,
Soc ia l W or k e r
Admins tr atio n & R ec e ptio n s taff
RIsk
Grading
& Care
Plan
Patie nt
e du c atio n
Adv is e &
c ou n se l
Id en tify &
g ra d e r is k
fa cto r s & ris k s
Phy s ica l
a ctiv ity
D ie ta ry
mod ifica tion
In ve s tig a te
Med ica tio n
r ev ie w
Pre s cr ib e
in tr in sic r isk s
e xtr in sic ris k s
3
Pro fe ss io na l
d ev e lop me n t
4
Pop u latio n
h ea lth
p ro g r ams &
p ro je cts
Q AC E lin k
Tra in ing an d
s up p or t
r es o ur c e s
Env ir on men tal
s afe ty &
s up p or t
Pre v en t
Id en tifie d
R es o ur c es
R efe r
C lin ic al a ud it
Mon itor
Evid e nc e a n d
q ua lity
a ss u ar a nc e
Actio n Pla n
Falls Risk Assessment and
Management System
(FRAMS)
http://www.falls.unimelb.edu.au
Typical Clinical Se tup for Acce s s ing Falls Pre ve ntion
De cis ion Support Se rve r
ove r the Inte rne t
Clinic B
Clinic A
GP in Clinic A accessing Falls Decision Support Server
using clinical and patient management software
Reception
GP 1
GPs in Clinic B accessing Falls Decision Support Server
using Falls Decision Support Web Site
Reception
Local Area Network
Local Area Network
GP 2
HTTP
GP 1
HT
T
P
ov
er
r
ove
ing
g
a
s
Mes TCP/IP L7
L, H
XM
.
g
E
TC
P/
API
Network Server/
Internet Gateway
(firewall)
IP
Medicus Server Internet Gateway
(firewall)
GP 2
GP 3
GP 3
HTTP over
TC
P/IP
Inte rne t
r
ove
g
n
i
sag
Falls Prev ention
Mes TCP/IP L7
H
Decision Support Serv er
,
L
XM
(FPDSS)
Eg.
Workflow
Patient
Patient Doctor
Reception
Patient given a
short questionairs to
fill during
registration
Doctor input initial
responses from short
questionairs using
Falls Prevention
Module
Patient
Patient Doctor
Doctor promted to
conduct further
evaluation using
Falls Prevention
Module
Doctor
Patient given Care
Plan generated by
Falls Prevention
Module
Work Flow for us e of Falls Pre ve ntion M odule
Screening questionnaire
Question
What is your age (years) and
gender?
Your Responses
¨
¨
¨
¨
¨
Have you had any falls in the
last 12 months?
¨
¨
¨
¨
Do you have any of the following
conditions?
How many different types of
medications do you take?
Female
¨ Male
less than 65 years
¨ less than 65 years
65-80 years
¨ 65-74 years
81-89 years
¨ more than 75 years
more than 90 years
None in 12 months
1 in the last 12 months
2 –3 in the last 12 months
4 or more in the last 12 months
Stroke
¨ Parkinson’s Disease
¨ Arthritis
¨ Dementia
¨ Heart condition
¨ Other conditions affecting your balance or
¨walking
No medications
¨ 1 –2 medications
¨ 3 medications
¨ 4 or more medications
¨
Do you have any difficulties with
your eyesight or hearing?
¨
No difficulty (does not limit activities at all)
Mild difficulty (mild limitation of activities)
¨ Moderate difficulty (moderate limitation of
activities)
¨ Marked difficulty (markedly limits activities)
Do you have any difficulties or
unsteadiness when standing up,
walking, or turning?
¨
¨
¨
¨
¨
No difficulty or unsteadiness
Mild difficulty or unsteadiness
Moderate difficulty or unsteadiness
Marked difficulty or unsteadiness
Grading
(Nurse to
complete
score)
[0]
[1]
[2]
[3]
[0]
[1]
[2]
[3]
Number of
conditions
nil [0]
1-2 [1]
3-4 [2]
>4 [3]
[0]
[1]
[2]
[3]
[0]
[1]
[2]
[3]
[0]
[1]
[2]
[3]
Mr JH aged 71 years
o Retired Parks and Wildlife Officer and
lives with his wife
o He loves gardening and has, over the
years, constructed various pathways,
which can be a little worn and ragged.
o Had a fall in the garden.
o Osteo-arthritis in his knees and hips.
o His knees sometimes give way on
uneven ground and over the last three
months he has stopped taking his dog
for walks, as he feels unsafe.
Mr JH aged 71
Mr JH aged 71
Mr JH aged 71
Falls Risk Assessment and
Management System
(FRAMS)
http://www.falls.unimelb.edu.au
Thank you