Transcript ACOVE 2: Falls and Mobility

ACOVE 2: Falls and Mobility
Falls Pretest
Question 1
n = 67
5
Please rate how confident you are in your ability
to:
4.5
4
3.5
3.42
3.33
2.84
3
2.5
2
1.5
1
0.5
0
Identify an older person at
higher risk for falls
Do a fall history
Do an exam to evaluate
the cause of falls
ACOVE 2
Falls and Mobility
Quality Indicators
• All elders 65+ should have documentation that they were
asked annually about falls.
• If a 65+ elder reports a history of 2 or more falls (or 1 fall
with injury) in the previous year, then there should be
documentation of a basic fall history.
• If a 65+ elder reports a history of 2 or more falls (or 1 fall
with injury) in the previous year, then there should be
documentation of a basic exam.
ACOVE 2 Falls and Mobility
Learning Objectives
Knowledge:
1. Understand consequences of falls
2. Identify risk factors for falls
3. Understand the Fall Assessment algorithm
4. Improve knowledge about:
1. Gait and balance disorders in elders
2. Assessments
3. Fall evaluation and intervention
Falls and Mobility in Aging
Each year, thousands of Americans 65 and over fall, resulting in:
Restricted mobility, Decreased ADL’s, Increased nursing home placement, and
Increased risk for death
Fall
reported in
last year
Risk factors
for falls
include:
Single fall
with no
injury
•4 or more
medications
•Circumstances
•Medications
•Chronic conditions
•Mobility
•ETOH intake
•Gait & balance
abnormality
•Decreased
visual acuity
Brief Fall History
Perform Timed Up & Go
test
ABNORMAL
•Orthostatic
hypotension
Evaluation of
falls includes:
2 or more
falls, 1 fall
with injury
•Timed Up and
Go (TUG) test
Do Falls Assessment
•Vitals – Orthostatics if indicated
•Visual assessment
•Lower extremity strength
•Targeted neuro exam
•Timed Up & Go test
•Cardiac evalif symptoms suggest syncope
NORMAL
Consider recommending
exercise program
Supported by a grant from the
DW Reynolds Foundation
Intervention Options
Reference
Chang, T.T. and David A. Ganz.
Quality Indicators for Falls and
Mobility Problems in Vulnerable
Elders. JAGS 55-S327-S334, 2007.
•Medication
review
•Gait, balance & exercise programs
•Medication modification
•Postural hypotension treatment
•Environmental hazard modification
•Cardiovascular disorder treatment
•Visual acuity
testing
•Orthostatic
blood pressure
ACOVE 2 Falls and Mobility
Learning Objectives
Skills:
1. Evaluate medications
2. Evaluate gait/mobility
3. Appropriate referral and self-management education
ACOVE 2 Falls and Mobility
Detailing Key Messages
Consequences of Falls
Risk Factors for Falls
Evaluation &
Treatment
Restricted Mobility
More than 4 Medications
Medication Review
Decreased ADLs
Gait & Balance
Abnormalities
Gait & Balance Evaluation
(TUG)
Increased NH Placement
Decreased Visual Acuity
Referral to PT
Increased Risk for Death
Orthostatic Hypotension
Vision Evaluation
Depressive Symptoms
Orthostatic Hypotension
Cognitive Impairment
Falls Pretest
Question 2-5
% answered question correctly
n = 67
100.0%
90.0%
80.0%
77.60%
70.0%
59.70%
60.0%
50.0%
Answered
Correctly
40.0%
30.0%
20.0%
17.20%
17.90%
10.0%
0.0%
Q2 Decrease risk Q3 NOT increase
of repeated falls? risk of falling?
Q4 Future
dependence in
ADL's?
Q5 NOT
evidenced-based
intervention for
decreasing risk of
falling?
ACOVE 2 Falls and Mobility
What We Hope to Achieve
At UIM:
1. Improved risk factor management and prevention of
future falls.
2. Early intervention, BEFORE falls occur.
3. Discontinuation or avoidance of high risk medications.
ACOVE 2 Falls and Mobility
What We Hope to Achieve
In the Hospital:
1.Knowledge learned in the clinic will persist:
– Consider patient stability at discharge
– Consider need for Physical Therapy
2. Avoid high risk medications.
From Knowledge to Performance:
Intervention Sequence for each ACOVE
Resident Lecture
Faculty & intervention
Development
Resident Detailing
Identify Patients
at the time of care
Assess performance:
Extract and analyze
Clinical data
Cue MDs to act
Record data on
clinical intervention
Provide decision
support
ACOVE 3: Dementia and Aging
Quality Indicators
Out-Patient:
•
If new to a primary care practice or inpatient service…
•
Cognitive and Functional Screening
•
Annual evaluation for changes in memory and function.
In-Patient:
•
IF a VE has a diagnosed dementia,
•
Depression Screening
•
IF screens positive for dementia…
•
Clinical Cognitive Evaluation
•
IF a VE with dementia has a caregiver…
•
Caregiver Support and Patient Safety Information
•
IF screens positive for dementia…
•
Medication Review
•
•
IF newly diagnosed with dementia…
•
Neurological Examination
IF a VE with dementia is physically restrained in the
hospital…
•
Safety concerns justifying the use of restraints
should be documented in the medical record and
communicated to the patient, caregiver, or guardian.
•
IF newly diagnosed with dementia…
•
Laboratory Testing
ACOVE 3 Dementia
The 3 D’s
Dementia – Depression – Delirium
Learning Objectives:
• Learn the testing characteristics of the
Mini-Cog and PHQ2 screens
• Understand the importance of depression
screening for demented patients
• Recognize secondary causes of dementia
• Differentiate different types of dementia
• Learn strategies of managing behavioral
symptoms