Transcript FallPrevAudio102606Brown

Fall Prevention Principles in Action:
The Birmingham/Atlanta GRECC
Fall Prevention Clinic
Cynthia J. Brown, MD, MSPH
October 26, 2006
GRECC Fall Prevention
and Mobility Clinic
• Objectives of the clinic
– To provide care to veterans with a history of falls,
near falls or other mobility problems
– To develop a program which can be exported to
other VA facilities
– To allow research into the area of falls, fall
prevention and mobility disability in a communitydwelling population
– To provide an educational venue for a variety of
trainees
Patient Population Served
by the Clinic
• Referrals from several sources including
primary care, neurology, and rehabilitation
• A Variety of ages, functional status
abilities and medical diagnoses are
represented
• All have a history of falls or near falls
Interdisciplinary Team Approach
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Occupational Therapist
Physical Therapist
Physician (Geriatrician)
Referrals as needed for other resources
or providers
Methods Adaptable for All
Healthcare Providers
• Fall prevention strategies can be
employed by all healthcare providers
within the VA.
• Key is multicomponent, interdisciplinary
interventions.
• Having this type of clinic is not essential.
Risk Factors Targeted by the
Team
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Muscle weakness
Mobility and balance impairments
Foot and footwear problems
Sensory and perceptive deficits
Cognitive impairments
Multiple medications
Postural hypotension and dizziness
Environmental hazards
Occurrence of Falls According
to the Number of Risks
(Tinetti, 1988)
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
0
1
2
# risk factors
3
4+
Muscle Weakness
• Evaluation:
• strength testing of the upper and lower
extremities
• functional tests like timed chair stands
• Treatment:
• referral for strength training either as an
outpatient or at home, depending on severity of
mobility problems
Mobility and Balance
Impairments
• Mobility (gait and transfers)
– Evaluation: timed chair stands, and timed 8 foot
walk (Short Physical Performance Battery); or Get
Up and Go test
– Treatment: Physical Therapy for gait and transfer
training, provision of an assistive device
• Balance
– Evaluation: progressive static balance tests
(feet together, semi-tandem, and tandem)
– Treatment: referral to PT or community exercise
programs (Tai Chi) for instruction in balance
exercises.
Foot and Footwear Problems
• We dare to take the patients shoes off !
– Evaluation:
• watching gait with shoes on
• examining shoes for wear patterns
• examining feet without shoes
– Treatment:
• Podiatry referral for nail care
• orthotics/prosthetics for shoe inserts, special
shoes or ankle-foot orthosis (AFO)
Sensory and Perceptive Deficits
• Vision
– Ask if any problems and refer as needed
• Hearing
– Ask if problems and refer as needed
• Sensation/ Proprioception Problems
– Check sensation to light touch and
proprioception
– Referral to podiatry, foot clinic
Cognitive Impairments
• Screen for depression
– Geriatric Depression Scale (GDS)
– Work with PMD or Mental Health, treat as
needed
• Screen for dementia
– Mini Mental State Exam (MMSE)
– Referral to Geriatric Assessment Clinic
– Assist family in understanding why the
patient falls and target other interventions
which may lower risk
Multiple Medications
• Physician review of medications
– Attempt to adjust or eliminate as able
– Focus on those known to be associated
with high fall risk
• Benzodiazepines
• Anticholinergic medications
• Psychoactive medications
Postural Hypotension and
Dizziness
• Evaluate by taking orthostatic blood
pressures on ALL patients
– Check after supine for five minutes, then
standing for one and three minutes
• Treatment:
– Review medications and adjust as able
– Instruct patients to change positions slowly
Environmental Hazards
• Occupational Therapist reviews home
environment with patient
• Handouts of hazards given and discussed
• Adaptive equipment provided as needed
(raised toilet seats, shower chairs, grab bars)
• Home health can evaluate for home safety
Benefits of an Interdisciplinary
Team Approach
• Research shows a multicomponent
approach most likely to be successful
• Allows a variety of targeted
interventions to be done simultaneously
• Educational opportunity
• Fun!
The Birmingham/Atlanta GRECC
Fall Prevention and Mobility Team
• J. Dennis Hughes, OTR/L
• Claire Peel, PhD, PT
• Cynthia J. Brown, MD, MSPH
Thanks to the patients who allowed
themselves to be photographed