Stand Up & Be Strong! MN APTA Evidence-Based Falls Prevention

1. Stand Up & Be Strong! MN APTA Evidence-Based Falls Prevention MN Chapter American Physical Therapy Association www.mnapta.org 651-635-0046 Co-sponsored by the MN Department of Human Services

2. Stand Up & Be Strong!MN APTA Evidence-Based Falls Prevention • You will be able to: • Measure fall risk due to lower body weakness • Incorporate screening of older adults into your program • Understand action steps to reduce this risk • Project Manager: • Kris Gjerde, PT, • Minnesota Chapter • American Physical Therapy Association

3. Minnesota Falls Prevention Initiative • MN Board on Aging RFP: Community Service/ System Change/ Service Development (CSSD) grants to foster decreased nursing home utilization • MN Chapter APTA ‘system change’ proposal: community based fall risk screen and action steps piloted in 10 Western MN Counties • MN APTA Collaborative partners: PrimeWest Health Services Area Agencies on Aging Local Health Care providers County public health departments • Other CSSD Falls Prevention grantees: Mayo Medical School-in home assessment by geriatric fellow, Olmstead County MN Fairview Ridges-in home assessment by PT Dakota County

4. Stand Up & Be Strong! MN Chapter American Physical Therapy Association Kris Gjerde, PT Project Manager 651-635-0046 www.mnapta.org

5. Specific Project Goals: • Create a community-based system that makes assessment of fall risk & prevention of falls routinely available • Enable individuals to assess lower body strength and related fall risk • Enable individuals to take action to decrease risk or maintain low risk

6. MN APTA Stand Up & Be Strong! • Demonstration project designed to prevent falls in older adults • Community based system change • Co-sponsored MN Dept of Human Services

7. Why Is This Unique? • MN CSSD grants are highly competitive • MN Chapter received the first state grant to a professional association • Innovative approach to sustainable system change • Use of membership network to disseminate public health program

8. MN APTA Workgroup • Reviewed the evidence • Identified Fall Risk Factors • Decreased strength and balance • Medication use • Vision impairment • Unsafe home environment • Unsafe outside environment • Having fallen in past year • Fear of falling

9. Stand Up!Guiding Evidence • Rand Report on Falls for CMS, 2003 • Multifactor approaches are most effective • Two most effective interventions are: lower body strengthening medication review • Strengthening was mentioned but not provided in the nine national programs reviewed by Rand

10. Stand Up! Development • Combined the expertise of MN APTA members • Assumptions: • Physical therapists will serve as trainers & consultants • Focus: community dwelling older adults • Adults currently perform single repetition of sit to stand • Requirements of screening tool: • Enables self assessment • Applicable to groups or individuals • Community based, not medical intervention • Includes action steps that allow variable technique

11. MN APTA Falls Prevention Initiative • Oct. 2005: MN APTA invited members in 10 pilot counties to participate • Apr 2006: MN APTA trained 30 PTs • May-Dec. 2006 PTs trained 587 community partners • Jun. 2006: Community partners started screening participants • Jan. 2007: Statewide dissemination began

12. Primary Fall Risk Screen • Have you fallen in the past year? • Are you afraid that you might fall? • Do you frequently need to use your arms to rise from chairs? • “YES” indicates that you may be at risk

13. Physical Prescreen • Cross your arms • Rise to standing position • Successful rise: continue with timed sit to stand • Unable: Proceed to high risk category

14. Timed Sit to Stand

15. Risk Score

16. Action Steps • High Risk: Consult your doctor or Physical Therapist for advice & instruction to improve your strength. Do the exercises only if you feel safe doing them on your own. • Moderate Risk: Do the exercises. Seek assistance if you do not feel safe • Low Risk: Continue your active lifestyle, add the exercises to your program • Groups: Add the two exercises to your program • Reassess every 3 months

17. Exercises • Sit to Stand • Side Hip Raise

22. Reach • 576 Physical Therapist trained • 1296 Community Partners trained • 1855 Individuals screened

23. June 2006 – June 2007 Adults aged 65 and older Risk Score 1662 total Percent High 741 45% Moderate 518 31% Low 359 22% Unknown 44 2%

24. Uptake Follow up calls at 1, 3, 6 months • Retention of information • Action taken after screening • MD, PT visit • Performed exercises • Increased activity • Falls since screen • Overall functional mobility • 4 mobility questions from SF 36

25. What’s Next? • Screen Older Adults in your community • Assisted Living • Home Health • Senior Centers • Area Agency on Aging • EMS, Sheriff Dept, Fire Dept • Parish Nurse • Faith based programs

26. To Learn More… • www.mnapta.org • www.healthyagingprograms.org • www.cdc.gov • www.aoa.gov • www.minnesotasafetycouncil.org/ • www.stopfalls.org

27. Stand Up & Be Strong! Kris Gjerde, PT Minnesota Chapter American Physical Therapy Association www.mnapta.org