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Deborah Behre, DPM [email protected]
NO DISCLOSURES
SAVE THE DATE ! SEPTEMBER 22
PATIENTS
FAMILY & FRIENDS
YOU, YOUR STAFF AND YOUR PRACTICES
THE HEALTH CARE SYSTEM (MEDICARE)
CDC & WHO
WHO CARES?
EVERY SECOND COUNTS 1 OUT OF 3 PEOPLE 65 Y.O. OR OLDER FALL (1 IN 4 REPORT) 1 OUT OF 5 IS SERIOUS TBI’S: 81% HIP FRACTURES: 95% 1 OUT OF EVERY 3 NEVER RETURN HOME
2012 3.2 MILLION NON FATAL INJURIES 24,190 FATALITIES
NON FATAL FATAL
2012 $30.3 BILLION $616.5 MILLION
2015 $ 31.3 BILLION $637.5 MILLION
AVERAGE COST OF A FRACTURED HIP: $50,000
DIRECT MEDICAL COSTS FOR FALL RELATED INJURIES
5000 providers
6 million Pts screened
1 million falls prevented (1 in 6)
$3.5 billion direct medical cost saving
Can we make a difference?
VISION MEDICATIONS MUSCLE WEAKNESS BALANCE HISTORY OF A FALL (FEAR OF FALLING) PERIPHERAL NEUROPATHY PRE DISPOSING DISEASES (CVA, Parkinson’s) LOW VIT D LEVELS FOOTWEAR – SHOES & SOCKS FOOT PAIN OTHER PODIATRIC FACTORS
RISK FACTORS
PERIPHERAL NEUROPATHY FOOT PAIN MUSCLE WEAKNESS (includes intrinsics) BALANCE PROPRIOCEPTION FOOTWEAR (SHOES & SOCKS) FOOT DEFORMITIES (hallux valgus, lesser toe deformities, equinus,foot
drop)
LOWER EXTREMITY RISK FACTORS
WOMEN AGE BAREFOOT OR SOCKS – 11x HEEL HEIGHT > 4.5 CM – 1.9 X HALLUX VALGUS - 2x LESSER TOE DEFORMITIES – 1.32X POOR FITTING SHOES – CONTRIBUTED to 51% OF FALLS IN
HOSPITALS
RISK INCREASES
EXERCISE – most important activity (Tai Ji Quan – for balance: 28% improvement)
VIT D – 43% improvement
RISK DECREASES
Pre Fab Inserts Shoegear (Non skid – fitting) Falls Prevention Education Exercise 30 minutes 3X/week) Falls Decreased 36%
PODIATRY BASED PROGRAM
HERE’S WHERE YOUR FALLS PREVENTION PROGRAM STARTS
OR IT MAY START HERE
IF YOU DO NOTHING ELSE HAND THIS TO YOUR PATIENTS
CONSIDER GOING FURTHER
Safety Appt Vision Exercise
SAVE
CONSIDER GOING FURTHER
THE RECOMMENDATION IS THAT EVERYONE 65 YEARS OR OLDER HAVE A YEARLY FALLS RISK ASSESSMENT
HERE’S WHAT’S RECOMMENDED FOR FALLS RISK ASSESSMENT
YOUR STAFF CAN DO THE FIRST PART OF THIS FORM
QUESTIONING ABOUT FALLS
3 GAIT, STRENGTH AND BALANCE TESTS TUG (Timed Up and Go) (Recommended) 30 second chair stand (Optional) 4 stage Balance Test (Optional)
WHY START HERE ?
ARM CHAIR MARK 10 FEET AWAY FROM CHAIR RECORD TIME TO STAND UP, WALK TO MARK, RETURN AND SIT DOWN OBSERVE GAIT (12 SECONDS OR LONGER = HIGH FALL RISK)
TIMED UP AND GO (TUG)
SIT IN CHAIR DON’T USE HANDS TO GET UP (USE OF HANDS = 0 SCORE) COUNT NUMBER LOOK UP SCORE ON CHART
30 SECOND CHAIR STAND
4 DIFFERENT STANDING POSITIONS (PROGRESS IN DIFFICULTY)
IF CAN DO 10 SECOND HOLD, GO ON TO THE NEXT POSITION
IF CAN’T DO TANDEM STANCE FOR 10 SECS, HIGH FALL RISK
4 STAGE BALANCE TEST
CONSIDER GOING FURTHER
SELF PROGRAM
EXERCISE CLASS: TAI JI QUAN,YMCA MOVING FOR BETTER BALANCE, SAIL (stay active and independent for life), STEPPING ON
PT CONSULT (OTAGO EXERCISE PROGRAM - dec falls 35-40%)
EXERCISE CHOICES FOR YOUR PTS
28 % improvement
WHY DISCUSS EXERCISE?
CHAIR RISE EXERCISE
MARBLES
TOWEL CURLS
SELF PROGRAM
MOVE 20 MARBLES PER FOOT
TOWEL CURL EXERCISES
CONSIDER GOING FURTHER
CONSIDER GOING FURTHER
PCP
OT (SAFETY)
PT (BALANCE, STRENGTH, PROPRIOCEPTION, OTAGO)
REFERRALS
CONSIDER GOING FURTHER
PRESCRIBE WALKING AIDS REFER FOR MOORE BALANCE BRACES PRESCRIBE AND DISPENSE MOORE BALANCE BRACES SELL SHOES AND SOCKS
CONSIDER GOING FURTHER
NO ONE WALKS ALONE (HOSPITAL BASED FALLS PREVENTION PROGRAM)
NOWA
JAPMA Nov/Dec 2013 Vol 3 # 6
APMA Webinar ‘Cloud’ (Falls Prevention)
CDC
NCOA
Good Sources of Information
SAVE THE DATE ! SEPTEMBER 22 NATIONAL FALLS PREVENTION DAY
REFERENCES 1. CENTER FOR DISEASE CONTROL ATLANTA, GA 2. J AM GERIATRIC SOCIETY 64:425-431,2016 3. BMC GERIATRIC 2011; 11-51 4. AM J LIFESTYLE MEDICINE 2016; JAN-FEB: 10(1) 5. APMA FALLS PREVENTION WEBINAR 6. MENZ et al FOOT & ANKLE RISK FACTORS FOR FALLS IN OLDER PEOPLE; A PROSEPECTIVE STUDY; JL OF GERONTOLOGY
2006;8:866 7. NATIONAL COUNCIL ON AGING (NCOA) ARLINGTON, VA 8. KOBYASHI et al; J PHYS THER SCI 1999, 11:31-34 9. WWW.MOOREBALANCEBRACE.COM 10. SAFESTEP.NET 11. GUIDELINE FOR THE PREVENTION OF FALLS IN OLDER PERSONS; JAGS May 2001-Vol. 49, No 5 pp 664-672 12. EFFICACY OF A MULTIFACETED PODIATRY INTERVENTION TO IMPROVE BALANCE AND PREVENT FALLS IN OLDER PEOPLE;
STUDY PROTOCOL FOR A RANDOMISED TRIAL pp 1-16 Spink, Mens, Lord (Australia) BMC Geriatrics 2008 13. GAIT AND BALANCE DISORDERS IN OLDER ADULTS SALZMAN, MD AMERICAN FAMILY PHYSICIANS July 1, 2010 Vol 82 # 1
pp61-68
Thank you!
SIMBA BOOTS REX LEO !