Nova Scotia Falls Prevention Initiatives

OIPRC IP Forum March 3, 2010Suzanne Baker

The leading causes of falls are preventable…

with a coordinated prevention effort.

Seniors’ Falls FactsFalls: the most common cause of injury for

seniors

• 3,317 hospitalizations

• 61% are females

• 54% of injury-related hospitalizations

Seniors' Fallsin Nova Scotia

District Reports

http://www.gov.ns.ca/hpp/publications/seniors_falls.pdf

Injury Related Hospitalizations

Injury Related Deaths

0

10

20

30

40

50

60

70

65–69 70–74 75–79 80–84 ≥85

Age group (years)

Num

ber o

f FRH

s pe

r 1,0

00 p

opul

atio

n Female Male

Annual fall-related hospitalization rates by age and gender, 2000–2004

Annual fall-related death rate by age and gender, 2000–2004

0

10

20

30

40

50

65–69 70–74 75–79 80–84 ≥85

Age group (years)

Num

ber o

f FRD

s pe

r 10,

000

popu

latio

n

Female Male

Fall related hospital days

0%

15%

30%

45%

60%

Head or Neck

Trunk Upper Limb

Hip Fracture

Other Lower Limb

Multiple orUnspecified

Anatomic site affected by fall injury

Perc

enta

ge o

f FRH

s

65–69 70–74 75–79 80–84 ≥85

Anatomic site of injury for falls requiring hospitalization, 2001–2004

Hospital Costs for Selected Fall-related Injuries

Among Seniors, B.C., 2001/2002 to 2004/2005Fall Injury Average Hospital Cost

per caseAverage Annual

Hospital Cost for all Cases

Hip fracture $18,508 $75,253,165

Upper limb injuries $11,571 $14,107,527

Head Injuries $14,425 $14,821,189

Abdomen, lower back, lumbar spine, and pelvis injuries

$14,135 $13,883,954

Economic Burden ReportsThe Economic Burdenof Injury in Canada,1998

The Economic Burdenof Unintentional Injury inCanada, 2004

Mortality Rates Due to Falls, 2004

New Brunswick 9.2Newfoundland and Labrador 3.4Nova Scotia 12.6Prince Edward Island 9.4CANADA 7

15

DeathsHospitalizationsEmergency Dept visits

Treated at home or never treated

Fall Injuries: the Surface

Treated in a physician’s office

Scope of the Issue

• By 2016• Anticipated fall related injuries• Fill a 523-bed hospital• Every bed• Every day

Department of Health • Department of Health - Falls Risk Assessment

Framework • Designed to raise the awareness of falls and falls

prevention• Provide necessary information • Create individualized, practical falls assessment tools

and programs• Relevance in home care, acute care, and long-term care

settings• Used to build on existing falls prevention programs or to

assist in developing new falls prevention programs.• http://www.gov.ns.ca/hpp/publications/FallsFramework.p

df

Purpose of Strategic Framework

• Get everyone focused • Establish a collaborative plan for:

– policy makers and government – DHAs, continuing care sector– communities– professionals

• Maximize collective ability to address seniors falls

Overview of Document• Consequences of Seniors’ Falls

– Human impact, costs, and Nova Scotia data highlights

• Causes of Seniors Falls – Risk Factors– Biological and Medical Risk Factors– Behavioural Risk Factors– Environmental Risk Factors– Socio-economic Factors

• Best Practice Approaches to Falls Prevention

• Strategic Framework Background– Purpose– Process– Strategic Alignments

Overview of Document

Guiding Principles

1. Living, evolving document2. Focused on risk factors 3. Strategies reflect community, cultural differences4. Evidence-based, comprehensive5. Relevant to needs, grounded in data and research6. Foster collaboration7. Support and build on existing efforts8. Population health approach 9. Be adequately resourced

Strong Foundation Exists• Provincial Intersectoral Falls Prevention Committee• Data Report• Community Links – Preventing Falls Together• Department of Health - Vitamin D and Falls Assessment

Framework) • Department of Seniors – Strategy for Positive Aging• District Leadership – South Shore Health• Falls Prevention Conference• Health Canada, Veterans Affairs, and Public Health

Agency of Canada

Strategic Goals

1. Leadership, Infrastructure, and Partnership2. Awareness and Understanding3. Education4. Supportive Environments5. Knowledge Development and Transfer

1. Leadership, Infrastructure & Partnership

GOAL: Appropriate and adequate leadership, infrastructure, and partnerships sustain all aspects of the Strategic Framework.

Leadership Activities

• Providing ongoing leadership and support at provincial and DHA levels

• Provincial Intersectoral Falls Prevention Committee

• Coordination funding• National Collaborative on Falls in Long-Term

Care• Funding Preventing Falls Together• Canadian Falls Prevention Curriculum Delivery

Safer Healthcare NOW! National Collaborative on Falls Prevention

• Three DHA • Annapolis Valley Health• South Shore Health• South West Health

• Acute Care sites• Alternative Level of Care units (# of beds)

• Promoting collaboration between DHA’s while enhancing Patient Safety and Quality of Life

Home Support Exercise Program (HSEP)

• The Home Support Exercise Program (HSEP) was developed for the frail elderly living in the community.

• It is comprised of 10 simple, yet progressive exercises designed to enable older adults to enhance and/or maintain their functional mobility and independence.

Home Support Exercise Program (HSEP)

• Evidence-based physical activity intervention for frail elderly

• Canadian Centre for Activity and Aging (UWO)

• Designed for home support workers• Capital Health and GASHA

Provincial Intersectoral Falls Prevention Committee

• Purpose: To guide and monitor the implementation of the seniors’ falls prevention strategic framework

• Philosophy• Responsibilities• Composition• Highlights

2. Awareness and Understanding

GOAL: Nova Scotians are aware of the issue of seniors’ falls and fall-related injuries and understand how to prevent them.

Activities

• Social marketing workshops to Falls Prevention Coalitions and other partners

• Support for annual falls prevention week• Ongoing education and meetings with

policy makers

A Population Health Approach to

Fall Prevention in NS

Community Links • Provincial, non-profit charity• Seniors issues• Member of the Group of IX• Age Friendly Communities• Community Development • Volunteerism• Members are seniors and senior serving

organizations

Preventing Falls Together

Goal

Reducing falls and fall related injuriesby seniors in NS using a population health

approach at regional coalitions

Preventing Falls Together• Population Health Approach• Age Friendly Communities• Regional Coalitions• Tool Kit & Checklists

Regional Coalition Projects

• Senior Parking Spots• Grit Bags• Safe Public Spaces• Walk Abouts• Physical Activity• Conference• Municipal Election

Regional Coalition Projects• Places of Worship• Hair Salons & Barber Shops • Presentations/workshops• Nightlight Partnership• Recreation Facilities• Falls Prevention Week

Susan King – Provincial CoordinatorEmail:

coordinator@preventingfallstogether.caTelephone: (902) 539-6098

www.preventingfallstogether.ca

Falls Prevention WeekNovember 23-27, 2009

Proclamations—towns and district health authorities

• Foot Care Information Session - Digby• Articles on Falls in Newsletters and papers in Western NS• Don't Fall For Christmas gift list • Posters enlarged and distributed throughout Western NS• Displays in hospitals, Red Cross Office and NQ Health Center• Placemats• Taglines on emails Digby and Area CHB• Places of Worship Project in Lunenburg and parts of Queens• Falls Prevention Talks• Falls Prevention Clinic

3. Education

GOAL: Seniors, care providers, organizations, and communities have the skills and knowledge to reduce the risk of falls and fall-related injuries.

• Canadian Falls Prevention Curriculum delivery and leadership (By the end of January more than 300 people will be certified in the CFPC)

• Support for Tri-District project• Funding for Red Cross H.E.L.P. program to

incorporate falls prevention within their initiative• Preventing Falls Together Toolkit• Falls Prevention Conferences

Activities

Canadian Falls Prevention Curriculum

• February 2008 • Participants will learn about:

• nature and scope of seniors’ falls • complex causes of falls • modifiable risk factors• Identification of seniors at increased risk of falling• evidence-based risk assessment tools• best practice interventions• applying a practical program planning model to the design • implementation initiatives• evaluating the effectiveness of programs

4. Supportive Environments & Policy

GOAL: Supportive environments are created and nurtured by healthy public policies that promote health and reduce the risk of falls and fall-related injuries.

• Canadian Falls Prevention Curriculum delivery and leadership

• Funding for part-time position to facilitate coordination among districts

• Provide expert advice to province and DHAs Strategy for Positive Aging

Activities

Provincial Falls Prevention District Network

Purpose: A forum for the DHA and IWK to collaborate

on data collection…

Scope: The focus of the network will be on the acute

care/hospital setting.

Strategy #1

• Establish a network of DHA leaders and staff

• Facilitate greater collaboration and sharing of falls prevention information

• Tools, policies and programs • Scope of the network includes the

continuum of care

Strategy #2

• Web-based central forum for the exchange

Strategy #3

• Develop and recommend standardized evidence based policies

• Data collection processes • Risk assessment• Intervention tools for the DHA

Strategy #4

• Guidelines for evaluating existing and future tools, interventions, and policies.

Accreditation: New Required Organizational Practices for 2008

• New Goal—Reduce the risk of injuries resulting from client falls

• New ROP—implement and evaluate a falls prevention strategy to minimize the impact of client falls– Falls prevention strategy– Population at risk for falls– Specific needs– Evaluation– Improvements

5. Knowledge Development & Exchange

GOAL: Community action and the decisions of policy makers are informed by timely collection, analysis, and dissemination of data and research on seniors’ falls.

Activities• Funding for Dalhousie University and South Shore

Health falls research partnership• National initiative involvement to improve collection and

dissemination of seniors’ fall-related data • Collaborator on CIHR Grant Proposal – Canadian

Longitudinal Study on Aging (CLSA)-Injury Team (IT) initiative

• Continue to share and promote the Seniors’ Falls Data Report

• Canadian Falls Prevention Curriculum Delivery and Leadership

Research Initiative

• Partnership between South Shore Health and Dalhousie University, funded by Health Promotion and Protection

• Addresses the effectiveness of processes used in a rural District Health Authority to develop and implement a complex health initiative, namely Seniors Falls Prevention.

• In the third phase of research, analyzing the data gathered from 3 teams taking action on falls.

Early Emerging Themes

• Complexity• Non-linear relationship • Barriers and supports

Next Steps• Establish seniors’ falls as a priority• Begin implementation with stakeholders and

partners.• Advocate for required resources.• Link with our provincial and federal counterparts to

collaborate regionally and nationally.• Rally partners and continue to build capacity.• Nova Scotia Health Promotion and Protection will

continue to lead coordination of strategy

Our Success Depends On…

• Leadership and collaboration across sectors.• Partners doing their part to support the strategic

goals.• Adjusting processes and policies – do things

differently and more effectively – not just a matter of more money.

• Recognizing that we can impact this issue and support sustainability of the health system.

Challenges

• Changing Behaviours– Educate– Change practice

• Create an environment that balances risk and best practice for the high risk patient

• Creating an Age Friendly Environment

Falls Prevention Coordinator

Suzanne BakerSouth Shore Health

Phone: (902) 634-8807 x3193Email: sbaker@ssdha.nshealth.ca