Over half of older adults in the United States fall annually, nearly 1/3 fall multiple times. Falls are the most frequent cause of trauma-related death in older adults. Medical costs are $50 billion annually. Fear of falling can be equally debilitating, when individuals become less active and spiral into functional decline.
Published studies have integrated the Center for Disease Control’s STEADI (stop elderly accidents, deaths, and injuries) fall prevention fundamentals of screening, assessment, and intervention into the workflow of primary care clinics. Achieving only a 60% adoption of the most important components, clinicians showed significant reduction in fall-related injuries. Incorporating these complex interventions requires time, expertise, and resources, which can be in short supply in primary care clinics.
Based on STEADI principles, a nurse practitioner (NP) and physical therapist (PT) created and implemented a multi-component falls prevention clinic for older adults. Referrals were received from primary care providers and emergency service personnel for patients with a recent history of a fall, or at high-fall risk. Patients underwent a comprehensive falls risk assessment and mobility testing. The NP developed patient-specific plans of care based on the assessment, made recommendations to the primary care provider around high-risk medications, and made referrals to specialists as appropriate. At 6 weeks patients were called; using motivation interviewing the NP was able to troubleshot barriers to compliance. Participants returned at 12 weeks to repeat gait and balance testing, and discuss continued exercise through home or community-based programs.
Early results from our work are extremely encouraging. Data analysis of pre-/post- measures using Wilcoxon Signed Ranks test reveals statistically significant improvement for both objective and subjective outcomes, including Dynamic Gait Index (difference: median=1.0, IQR=0,2, p=0.0004), Activities-Specific Balance Confidence Scale (difference: median=4.7, IQR=-1.0,14.0, p=0.0006), and Timed Up and Go (difference: median=-2.0, IQR: -3.70,0.39, p=0.0051). Participants described the impact they perceived, with excerpts from the satisfaction survey below: • “I became more observant of my environment so have been less likely to fall.” • “I felt reassured gaining better balance and control.”
This is an NP-driven fee for service model of care resulting in falls risk reduction for older adults.
MSN, ANP-BC, GS-C,
Duke University Health System
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9/20/20 1:22 pm
Thank you. Loved the continuity of long term connections with the community programs. Seems that increases socialization would be evident also.
9/24/20 6:04 pm
Very creative. Love it. Supports continuity of care in our geriatric population
9/24/20 6:14 pm
Good ideas. I would have liked more info on the poster on recommendations and follow up.