Fall Prevention at CDC Moving From Research To Practice
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1 Fall Prevention at CDC Moving From Research To Practice Judy A. Stevens, Ph.D. Division of Unintentional Injury Prevention National Center for Injury Prevention & Control 2006 BC Injury Prevention Conference March 3, 2006
2 Public Health Model Translate & Disseminate Develop & Test Test Interventions Identify Risk Risk Factors Define Define Problem
3 Public Health Model Translate & Disseminate Develop & Test Test Interventions Identify Risk Risk Factors Define Define Problem
4 Data Sources hvital Records Death Certificates hnational Electronic Injury Surveillance System All Injury Program (NEISS-AIP)
5 Fatal & Nonfatal Fall Injuries Among People 65+, U.S., ,700 1% - Died 1.8 million 473,000 1,360,000 26% - Treated in ED & hospitalized 74% - Treated in ED & released Nonfatal falls: NEISS-AIP, 2003 Fall deaths: NCHS, Vital Records, 2003? Millions Fall-related injuries
6 Economic Impact In 2000, total cost of fatal fall injuries among people 65+: Total: $19.6 billion 4Fatal falls: $179 million 4Nonfatal injuries: $19.3 billion
7 Quality of Life Impact h20% - 30% fear falling 1 h20% die within a year after hip fracture 2 h25% in a nursing home one year later 3 1. Vellas BJ, Age & Aging, 1997; Friedman SM, JAGS, Lu-Yao GL, AJPH, Magaziner, J Gerontology: Medical Sciences, 2000
8 Public Health Model Translate & Disseminate Develop & Test Test Interventions Identify Risk Risk Factors Define Define Problem
9 Not Modifiable Personal Risk Factors holder age hfemale hwhite hchronic diseases hmentally impaired
10 Modifiable Personal Risk Factors Relative Risk hmuscle weakness 4.4 hgait & balance problems 2.9 hvision problems 2.5 hpsychoactive medications 1.7 American Geriatrics Society, JAGS, 2001
11 Modifiable Environmental Factors hclutter & tripping hazards hno stair railings or grab bars hdim lighting
12 Public Health Model Translate & Disseminate Develop & Test Test Interventions Identify Risk Risk Factors Define Define Problem
13 Interventions What Works? hcomprehensive clinical assessment 1 hexercise for balance & strength 2 hmedication management 3 hvision correction 4 hreducing home hazards 5 1. American Geriatrics Society, JAGS, Lord SR, JAGS, Cumming RG, Drugs & Aging, Ray W, Topics in Geriatric R Rehab, Day L, BMJ 2002; Gill TM, JAGS, 1999
14 Dane Co. SAFE Study RCT; PI: Jane Mahoney, MD Wisconsin Dept of Health & University of Wisconsin High risk seniors age 65+ Comprehensive in-home assessment by nurse practitioners & physical therapists
15 Dane Co. SAFE Study (cont.) Individualized fall risk reduction 4Educate about fall risks 4Encourage exercise or PT 4Promote changes in medications 4Improve functional status & home environment 4Refer to primary MD & specialists Education for physicians
16 No More Falls! Study RCT; PI: Barb Alberson, MPH California Department of Health & University of California, San Francisco hcommunity seniors age 65+ hattending Preventive Health Care for the Aging (PHCA) Program
17 No More Falls! Study (cont.) hbasic assessment by RNs in senior centers hcounseling 4Educate about fall risks 4Promote physical activity 4Review medications & refer to MD 4Assess & modify home environment
18 Factors that Influence Hip Protector Use hfeb 2004; PI: Susan Blalock, PhD huniversity of North Carolina hfocus groups, interviews, trial use with follow-up interviews hattitudes, perceptions & perceived barriers
19 Fall Risk Assessment hsep 2005; PI: Lawrence Rubenstein, MD hiaa with Los Angeles VA hdevelop & validate a self-assessment instrument hlearn how risk perceptions influence protective behavior
20 Public Health Model Translate & Disseminate Develop & Test Test Interventions Identify Risk Risk Factors Define Define Problem
21 Community Tai Chi Program hoct 2005; RCT; PI: Fuzhong Li, PhD horegon Research Institute htranslate science-based Tai Chi intervention and implement in a community setting hseniors age 60+ hevaluate program fidelity, feasibility & acceptability
22 Quality of Evidence Project Purpose: Provide public health practitioners and others with detailed information about rigorously tested & effective interventions.
23 Compendium of Effective Interventions huse database to develop document 4Provide summary of each study 4Describe interventions 4Include details about how the interventions were carried out
24 National Resource Center for Safe Aging hsan Diego State University hcollects, organizes, disseminates injury prevention information hserves public health professionals & aging service providers
25 Tool Kit of Fall Prevention Materials hhome safety checklist hfall prevention brochure hfact sheets & graphs hsummary of research
26 For More Information:
27 Conclusion Translate & Disseminate Develop & Test Test Interventions Identify Risk Risk Factors Define Define Problem
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