The Independence at Home Program: One Step in Falls Prevention. Deborah Peace, Michelle Shilton and Meghan McBride Rehab Best Practice Day 2012

Transcription

1 The Independence at Home Program: One Step in Falls Prevention Deborah Peace, Michelle Shilton and Meghan McBride Rehab Best Practice Day 2012

2 Objectives To describe the Independence at Home Program To illustrate the program s unique features and benefits To provide a summary of a preliminary analysis To consider future directions

3 Independence at Home Program The Independence at Home Program is a Travelling Falls Assessment clinic funded through the HNHB LHIN Aging at Home Strategy and was launched in January 2010 The purpose of the program is the assessment and management of community dwelling individuals who are at high risk of falls or who are already falling

4 1 Self referral, Referral by family or Health Care Provider Independence at Home Program 2 3 Screen for fall(s) or risk for falling (See sidebar) ] Administration of Falls Efficacy Scale and Physical Assessment Sidebar: Screening for Fall(s) Questions 1. Number of falls in prior 6 months? 2. Most recent fall description 3. Environmental Safety and Support 4 5 Evaluate gait and balance through Tinetti Balance and Gait Assessment and Timed Up and Go Assessment summary and recommendations provided to client, FP and referral sources 6 Client follow-up at 3 and 6 months. Obtain medical history, Physical and functional assessment including: History of falls Medication ADL/IADL Balance Sensation Cognitive Screening Muscle strength Heat rate and BP Postural hypotension Feet and footwear. Environmental hazards

5 Unique Aspects of the Program Clients can self refer or be referred by a family member or Health Care Provider Staffed by a Nurse and a Physiotherapist Program is conducted LHIN wide Sites are community based rather than Hospital based e.g. Seniors Apartments, Retirement Homes, Seniors Recreation Centers

6 Program Benefits One stop comprehensive assessment to identify intrinsic and extrinsic risk factors for falls Assessment of functional mobility using standardized tools with results correlated with level of fall risk System navigation with linkages for clients and caregivers to health care services and community resources Follow-up to monitor compliance with recommendations and to ensure linkages are made

7 Program Analysis: Demographics Period of Analysis: April March 2011 Number of Client s Analyzed: 60 clients Male: 19 Female: 41 Age: 79.4 yrs (Range: yrs) Average number of identified co-morbidities: 5.2 Average number of falls within the last 6 months: 2.15

8 Total 7-10 Total Total Program Analysis Falls Efficacy Scale Total Total Score Total Total > Total score: 28pts Score > 10 indicates significant concern about falling Kemper GI et al Age Ageing Jan;37 (1): Epub 2007 Nov 20 N=60 pts

9 Program Analysis Timed Up and Go Patient < 10 sec sec sec sec sec > 30 sec Less than 10 sec: Independent & Mobile: 10 to 29 sec.: Varying levels of Independence of Seniors >14 sec: Correlated with probability of senior falling More than 30 sec. : Higher level of dependency N=60 pts Podsiadlo D, Richardson S. J Am Geriatr Soc 1991;39:142-8.

10 Program Analysis Tinetti Balance and Gait Assessment < >27 # Pt Total Score: 28 pts Score of 19-24pts indicates moderate risk of falls; < 19 high risk of falls Tinetti ME. JAGS 1986; 34: N=60 pts

11 Program Analysis Referral Pattern Continence Clinic Exercise Gait & Mobility Medication Vision &Hearing Hip Protectors Home Safety Nails & Shoewear Average # referrals/person: 4.23

12 Program Analysis Follow-up: Rate of Falls Admission Follow-up 2 0 Analysis of falls rates 6 mths prior to admission and at follow-up 6mths after program admission N=34 patients

13 Program Analysis Follow-up: Injury Analysis Fall w injury & ER Fall with injury Fall with no injury Nonfallers 0 No falls Falls Analysis of patients at follow-up, fall occurrence and level of injury /intervention N=34 patients

14 Conclusion The development of the Independence at Home Program has provided an opportunity to create a service based on best practice guidelines and evidenced based outcomes This program provides a practical and unique service delivery model for falls prevention that could be adapted to other care delivery settings It allowed us to appreciate the critically important component of system navigation for patients and their families as well as the specialized needs of the communities that we serve

15 Any Questions? Deborah Peace: Meghan McBride: Michelle Shilton: