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Older Americans Month – Preventing Falls, Supporting Seniors

Bonnie Ewald
May 29, 2014
As we approach the end of May, we’re also coming to the end of Older Americans Month. This year’s theme - “Safe Today. Healthy Tomorrow.” – has focused on the steps we can take as a community to help prevent falls, an initiative that ties into several of our projects here at Health & Medicine.

Over one-third of the older adult population falls each year. Falls are a serious public health concern that can result in fractures, traumatic brain injuries, loss of independence, and fatality. In addition to the physical toll falls take on older people, they also contribute to hospitalizations, Emergency Department utilization, and rehabilitative therapy costs. Falls can particularly be an obstacle for vulnerable seniors - studies have found that older adults who are low-income, live in rural areas, and live alone have higher falls risks

Whether from lack of access to healthcare, costs of healthcare, physician time restrictions, or patient non-compliance, too many older adults are not properly screened for risk of falls.

As part of my work at Health & Medicine, I support two program areas that work directly to prevent falls among older adults: our Chicago Area Schweitzer Fellows Program – a year-long service learning program for health professions graduate students – and the Bridge Model, a social work based approach to working with older adults as they discharge from a hospital and return to life back in the community.

Through the Schweitzer Program, each year 30 exceptional students design and implement service projects to improve the health and well-being of underserved Chicago communities. This year, Fellow Timothy Kosiba, a physical therapy student at Northern Illinois University, has designed a program that specifically works to prevent falls.

“Over one third of adults 65 years and older fall each year which has become the leading cause of death by injury for older adults.  As the population ages, this number will only increase without strategies to help prevent it.  After seeing the impact falls have had on the independence and health status of my family and in my profession, this has become a major area of interest for me,” Tim said. 

Through the Fellowship, Tim has partnered with Northern Illinois University Health Wellness and Literacy Center to develop a project called Rise Up Against Falls. This falls prevention program is focused on working in communities of the DeKalb/Chicagoland area and providing free fall prevention screening, education, and wellness activities aimed at helping older adults maintain their independence and safety against fall-related issues.

“More times than not, therapists usually handle the aftermath of what falls can do. This could result in months or more of therapy working to regain as much function as possible that has been lost. I believe this project gives me the opportunity to advocate for my patients, helping them maintain their independence instead of trying to regain it,” he said.

In addition to supporting Tim and other Schweitzer Fellows with their projects, I also work with the Bridge Model through our Center for Long Term Care. Like the Schwietzer Fellowship, this transitional care program is focused on developing community-centered solutions to public health problems. In this case, the Bridge Model helps older adults age in place by supporting them as they are discharged from the hospital and return to their communities.

Hospitalizations often present a lot of changes for an individual, including changes in physical mobility, cognitive ability, newly prescribed medications, and emotional status. If older adults are not properly supported through this transition back to their homes, these changes can lead to a readmission.

Bridge Care Coordinators apply a thorough assessment and use social work clinical skills to address the many biopsychosocial factors that may challenge clients and their caregivers in their transition home from the hospital. Bridge emphasizes collaboration among hospitals, community-based providers, and the Aging Network in order to ensure a seamless continuum of health and community care across settings.

Bridge Care Coordinators work closely with on-the-ground partners such as Aging Network case managers and home health nurses to monitor the safety of in-home environments. They can help connect individuals in need with falls and readmission prevention services that address in-home safety concerns, hearing and vision loss, physical mobility challenges, and medication reconciliation concerns.

Like Schweitzer Fellow Tim Kosiba, our Bridge Care Coordinators understand that falls are not a “normal” part of aging, and they can be prevented through a combination of interventions. These include exercising, getting a falls risk assessment, reviewing medications, having vision and hearing checked, and making the home environment safe.

Below we’ve highlighted three important interventions that can help prevent falls, as well as health policy initiatives that could make these interventions more effective:

  • Reviewing Medications: Commonly prescribed medications, including antidepressants and insulin, increase the risk of falling by causing changes in cognitive and physical function, dizziness or lightheadedness, balance difficulties, confusion, and sedation. Therefore it is important for health plans and providers to complete a medication review upon prescription or a hospital discharge. However, a literature review revealed that many healthcare facilities include pharmacy review of medications only after a patient falls or is screened and identified as having a high risk for falling.  
  • Hearing screenings: Individuals with “mild” hearing loss have been found to be three times more likely to experience a fall.  Original Medicare does not cover many hearing tests or hearing aids, and Medicaid coverage varies by state, so individuals often need to pay for costs out of pocket or by reaching out to local community-based organizations.  According to the Hearing Healthcare Alliance for Underserved People (of which Health & Medicine is a member), just 5 of 40 surveyed Chicago-area hospitals, audiology clinics, and other health clinics provide hearing aids to Medicaid beneficiaries due to prohibitively low reimbursement rates.  
  • In-home safety: Modifications in the home environment can include installing appropriate lighting, making modifications to uneven flooring, and adding sturdy handrails to stairways and bathrooms. While community-based organizations such as Housing Opportunities and Maintenance for the Elderly can help older adults address these issues, traditional Medicaid does not cover these modifications, so they may be out of reach to older adults in need. In Illinois, older adults who are eligible for Medicaid home and community-based services programs can receive some home modifications that may mitigate fall risk. However, individuals must have enough functional impairment to qualify for nursing home placement in order to be eligible for those services. This requirement excludes many older adults who could benefit from services that could maintain their existing capability to live independently.

Older Americans Month reminds us that there are a number of avenues we can explore to help support older people in our communities – be it through direct service like the Schweitzer Fellowship and the Bridge Model or through health policy initiatives like those touched on above. Working with other advocates, providers, and communities, we can use Older Americans Month to support comprehensive falls prevention services for communities in need long after the month ends.