Best Practice Guidelines for Fall Prevention in Assisted ... · perceptions of fall risk and...
Transcript of Best Practice Guidelines for Fall Prevention in Assisted ... · perceptions of fall risk and...
Best Practice Guidelines for Fall Prevention in Assisted Living
November 20th, 2008
Promoting Active Living (PAL)
PAL Project Sponsors:
Slide 3
Acknowledgements
• Staff, Residents, Administration of:– Elim Housing Society – Nikkei home
• Collaborators:– Suni Arinobu– Marcia Carr– Marian Heemskerk– Keith McBain– Rachel Miles– Giulia Scime
• Research team: – Vicky Scott– Hansdeep Bawa– Fabio Feldman– Joanie Sims Gould– Ming Leung– Nikki Tan
Slide 4
The PAL Project – Goals & Objectives
• Goal: to develop practical, user-friendly guidelines tailored to the fall risk profiles of seniors living in Assisted Living Facilities
• Objective: Test the feasibility of evidence-based fall prevention strategies in Assisted Living settings in a 1-year ‘action’ research project
Slide 5
The PAL Project – Methodology
• Baseline assessments using:– Timed Up and Go (TUG) tests
• Prior falls history• Staff and resident focus groups on their
perceptions of fall risk and prevention• Implemented interventions based on staff
and resident survey, focus group findings, current AL practices, and relevant evidence
Slide 6
• Self monitoring, tracking, & reporting of all falls by residents– Client Calendar
• Surveillance and tracking of all falls– Fall Report form
The PAL Project – Interventions
Slide 7
• Promoting and encouraging physical activity– At home balance & strength
exercises – OsteoFit on-site (group classes for
education, lifestyle management & exercise)
– Recommendations for a facility-wide exercise room and equipment
The PAL Project – Interventions
Slide 8
• Individual education – Checklist & Action Plan: An education booklet
• Group education – Monthly Education sessions
The PAL Project – Interventions
Slide 9
PAL Monthly Education Sessions
1. Walker Clinic2. Hip Protector/
Blood Pressure3. Vision 4. Feet and Footwear5. Incontinence 6. Medications
N=73 (38%)N=40 (31%)N=33 (51%)Total # of fallers
N=155N=84N=71Total # of falls
BothSite 2Site 1
PAL Fall Report Findings Total number of residents = 192
2.111.752.82Rate of fallers per 1,000 resident days
4.483.676.07Rate of falls per 1,000 resident days
BothSite 2Site 1
PAL Fall Report Findings
Rate of Falls per 1,000 Resident DaysBoth Sites (Aug 07 - Jan 08)
5.73
3.24
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
Aug-Oct Nov-Jan
Fall
Rate
per
1,0
00 R
esi
dent
Day
N=192
Falls by Month By Sites (Aug 07 - Jan 08)
11
17 17
8
13
5
24
15 1514
7
9
0
5
10
15
20
25
30
August September October November December January
Month
# o
f fa
lls
Site 1
Site 2
PAL Fall Report Findings
PAL Fall Report Findings
Location of FallBoth Sites (Aug 07 - Jan 08)
2
2
3
5
7
7
8
15
19
21
66
0 10 20 30 40 50 60 70
Unknown
Public grounds
Grounds of AL facility
Other
Dining Room
Transition area
Hallway
Kitchen
Living/Family room
Bathroom
Bedroom
Number of falls
PAL Fall Report Findings
Activity at Time of FallBoth Sites (Aug 07 - Jan 08)
16
1
1
5
5
6
7
12
16
16
69
0 20 40 60 80
Unknown
Bathing
Working in yard
Dressing Undressing
Using toilet
Other
Turning
Getting in/out of bed
Bending/ Reaching
Standing up/ Sitting down from seat
Walking
PAL Fall Report Findings
Injurious FallsBoth Sites (Aug 07 - Jan 08)
Injury46%
No Injury54%
Fractured bones N=4
Cuts/Scrapes/Abrasions N=17
Bump on Head N=15
Bruises/redness/swelling N=21
Pain N=37
Slide 17
PAL Best Practice Guidelines – Summary
Step 3: Evaluation
Step 1: Assessment
Step 2: Implementation
1. Prior Falls2. Timed Up and Go (TUG)3. Post fall assessment
1: Fall Report form2: Monthly Calendar3: Individual & Group Education 4: Physical Activity5: Equipment/Assistive aides
1. Monthly summary report2. Repeat TUG3. Care plans for high-risk fallers4. Community action
Slide 18
PAL Project – Next Steps
• Disseminate Best Practice Guidelines to all registered ALRs in BC
• Develop provincial PAL Training Program for ALR Staff
• Merge Guidelines on Physical Activity in AL with PAL Guidelines - BC Recreation and Parks Association (April – Dec 2008)
Slide 19
“Falls do happen. But I think it the PAL project makes us realize how common it
is, and how easily we can prevent it.”
(AL Staff, PAL focus groups, 2007)
Slide 20
Thank You!