Spectrum of PreventionA unified response to challenges in an aging community

2015 Aging in Texas ConferenceAustin, TexasJuly 30, 2015

Objectives•Distinguish how a public health framework is critical

to developing multidisciplinary collaborations

•Utilize a public health framework to address complex and urgent challenges of an aging population

•Develop a strategy using the Spectrum of Prevention to address a public health concern

Why is this important?Presented by:Jennifer Jurado Severance, PhDSenior Citizen Services of Greater Tarrant County, Inc.

Why apply a public health approach?• Good health is key to independent living and quality of life

•Demographic and epidemiologic shifts impact medical and social services

•Disparities exist among subgroups

•Health promotion and disease prevention can prevent or delay onset of acute and chronic conditions

What Makes Us Healthy vs. What We Spend on Being Healthy, Tuesday, June 5, 2012 Retrieved from http://bipartisanpolicy.org/

“This spectrum tool was derived

from practice and developed out of

the conviction that complex

problems require comprehensive

solutions.”Larry Cohen and Susan Swift, 1999

in Injury PreventionRetrieved from http://www.preventioninstitute.org on October 13, 2010. Model originally developed by Larry Cohen director of the Contra Costa Health Services Prevention Program, the Spectrum is based on the work of Dr. Marshall Swift in treating developmental disabilities. It has been used nationally in prevention initiatives targeting traffic safety, violence prevention, injury prevention, nutrition, and fitness

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Fort Worth Safe Communities CoalitionPresented by:Amanda Robbins, MS, APRN, GCNS-BCNICHE CoordinatorTexas Health Harris Methodist Hospital Fort Worth

• 1989 - First World Conference on Accident and Injury Prevention, held in Stockholm, Sweden

• No single approach to injury prevention and safety promotion can be as effective as a collaboration among community organizations and community members

▫ The leading role is played by the community itself, an entity that is larger than any of its parts.

▫ “All human beings have a right to health and safety”

World Health OrganizationCollaborating Center for Prevention

•Demonstrate partnership and collaborations with all community sectors that are responsible for promoting safety within the community.

• Long-term and sustainable programs covering both genders, all ages, environments, situations, and include emergency and disaster preparedness.

• Collect data on number and causes of injuries.

Criteria as Established by the World Health Organization

• Programs target high-risk groups and environments, and promote safety for vulnerable groups.

•Evaluate the programs, processes, and the effects of change.

•Participate in National and International Safe Communities networks.

Criteria (cont.)

Safe Communities America

•Sponsoring agency in America•Nonprofit organization• Leading safety advocate for >100 years•Vision: Making our world measurably safer•Unintentional injuries fifth leading cause of death in

U.S.•Safe Communities overall have a 8-10% decrease in

injury related deaths

National Safety Council

•Form Coalition •Audit safety and injury prevention programs•Contact Safe Communities America

Becoming a Safe Community

Fort Worth Safe Communities Coalition•World Health Organization •National Safety Council•Conceived November 2011•Steering Committee•Born February 2013•300th worldwide• ‘New gold standard”

Fort Worth Safe Communities Coalition Task Forces

• Child Injury • Domestic Violence• Motor Vehicle Crash• Drug Overdose• FW Drowning Prevention Coalition• Elder Abuse• Sports Injury• Disaster Preparedness• Bicycle Safety• Take 20 for Life• Falls

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Public Health Problem: Elder Abuse• Elder Abuse is under reported. 1 in 14 elder abuse cases are reported to

authorities.

• Elders who experienced even modest abuse, had a 300% higher risk of death compared to those who had not been abused.

• ~ 50% of people with dementia experience some kind of abuse.

• The fiscal impact: ▫direct medical costs from violent injuries > $5.3 billion ▫financial loss by victims of financial exploitation > $2.9 billion

http://www.ncea.aoa.gov/Library/Data/index.aspxNYS Elder Abuse Prevalence Study; Weill Cornell Medical College, NYC Department for the Aging; Lifespan; (2011)

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Texas Data• Since the 1980s, states have been enacting laws related to the abuse, neglect and

financial exploitation of elderly residents.

• As part of the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010, the Elder Justice Act (EJA) was the first piece of federal legislation passed to authorize a specific source of federal funds to address elder abuse, neglect and exploitation.

• In 2014, Population of Older Adults aged 65+ n= 3,086,103 Total APS In-Home intakes 103,024 Total Completed Investigations 81,681 (79% of intakes completed) Validated APS investigations 54,731 (67% of validated investigations)

http://www.ncea.aoa.gov/index.aspxhttps://www.dfps.state.tx.us/About_DFPS/Data_Books_and_Annual_Reports/2014/http://www.americanbar.org

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Tarrant County, Texas

Population Data Source: Texas State Data Center, University of Texas (San Antonio). Based on Census 2010 data.

Source: https://www.dfps.state.tx.us/About_DFPS/Data_Books_and_Annual_Reports/2014/

• 4th highest number of Validated In-Home APS Investigations

• As a portion of Region3, Tarrant and Dallas counties contribute greatly to the region’s status:

Highest volume of older adults per Region Highest volume of Validated In-Home APS Investigations

(11,507 – 14% of those in TX)

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Risk Factors for Abuse to an Older Adult

Dementia and Cognitive Impairment

Increased caregiver burden

Domestic Violence Grown Old

Relationships with a history of domestic violence continue

Personal Problems with Abusers

Financial, Medical/Psychiatric, Dependency

Living Arrangements – group settings and social isolation

http://www.ncea.aoa.gov/faq/index.aspx

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Level Strategy FWSCC Elder Abuse Prevention Task Force Strategies

6 Influencing Policy and Legislation

5 Changing Organizational Practices

4 Fostering Coalitions and Networks

3 Educating Providers

2 Promoting Community Education

1 Strengthening Individual Knowledge and Skills

Strategies

Established County’s Adult Fatality Review Team, Involvement of the TSHL

Create and studying a screening tool for first responders, Improved tool for investigation

•Develop task force membership•Active participation and coordination among existing collaboratives re: Elder AbuseDetermine need for education to care providers about assessments and reporting

Promote through community events

Identify resources for available to the public for individual use

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Results•Expanded task force•Provider education•Enhanced Awareness•Support Stress Buster Classes for Caregivers•First Responders involvement•Grant Activity•Adult Fatality Review Task Force

D.E.T.E.C.T.

Public Health Problem: Falls• Every 29 minutes an older adult dies from a fall

• 1 in 3 community dwelling adults ≥65 yrs fall each year

• Those who fall are 2-3 times more likely to fall again

• Each year, over 2 million older adults are treated in emergency departments for nonfatal fall injuries, with about 30% requiring hospitalization

• The annual cost of injuries from falls in those ≥65 is estimated at $30 billionSource: CDC, Retrieved at http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

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Texas Data

A fall is the leading cause of injury in for ages 45+ (Texas EMS/Trauma Registry, 2013)

• 60,692 hospitalizations due to a fall

• Falls make up almost half of all injuries reported to the registry

• 45% were male, 55% were female

• Over half were 65 years old or older

Source: CDC.gov/injury/wisqars

Fort Worth: JPS Health Network• In 2013, ▫701 total admits for fall ▫67 average number of falls

per month ▫29% of all trauma

admissions• In 2014,▫850 total admits for falls▫73.4 average number of falls

per month▫31% of all trauma

admissionsSource: JPS Health Network Trauma Registry 2013 and 2014

Modifiable Risk FactorsBiological

Leg weaknessMobility ProblemsBalance Problems

Poor Vision

EnvironmentalClutter & tripping hazardsAbsences of stair railings

or grab barsPoor lighting

BehavioralPsychoactive medications

PolypharmacyRisky behaviors

Inactivity

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Falls Prevention Task Force

Cross-sector collaboration

Aging Services

FirstResponders

County Government

Public Health

Healthcare Systems

Higher Education

•SCS•AAA•United Way•MOW

•FWFD•FWPD•MedStar

Univ. of North Texas Health Science Center (UNTHSC)

Judge Whitley’s Office

Tarrant County Public Health Dept.

• Texas Health Resources•JPS Health Network•UNTHSC•Healthsouth•PCPs

StrategiesLevel Strategy FWSCC Falls Safety Task Force Strategies

6 Influencing Policy and Legislation

Letter to local government to introduce task force, falls impact, need for falls prevention

5 Changing Organizational Practices

Create opportunities for hospitals and providers to directly connect patients to community programs

4 Fostering Coalitions and Networks

•Develop task force membership•Active participation and coordination among coalitions regarding falls prevention

3 Educating Providers-

Education to providers about evidence based practices and community based programs

2 Promoting Community Education programs at community

• Geomapping of target areas•Promote events

1 Strengthening Individual Knowledge and Skills

•Identify gaps in services

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Results•Expanded task force•Provider education•Community education•AMOB classes•Home Meds screenings•Geomapping•First Responders program•Prescription Pads

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Problem: Mental Health Needs• 20% of people age 65+ experience some type

of mental health concern.• The most common mental health concerns are

anxiety, severe cognitive impairment and mood disorders.

• Older men have the highest suicide rate of any age group.

• Older adults with depression have higher health care and medication use, and longer hospital stays.

• Older adults are less likely to receive mental health services than younger and middle aged adults.

APA Office on Aging at http://www.apa.org/about/gr/issues/aging/mental-health.; “State of Mental Health and Aging in America” CDC, 2008, Retrieved at http://www.cdc.gov/aging/pdf/mental_health.pdf

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Narrow Focus: Suicide in the Elderly• Older adults make up 12% of the US population but account for 18% of all

suicide deaths

• Elder suicide may be underreported by up to 40%

• Most elder suicide victims live with relatives or are in regular contact with friends and family.

• 70% if elder suicide victims die within one month of a primary care visit.

• Community agencies are often focus on independence or self-sufficiency

American Association for Marriage and Family Therapyhttp://www.aamft.org/iMIS15/AAMFT/Content/Consumer_Updates/Suicide_in_the_Elderly.aspx

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Activity•Using the handout,▫Assess current interventions▫Identify gaps in each level▫Brainstorm possible strategies

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Level Strategy Examples

6 Influencing Policy and Legislation

5 Changing Organizational Practices

4 Fostering Coalitions and Networks

3 Educating Providers

2 Promoting Community Education

1 Strengthening Individual Knowledge and Skills

Strategies

Funding and legislative initiatives to address this preventative tragedy

Utilize screening tools for early recognition of depression, mental health concerns•Develop task force membership•Active participation and coordination among existing collaboratives

Assess and recognize of risk factors for self-harm, offer treatment for person and support system

Campaign on mental health awareness, depression not normal aging, prevention strategies

Empower person and support system with tools for recognition, management and prevention

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Q&AAmanda Robbins MS, APRN, GCNS-BCNICHE Coordinator, Texas Health Hospital Fort Worth817.250.5088AmandaRobbins@texashealth.org

Jennifer Severance Ph.D.Program Manager, Senior Citizen Services of Greater Tarrant County, Inc.817.413.4949 ext 226JSeverance@scstc.org

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Resources• www.cdc.gov/injury• www.stopfalls.org• CDC.gov/homeandrecreationalsafety/falls/adultfalls • www.preventioninstitute.org • www.who.int/en/• www.nsc.org/pages/home.aspx• www.ncea.aoa.gov/index.aspx• www.dfps.state.tx.us/About_DFPS/Data_Books_and_Annual_Reports/• www.americanbar.org