Importance of Falls Prevention
Falls prevention among geriatric patients takes a coalition of EMS professionals, public health officials, injury prevention specialists, hospital staff, patient personal physicians, pharmacists, exercise specialists, and more. I recently discussed prevention and program design with Colleen Campbell, Senior Injury Prevention Coordinator for the Alameda County Public Health Department Emergency Medical Services.
Ms. Campbell described the multiple efforts of the Alameda County Public Health Department to reduce falls by seniors in a large and densely populated county. After working on falls prevention related programs for more than twelve years she explained that it is “most important to incorporate fall prevention into services that already exist.”
Make Fall Prevention part of Existing Services
An EMS agency that wants to make an immediate impact after receiving a fall prevention funding grant may want to charge into the community and start making a difference immediately with a new program, but Ms. Campbell advises a long-term approach that will help the fall prevention program survive. She said, “The development is slower, but that leads to sustainability for the fall prevention program.”
EMS agencies can help create or join existing coalitions of community organizations that focus on older adult injury prevention. A broader based focus will include senior safety while driving, other types of injury prevention like food safety, and preparation for natural disasters that are community or region specific. In Wisconsin older adults need to be prepared for winter weather. Older adults in Alameda County need to be prepared for earthquakes.
Fall prevention can and should be integrated into many existing services. Does your community have a regular meal schedule at a senior center or other community building? The Alameda County falls program invites pharmacists to deliver presentations at congregate meal sites. Older adult attendees bring a “brown bag” or list of their medications to have them reviewed by a pharmacist. After reviewing the medications the pharmacist can advise the older adult on medication precautions and the need to check with their personal physician about potential medication interactions that could increase falls risk or cause other problems.
By maintaining the general health of the older adult with programs that include staying physically active, proper nutrition, and medication management EMS agencies and coalition partners can impact older adult’s overall health and prevent falls. Ms. Campbell explained, “4,000 people over age 60 are hospitalized in California each year just from medication mismanagement.” Medication mismanagement is a significant fall risk factor.
Innovative Fall Prevention Program
EMS professionals routinely transport geriatric patients from the hospital to home. On these discharge runs the patient is well enough to go home, but to sick and or lacking the friend or family support or resources for a ride in a private vehicle or other type of transport. Unfortunately, the patient is usually returning to the same home that has the same fall and safety hazards that existed before they left for the hospital. Many of those hazards may now be exacerbated because the patient has reduced or impaired mobility, is taking more medications and or new medications, and is being cared for by a spouse or friend that is now at risk of a fall while assisting to the patient.
An innovative program in Alameda County recognizes the problem of falls prevention and engages EMS professionals to talk about falls prevention with patients and their caregivers at the time of discharge. The BLS hospital to home program is a collaboration of the Alameda County EMS Senior Injury Prevention Program (SIPP) and the BLS ambulance providers in the county. Colleen Campbell of Alameda County Public Health and Lauri McFadden of American Medical Response, along with other coalition partners, launched the program when they realized the tremendous opportunity for EMS providers to assist with falls prevention at this critical point in patient care.
Every BLS ambulance in Alameda County has a one-page script for the EMS professionals to review the contents of a large red folder with the patient and their caregivers. The script is used to describe these folder contents:
- Existing community services for older adults
- Local transportation options for older adults
- Fall prevention manual with information on medication management, behavior modification, nutrition, and home safety checklist
- Medication management form
The most comprehensive portion of the scripted conversation is about medication management. The EMT explains the hazards of taking multiple medications, documenting all medications on a medication form, and bringing that medication form to every physician appointment. The form includes recommended questions for the patient to ask their physician about their medications.
The script and red folder contents take ten to twenty minutes for the EMT to review with the patient. Since the inception of the program packets have been distributed to several hundred patients. EMTs enjoy doing this because they know they are potentially preventing a future call and many of them have older adult friends and relatives that have been injured from a fall. Lauri McFadden, Alameda County Operations for AMR shared this quote from EMT Cary Shelby, “We arrived at the patient’s residence where all his family members were eagerly awaiting his arrival. We took advantage of the moment and began to explain the information in the packet, which had all the answers to the questions that they asked. The packet contained all the information that the family needed to build their confidence on how to better take care of their sick family member.”
Alameda County has made their BLS Hospital to Home Discharge program resources available to other EMS professionals and agencies:
- Preventing Falls for Sixty Plus Adults – PDF document link
- BLS Provider Hospital to Home Discharge Script – Word document link
- Medication List with Questions for my Doctor and Pharmacist – Word document link
For additional information browse to Alameda County EMS Senior Injury Prevention Program
