Learning Together, Working Together An Interprofessional Approach to Falls and Gait Assessment Steve Jernigan, PT, PhD Laura Zahner, PT Dory Sabata, OTD Shelley Bhattacharya, DO, MPH Mandi Sehgal, MD Crystal Burkhardt, PharmD, MBA, BCPS Myra Hyatt, LMSW 1
22
Embed
An Interprofessional Approach to Falls and Gait …1).pdf · An Interprofessional Approach to Falls and Gait Assessment Steve Jernigan, PT, PhD . ... Morse Fall Scale . 7 .
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Learning Together, Working Together
An Interprofessional Approach to Falls and Gait Assessment
Steve Jernigan, PT, PhD Laura Zahner, PT Dory Sabata, OTD Shelley Bhattacharya, DO, MPH
Outline Fall Defined Risk Factors for Falls Fall Risk Assessment Environmental Context Falls Intervention Gait Assessment Approaches & Terminology
2
Fall Defined What is a “fall”? Healthcare providers How do different healthcare professions
define falls? Researchers Patient
Important to clarify what we mean when we ask our patients/clients about “falls”.
3
Presenter
Presentation Notes
An event that results in a person coming to rest unintentionally on the ground or other level, not as the result of a major intrinsic event or overwhelming hazard. Injured or not? (report only serious falls) Loss of balance but did not fall
Risk Factors for Falls Fall history Muscle weakness Sensory deficits Balance problems Gait problems Assistive device use Visual deficits Arthritis Depression ADL limitations Age > 80 years Sex (Female)
BMI (> 30) Physical activity levels Fear of falling Polypharmacy Certain medications (e.g.
psychotropic medications) Extrinsic factors
(environment) * Clearly necessitates a multifactorial assessment
4
Fall Risk Assessment Do different healthcare professions have different approaches to
fall risk assessment? How are the approaches different? Subjective Exam (History) History of Falls Activity Levels Fear of Falling (Tinetti’s Falls Self-Efficacy Scale, ABC Scale) Risk Awareness Use of Assistive Devices Medication Reconciliation Home Environment
Vision and Hearing How would your assessment change in different patient care
settings?
5
Please note that this slide only covers a few of the essential components to a multi-factorial assessment of fall risk.
Guideline for the Prevention of Falls in Older Persons
Journal of the American Geriatrics Society Volume 49, Issue 5, pages 664-672, 21 DEC 2001 DOI: 10.1046/j.1532-5415.2001.49115.x http://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2001.49115.x/full#f1
*See pdf document
Presenter
Presentation Notes
Algorithm summarizing the assessment and management of falls. IF THIS IMAGE HAS BEEN PROVIDED BY OR IS OWNED BY A THIRD PARTY, AS INDICATED IN THE CAPTION LINE, THEN FURTHER PERMISSION MAY BE NEEDED BEFORE ANY FURTHER USE. PLEASE CONTACT WILEY'S PERMISSIONS DEPARTMENT ON [email protected] OR USE THE RIGHTSLINK SERVICE BY CLICKING ON THE 'REQUEST PERMISSIONS' LINK ACCOMPANYING THIS ARTICLE. WILEY OR AUTHOR OWNED IMAGES MAY BE USED FOR NON-COMMERCIAL PURPOSES, SUBJECT TO PROPER CITATION OF THE ARTICLE, AUTHOR, AND PUBLISHER.
Fall Risk Assessment – Objective Exam Tools Timed Up and Go (Get Up and Go) Dynamic Gait Index Berg Balance Scale Chair Rise Test Morse Fall Scale
7
Presenter
Presentation Notes
Advantages Relatively easy to administer and quick Low financial cost (few resources needed to conduct) Closely related to a person’s function in daily activities Can assess many different domains of balance in one test Some tests are tailored to the functional deficits of certain types of patients Disadvantages Some require clinical judgment and experience Inter-rater and intra-rater reliability concerns Difficult to assess all levels of functional ability with one tool Do not capture all of the environmental contexts that exist in daily activities Often developed with a specific population in mind – validity concerns
Timed Up and Go Test (TUG) Cut-off score for high fall risk (>13.5 seconds) Other cut-off scores?
Quantitative, but consider the qualitative aspects
9 Whitney, S., Wrisley, D., & Furman, J. (2003). Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular dysfunction. Physiother Res Int, 8(4), 178-186.
10 Berg, K. O., Wood-Dauphinee, S. L., Williams, J. I., & Maki, B. (1992). Measuring balance in the elderly: validation of an instrument. Can J Public Health, 83 Suppl 2, S7-11.
11 Buatois S, Miljkovic D, Manckoundia P, Gueguen R, Miget P, Vancon G et al. Five times sit to stand test is a predictor of recurrent falls in healthy community‐living subjects aged 65 and older. J Am Geriatr Soc 2008; 56(8):1575‐1577.
Know what the fall risk cut-off or classification scores are for the tool being used. How does the patient’s score relate to the normative data and/or fall risk classification that has been established? Are there any things you should consider? Validity Floor or Ceiling Effect Reliability It is best to err on the side of caution and take precautions. Important to not assume that a single fall risk assessment tools captures the full picture of fall risk for a single patient. Falls are multifactorial in nature.
Do different healthcare professions approach gait assessment differently? If so, what are the approaches used? Why are they different? Terminology Step length En bloc turns Path deviation Others?
16 Watelain E. et al. Comparison of clinical gait analysis strategies by french neurologists, physiatrists and phyiotherapists. J Rehabilitation Medicine, 2003; 35: 8-14.
Questions Do you have any questions for the other
professions here today, in relationship to falls and/or gait?
17
18
Uniprofessional
Interprofessional
Community Resources National Council on Aging http://www.ncoa.org/improve-health/center-for-healthy-
aging/falls-prevention/
Shepherd’s Center http://www.shepherdscenterkck.org/
Link for Care https://www.linkforcare.org/Provider/SearchByCategory/21
Aging in Place (Lifewise Renovations) http://lifewiserenovations.com/
6 Steps to Prevent a Fall 1. Talk to your health care provider. Ask for a fall risk assessment. 2. Regularly review your medications with your doctor or pharmacist. 3. Get your vision and hearing checked annually & update your glasses. 4. Keep your home safe. Remove tripping hazards, increase lighting, make stairs safe, and install grab bars. 5. Exercise safely based on recommendations from your health care team. 6. Talk to your family and friends. Falls are not just a senior’s issue.
20
Community Resources ASSISTIVE TECHNOLOGY Assistive Technology for Kansans 785-267-1717 Rehabilitation Institute of KC 816-751-7783
EMERGENCY MEDICAL ASSISTANCE DEVICES Alert 1 888-744-9890 Phone-4-Help 800-842-0074
EXERCISE PROGRAMS Landon Center on Aging 913-588-0716 YMCA of Greater KC 816-561-9622 YMCA KCK 913-378-9255
21
Community Resources EXERCISE PROGRAMS Gold’s Gym KCMO Silver Sneakers 816-931-9888 Bethel Neighborhood Center 913-371-8218
FOR THE HOME Amramp Kansas City (home ramps) 816-916-7277 Bath Innovations Walk-In Bathtubs 913-912-1750 Mobility First 816-350-7600
VESTIBULAR REHABILITATION Blue Valley Physical Therapy 913-897-1100