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Learning Together, Working Together
An Interprofessional Approach to
Falls and Gait Assessment
Steve Jernigan, PT, PhD
Laura Zahner, PT
Kelli Reiling, OTD, OTR/L
Shelley Bhattacharya, DO, MPH
Mandi Sehgal, MD
Crystal Burkhardt, PharmD, MBA, BCPS
Myra Hyatt, LMSW
Dory Sabata, OTD
1
Outline
Fall Defined Risk Factors for Falls Fall Risk Assessment Fall Risk Considerations Environmental Context
2
Falls Defined – Collaborate What is a “fall”?
Organize yourselves into IP groups (no more than 2 from each profession in each group)
Develop your BEST interprofessional definition for a “fall” that you will use in the clinicConsider your definition as a healthcare
providerConsider how your patient might define a
“fall” – this is important Report out
3
Risk Factors for Falls – Collaborate
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.
In the same IP groups, decide which of the following factors each of your professions would most likely be able to address during the course of a usual patient care visit.
Consider also which other professions should be included. Report Out
Guideline for the Prevention of Falls in Older Persons
Journal of the American Geriatrics SocietyVolume 49, Issue 5, pages 664-672, 21 DEC 2001 DOI: 10.1046/j.1532-5415.2001.49115.xhttp://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2001.49115.x/full#f1
9Podsiadlo, D., & Richardson, S. (1991). The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 39(2), 142-148.
10Whitney, 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.
11Berg, 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.
12Buatois 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.
History of falls (yes/no) Secondary Diagnosis (yes/no) Ambulatory Aid (bed rest/nurse assist, crutches/cane/walker, furniture) IV/Heparin Lock (yes/no) Gait/Transferring (Normal/bed rest/immobile, weak, impaired) Mental Status (Oriented to own ability, forgets limitations)
Classifies fall risk No Risk (0-24) Low Risk (25-50) High Risk (≥ 50)
Environmental Context In your interprofessional groups, what would each professional
want to assess in the home environment context? Environmental Assessment
Home Environment OT/PT referral Useful tools:
http://agingresearch.buffalo.edu/hssat/assessment.pdf http://www.enabler.nu/Screeningtool.pdf Comprehensive Assessment and Solution Process for Aging Residents (EHLS)
Community Environment Personal
See Common Fall Prevention Strategies handout – related to these environments