Physicians who treat older adult patients know how devastating a fall can be to
an individual?s overall health and well-being. Over 2 million people age 65 and
older are treated in the emergency room (ER) for fall-related injuries each
year; nearly 600,000 are admitted to the hospital.
1 The most common
non-fatal fall injuries are fractures — and they are also the most
costly. In addition to the direct costs of fall-related injuries, about 30
percent of patients need help with daily activities while they recover, often
for an extended period of time.
2 Falling can also take a toll on the
quality of life for older adults. Many older adult patients voluntarily limit
their activities for fear of another fall and never completely regain their
independence. This chain of events can lead to nursing home care and early
death.
1
Falls go unreported
Despite the high rate of falls among people 65 and older (one in three falls
each year), these events may not come to the primary care provider?s attention
unless a patient receives hospital or ER care.
3 In the 2002
Medicare Current Beneficiaries Survey (MCBS), fewer than half of the
respondents reported telling their physician about a fall in the previous
year.
4 Since even minor falls can signal potentially dangerous
balance problems, it is important to actively collect information from your
patients about their fall history at least every 12 months.
5
Managing fall risk
To help health insurance plans and providers identify and manage patients at
high risk of fall-related injury, the Medicare Health Outcomes Survey (HOS)
collects data on the percentage of plan members who have falling, walking, or
balancing problems and who discussed the problem with their physician and
received treatment.
A health plan receives a 4-star rating from the Centers for Medicare & Medicaid
Services if at least 59 percent of members seen in the last year and identified
as at-risk for falling receive an intervention from their current practitioner.
A positive response of 76 percent or above earns 5-stars.
6 Keystone
65 HMO (at 68 percent) and Personal Choice 65
SM PPO (at 63 percent)
both currently have a 4-star rating for this measure.
Talking to your patients about falls
Including questions from the HOS in conversations with your patients is a good
starting point for identifying high-risk individuals. Specifically, the HOS
survey asks:
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A fall is when your body goes to the ground without being pushed. In the past
12 months, did you talk with your doctor or other health provider about falling
or problems with balance or walking?
Did you fall in the past 12 months?
Has your doctor or other health provider done anything to help prevent falls or
treat problems with balance or walking? Some things he or she might do include:
suggest that you use a cane or walker;
check your blood pressure lying down or standing;
suggest that you do an exercise or physical therapy program;
suggest vision or hearing testing.
Defining falls
When talking to your patients about their fall history, it is key to arrive at
a common definition of a "fall." Technically, a fall involves the body coming
in contact with the ground; however, a variety of terms are used
interchangeably in casual conversation. When discussing falls with your
patients, be sure to also explore events such as slips, trips, missteps, or
near-falls even if they did not result in contact with the ground. These
problems can be warning signs of balance or gait irregularities that could lead
to injury down the road.
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Reducing falls
The Updated American Geriatrics Society/British Geriatrics Society Clinical
Practice Guideline for Prevention of Falls in Older Persons (2010) suggests a
?multifactorial intervention? approach to fall prevention in community-dwelling
seniors.
Depending on the needs of the individual patient, components may
include:
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lowering doses of medications that have been linked to falls;
designing a customized exercise program that includes cardiovascular,
strengthening, flexibility, and balance activities;
correcting vision problems;
managing postural hypotension;
managing heart rate and rhythm abnormalities;
prescribing vitamin D supplementation;
treating foot problems and recommending proper footwear;
modifying the home environment to reduce falling hazards;
providing education on fall prevention.
If you have patients who need additional support with fall prevention, consider
referring them to a Health Coach. Health Coaches — health care
professionals such as registered nurses — from the
Connections
SM Program are available to speak with your patients
about preventing falls. Plus they can provide information and support for some
of the most common chronic conditions.
To learn more about the health coaching services available to our members, call
1-866-866-4694 or refer to our
Connections
Health Management Program web page.
You can also refer a patient for Health Coaching by completing the online
Physician Referral Form.
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