ACOVE 2: Falls and MobilityACOVE 2: Falls and Mobility

Falls PretestQuestion 1

n = 67

ACOVE 2Falls and MobilityQuality Indicators

• All elders 65+ should have documentation that they All elders 65+ should have documentation that they were asked annually about falls.were asked annually about falls.

• If a 65+ elder reports a history of 2 or more falls (or 1 If a 65+ elder reports a history of 2 or more falls (or 1 fall with injury) in the previous year, then there should fall with injury) in the previous year, then there should be documentation of a basic fall history.be documentation of a basic fall history.

• If a 65+ elder reports a history of 2 or more falls (or 1 If a 65+ elder reports a history of 2 or more falls (or 1 fall with injury) in the previous year, then there should fall with injury) in the previous year, then there should be documentation of a basic exam.be documentation of a basic exam.

ACOVE 2 Falls and MobilityLearning Objectives

Knowledge:

1. Understand consequences of falls

2. Identify risk factors for falls

3. Understand the Fall Assessment algorithm

4. Improve knowledge about:1. Gait and balance disorders in elders2. Assessments3. Fall evaluation and intervention

 

Evaluation of falls includes:

•Medication review

•Timed Up and Go (TUG) test

•Visual acuity testing

•Orthostatic blood pressure

Falls and Mobility in AgingEach year, thousands of Americans 65 and over fall, resulting in:

Restricted mobility, Decreased ADL’s, Increased nursing home placement, and Increased risk for death

Risk factors for falls include:

•4 or more medications

•Gait & balance abnormality

•Decreased visual acuity

•Orthostatic hypotension

Brief Fall History

•Circumstances•Medications•Chronic conditions•Mobility•ETOH intake Do Falls Assessment

•Vitals – Orthostatics if indicated•Visual assessment•Lower extremity strength•Targeted neuro exam•Timed Up & Go test•Cardiac evalif symptoms suggest syncope

Perform Timed Up & Go test

Consider recommending exercise program Intervention Options

•Gait, balance & exercise programs•Medication modification•Postural hypotension treatment•Environmental hazard modification•Cardiovascular disorder treatment

ReferenceChang, T.T. and David A. Ganz. Quality Indicators for Falls and

Mobility Problems in Vulnerable Elders. JAGS 55-S327-S334, 2007.

Single fall with no injury

2 or more falls, 1 fall with injury

Fall reported in

last year

ABNORMAL

NORMAL

Supported by a grant from the DW Reynolds Foundation

ACOVE 2 Falls and MobilityLearning Objectives

Skills:

1. Evaluate medications

2. Evaluate gait/mobility

3. Appropriate referral and self-management education

ACOVE 2 Falls and MobilityDetailing Key Messages

Consequences of Falls

Risk Factors for Falls

Evaluation & Treatment

Restricted Mobility More than 4 Medications

Medication Review

Decreased ADLs Gait & Balance Abnormalities

Gait & Balance Evaluation (TUG)

Increased NH Placement

Decreased Visual Acuity

Referral to PT

Increased Risk for Death

Orthostatic Hypotension

Vision Evaluation

Depressive Symptoms Orthostatic Hypotension

Cognitive Impairment

ACOVE 2 Falls and MobilityACOVE 2 Falls and MobilityWhat We Hope to AchieveWhat We Hope to Achieve

At UIM:At UIM:

1.1.Improved Improved risk factor managementrisk factor management and prevention and prevention of future falls.of future falls.

2.2. Early interventionEarly intervention, BEFORE falls occur., BEFORE falls occur.

3.3. Discontinuation or avoidance of Discontinuation or avoidance of high risk high risk medicationsmedications..

ACOVE 2 Falls and MobilityACOVE 2 Falls and MobilityWhat We Hope to AchieveWhat We Hope to Achieve

In the Hospital: In the Hospital:   

1.1.Knowledge learned in the clinic will Knowledge learned in the clinic will persist:persist: – Consider patient stability at discharge Consider patient stability at discharge – Consider need for Physical TherapyConsider need for Physical Therapy

2.2.Avoid high risk medications.Avoid high risk medications.

From Knowledge to From Knowledge to Performance:Performance:Intervention Sequence for each ACOVEIntervention Sequence for each ACOVE

Faculty & intervention Development

Resident Lecture

Identify Patients at the time of care

Cue MDs to act

Provide decision support

Record data on clinical intervention

Assess performance:Extract and analyze Clinical data

Resident Detailing

ACOVE 3: Dementia and AgingACOVE 3: Dementia and AgingQuality IndicatorsQuality Indicators

Out-Patient:Out-Patient:  • If new to a primary care practice or inpatient service…

• Cognitive and Functional Screening • Annual evaluation for changes in memory and function.

• IF screens positive for dementia… • Clinical Cognitive Evaluation

• IF screens positive for dementia… • Medication Review

• IF newly diagnosed with dementia… • Neurological Examination

• IF newly diagnosed with dementia…• Laboratory Testing

In-Patient:In-Patient:

• IF a VE has a diagnosed dementia, • Depression Screening

• IF a VE with dementia has a caregiver…• Caregiver Support and Patient Safety Information

• IF a VE with dementia is physically restrained in the hospital…• Safety concerns justifying the use of restraints

should be documented in the medical record and communicated to the patient, caregiver, or guardian.

ACOVE 3 DementiaACOVE 3 DementiaThe 3 D’sThe 3 D’sDementia – Depression – DeliriumDementia – Depression – DeliriumLearning Objectives:Learning Objectives:

• Learn the testing characteristics of the Learn the testing characteristics of the Mini-Cog and PHQ2 screensMini-Cog and PHQ2 screens

• Understand the importance of depression Understand the importance of depression screening for demented patientsscreening for demented patients

• Recognize secondary causes of dementiaRecognize secondary causes of dementia

• Differentiate different types of dementiaDifferentiate different types of dementia

• Learn strategies of managing behavioral Learn strategies of managing behavioral symptomssymptoms