Best Practice Guidelines for Fall Prevention in Assisted Living

November 20th, 2008

Promoting Active Living (PAL)

PAL Project Sponsors:

Slide 3

Acknowledgements

• Staff, Residents, Administration of:– Elim Housing Society – Nikkei home

• Collaborators:– Suni Arinobu– Marcia Carr– Marian Heemskerk– Keith McBain– Rachel Miles– Giulia Scime

• Research team: – Vicky Scott– Hansdeep Bawa– Fabio Feldman– Joanie Sims Gould– Ming Leung– Nikki Tan

Slide 4

The PAL Project – Goals & Objectives

• Goal: to develop practical, user-friendly guidelines tailored to the fall risk profiles of seniors living in Assisted Living Facilities

• Objective: Test the feasibility of evidence-based fall prevention strategies in Assisted Living settings in a 1-year ‘action’ research project

Slide 5

The PAL Project – Methodology

• Baseline assessments using:– Timed Up and Go (TUG) tests

• Prior falls history• Staff and resident focus groups on their

perceptions of fall risk and prevention• Implemented interventions based on staff

and resident survey, focus group findings, current AL practices, and relevant evidence

Slide 6

• Self monitoring, tracking, & reporting of all falls by residents– Client Calendar

• Surveillance and tracking of all falls– Fall Report form

The PAL Project – Interventions

Slide 7

• Promoting and encouraging physical activity– At home balance & strength

exercises – OsteoFit on-site (group classes for

education, lifestyle management & exercise)

– Recommendations for a facility-wide exercise room and equipment

The PAL Project – Interventions

Slide 8

• Individual education – Checklist & Action Plan: An education booklet

• Group education – Monthly Education sessions

The PAL Project – Interventions

Slide 9

PAL Monthly Education Sessions

1. Walker Clinic2. Hip Protector/

Blood Pressure3. Vision 4. Feet and Footwear5. Incontinence 6. Medications

N=73 (38%)N=40 (31%)N=33 (51%)Total # of fallers

N=155N=84N=71Total # of falls

BothSite 2Site 1

PAL Fall Report Findings Total number of residents = 192

2.111.752.82Rate of fallers per 1,000 resident days

4.483.676.07Rate of falls per 1,000 resident days

BothSite 2Site 1

PAL Fall Report Findings

Rate of Falls per 1,000 Resident DaysBoth Sites (Aug 07 - Jan 08)

5.73

3.24

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

Aug-Oct Nov-Jan

Fall

Rate

per

1,0

00 R

esi

dent

Day

N=192

Falls by Month By Sites (Aug 07 - Jan 08)

11

17 17

8

13

5

24

15 1514

7

9

0

5

10

15

20

25

30

August September October November December January

Month

# o

f fa

lls

Site 1

Site 2

PAL Fall Report Findings

PAL Fall Report Findings

Location of FallBoth Sites (Aug 07 - Jan 08)

2

2

3

5

7

7

8

15

19

21

66

0 10 20 30 40 50 60 70

Unknown

Public grounds

Grounds of AL facility

Other

Dining Room

Transition area

Hallway

Kitchen

Living/Family room

Bathroom

Bedroom

Number of falls

PAL Fall Report Findings

Activity at Time of FallBoth Sites (Aug 07 - Jan 08)

16

1

1

5

5

6

7

12

16

16

69

0 20 40 60 80

Unknown

Bathing

Working in yard

Dressing Undressing

Using toilet

Other

Turning

Getting in/out of bed

Bending/ Reaching

Standing up/ Sitting down from seat

Walking

PAL Fall Report Findings

Injurious FallsBoth Sites (Aug 07 - Jan 08)

Injury46%

No Injury54%

Fractured bones N=4

Cuts/Scrapes/Abrasions N=17

Bump on Head N=15

Bruises/redness/swelling N=21

Pain N=37

Slide 17

PAL Best Practice Guidelines – Summary

Step 3: Evaluation

Step 1: Assessment

Step 2: Implementation

1. Prior Falls2. Timed Up and Go (TUG)3. Post fall assessment

1: Fall Report form2: Monthly Calendar3: Individual & Group Education 4: Physical Activity5: Equipment/Assistive aides

1. Monthly summary report2. Repeat TUG3. Care plans for high-risk fallers4. Community action

Slide 18

PAL Project – Next Steps

• Disseminate Best Practice Guidelines to all registered ALRs in BC

• Develop provincial PAL Training Program for ALR Staff

• Merge Guidelines on Physical Activity in AL with PAL Guidelines - BC Recreation and Parks Association (April – Dec 2008)

Slide 19

“Falls do happen. But I think it the PAL project makes us realize how common it

is, and how easily we can prevent it.”

(AL Staff, PAL focus groups, 2007)

Slide 20

Thank You!