Fall Prevention for Older Adults

(see report: Falls and Fall Injuries Among Michigan's Older Adults, 2004)

To address fall injury prevention in adults 65 and older, the Injury & Violence Prevention Section of the Michigan Department of Community Health received a three-year grant from the Centers for Disease Control and Prevention, effective October 1, 2002. Through this grant, the IVPS develops, implements, and evaluates hospital-based geriatric fall prevention clinics using a research design. Two Michigan hospitals offer interventions and referrals through the clinics to patients 65 and older identified in the Emergency Department (ED), whose visit was the result of a fall or fall injury.  The two hospitals are Crittenton Hospital Medical Center in Rochester and Genesys Regional Medical Center in Grand Blanc.

In the fall prevention clinics, the two hospitals offer multi-factorial interventions and referrals to reduce fall risk.  Interventions include counseling and education of patients and their families; provision of a fall-related home hazard assessment; a review of medications; lessons in Tai Chi; and referrals to other Medicare-reimbursable hospital services.  These services include vision testing; physical therapy for gait, balance and muscle strengthening; treatment of chronic and acute conditions that can lead to falls (e.g., cardiac conditions, incontinence), and bone mineral density testing for osteoporosis.  Intervention and control group patients are followed monthly and at six-month and one-year intervals to assess changes in risk factors and to document subsequent falls and fall injuries.

In addition to the fall prevention clinics and FRAT, a third project component is the development of training courses for interdisciplinary providers to improve their skills in identifying and managing adults over the age of 65 with fall injuries.  Project staff have developed courses for nurses, physicians, physical therapists and occupational therapists; the courses for nurses and physical therapists have been approved for continuing education credits.

Evaluation of the interventions focuses on the outcomes of reducing falls and fall injuries, quality of life issues for older adults and their caregivers and changes in health professionals' knowledge and behavior regarding fall risk assessment and management.  Process evaluation, including focus groups of older adults, addresses the factors of the intervention that ensure successful outcomes.