8/23/2018 Fall Risk Screening Training and Instructions ENCOURAGING COMMUNITY OUTREACH APTA OF MA GERIATRIC SPECIAL INTEREST GROUP (GSIG) Presenter and Contributors ��������� Carolyn Cwalinski PT, DPT, MS, GCS ������������ ������������������ Carolyn Cwalinski PT, DPT, MS, GCS – Chair Laurel Mangelynkx PT, DPT, GCS – Vice Chair Catherine McLaughlin PT, DPT, GCS – Treasurer Emily Righter PT, DPT, GCS – Secretary Objectives ���������������������������������������������������� ��������������! Educate community members about the benefit of physical therapy 1. for reducing falls ▶ True Cost of a Fall Poster ▶ Balance Poster Identify community members who are at risk for falling 2. ▶ Fall Risk Screening Refer community members at risk for falling to appropriate 3. professionals ▶ Fall Risk Screening Results Handout 1
8/23/2018 Objectives Continued Educate community members about how to decrease their risk of 4. falling ▶ How to Get Up from the Floor Handout (includes facts to decrease risk of falling Educate community members about how to modify their home to 5. decrease their risk of falling ▶ Home Modification Handout Educate community members about how to safely get up from the 6. floor ▶ How to Get Up from the Floor Handout National Fall Prevention Day • National Council on Aging – First day of fall – Sept 22, 2018 • This year is their 10 th annual national fall prevention day • APTA of MA campaign will run from Sept 20;23 (Thurs;Sun) Planning for the day ● FAQ about holding a fall screening 2
8/23/2018 Planning ▶ Where should I hold the fall risk screening? ▶ You can hold the screening in a variety of places: Physical therapy clinic ▶ Church function room ▶ Senior center ▶ Doctors office ▶ Library ▶ Town hall ▶ Pharmacy/drug store ▶ GSIG Board Member Performing Balance Tests while Advocating at the State House Planning ▶ How much time do I need to conduct a fall risk screening? This will depend on how many people attend and how many ▶ people are helping to run the screening. We generally allot around 20;25 mins per participant to ▶ complete the screening. TUG < 5 mins ▶ 30 second sit to stand < 3 mins ▶ 10 Meter walk test < 5 mins ▶ 4 stage balance test (including SLS) < 5mins ▶ Review of results ~ 5 mins ▶ We generally allot 3;4 hours for the entire event. ▶ ��������������������������������������������������������������������������������������������������� Planning ▶ How much space will I need? ▶ Again, this depends on if you are doing one person at a time or multiple stations approach. ▶ Generally, we allot a minimum of 6’ x 35’ – enough to perform the 10 meter walk test 3
8/23/2018 Planning ▶ What kind of supplies do I need to do a fall risk screening? ▶ Stop watch ▶ Standard chair (18” high with arm rests) ▶ Tape for floor ▶ Handouts ▶ Posters Planning ▶ What additional (optional) resources might be included in a fall risk screening? ▶ Food/snacks ▶ Drinks Planning – TO DO List In general….. Months/Weeks Prior ▶ Secure location ▶ Market event: senior centers, doctor’s offices, churches – we ▶ have flyers you can use to send out. Gather/purchase supplies for tests ▶ Print handouts – we will provide these to you! ▶ Print posters – we will provide these to you! ▶ Week before ▶ Order food ▶ Day of ▶ Set up area/stations ▶ 4
8/23/2018 The day has come! ● Overview ● Stations Overview of Day ��������� May do all of these at one station or have separate stations depending on how many people are helping day of and the amount of space you have. • Registration • Testing • Review of results Registration Station Registration ▶ Have person fill out the first page of your participant screening sheet which contains: ▶ Fall risk checklist ▶ Medication check list ▶ Explain process 5
8/23/2018 Testing Area • Tests ▶ 30 second sit to stand ▶ TUG ▶ Walking speed ; 10 Meter Walk test ▶ 4 Stage Balance Test ▶ Optional Additions (info at end of presentation) ▶ Vital signs Orthostatic hypotension test ▶ Exercise;induced ▶ hypertension ▶ Cognitive screen GSIG Board Member Performing a Test at the State House A Bit of Background Why did we choose the tests we chose? CDC RECOMMENDATIONS • STEADI Program ; Stopping Elderly Accidents, Deaths, & • Injuries Initiative TUG • 4 Stage Balance Test • 30 second sit to stand • Vital signs – orthostatic hypotension • SYSTEMATIC REVIEW WITH META ; ANALYSIS BY LUSARDI ET AL. • (2017) Determining Risk of Falls in Community Dwelling Older • Adults: A Systematic Review and Meta;analysis Using Posttest Probability Single leg stance – eyes open • Walking speed – 10 meter walk test • What do they promote? According to systematic review with meta;analysis from 2017 – CDC STEADI materials Algorithm and check list for Fall Assessment and Interventions • • Functional Assessments Medication Review • Other Tools • Fall Prevention Referral Form ▶ Falls Risk checklist ▶ According to systematic review with meta;analysis from 20003 – updated 2015 – Lusardi et al. To identify persons in need of more in;depth examination of balance: 5 simple medical history questions (yes/no) ▶ Any previous falls ▶ Psychoactive medication ▶ List of meds: http://whatmeds.stanford.edu/medications/categories.html ▶ Requiring any ADL assistance ▶ Self;report fear of falling ▶ Ambulatory assistive device use ▶ Centers for Disease Control and Prevention, 2015; Centers for Disease Control and Prevention, 2017; Lusardi et al, 2017 6
8/23/2018 Performing the Tests ● Four stage balance test ● Timed up and go ; TUG ● 30 second sit to stand ● Walking speed – 10 meter walk test Test ; TUG Purpose: Screen mobility, balance, walking ability and fall risk in older adults. Equipment & Set;up: Measure and mark a 3 meter walkway (9.8 feet). ▶ Place a standard height chair (seat height 18''/47 cm and arm ▶ height 67 cm) at the beginning of the walkway. Stopwatch to time test. ▶ Podsiadio & Richardson, 1991; Shumway;Cook et al. 2000 Image: Benavent- Caballer V. (2016). The effectiveness of exercise interventions and the factors associated with the physical performance in older adults. Retrieved from https://www.researchgate. net/profile/Vicent_Benave nt- Caballer/publication/3156 98817/figure/fig1/AS:477 564104908800@149087 1563212/Schematic- illustration-of-the-Timed- Up-and-Go-Test.jpg Test ; TUG General Instructions: Patient Instructions: Subject sits in a standard Instruct the subject to sit in ▶ ▶ armchair, placing their back the chair and place his/her against the chair and resting back against the chair and their arms on the chair’s arms. rest arms on arm rests. Subject can use any assistive ▶ Demonstrate the test to the device for this test. ▶ subject. When the subject is The subject walks to a line that is ▶ ready, say “Go”. The stop 3 meters away, turns around at watch should start when the line, and walks back to the chair and sits back down. you say “Go” and should be stopped when the The test ends when the subject’s ▶ patient’s buttocks touches buttocks touches the seat. the seat. Subject is instructed to use a ▶ comfortable and safe walking Time to complete: speed. < 3 mins ▶ Podsiadlo and Richardson, 1991; University of Missouri, n.d. 7
8/23/2018 Test ; TUG Video Instructions ▶ https://youtu.be/BA7Y_oLElGY Outcomes ▶ "�#$%&���������'�(�������)��������*������ �����+� adults (Shumway;Cook et al, 2000) ▶ > 32.6 seconds = frail elderly (Thomas et al, 2005) ▶ < 20 seconds = independent for basic transfers in community dwelling adults (Podsiadlo and Richardson, 1991) ▶ > 30 seconds = dependent on transfers, needed help to enter/exit shower or tub, did not go out alone (Podsiadlo and Richardson, 1991) Test – 4 Stage Balance Test Purpose: • To assess static balance Equipment: • Stopwatch Time to complete: < 5 mins (including • SLS) Centers for Disease Control and Prevention, 2017; Rossiter-Fornoff, Walf & Wolfson 1995 Test – 4 Stage Balance Test General Instructions: • There are four progressively more challenging positions. Patients should not use an assistive device (cane or walker) and keep their eyes open. • Describe and demonstrate each position. Stand next to the patient, hold his/her arm and help them assume the correct foot position. When the patient is steady, let go, but remain ready to catch the patient if he/she should lose their balance. For each stage, say “Ready, begin” and begin timing. After 10 seconds, say “Stop.” Centers for Disease Control and Prevention, 2017; Rossiter-Fornoff, Walf & Wolfson 1995 8
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