Falls Prevention: Making Sure Seniors Who Stay Home Can Stay on Their Feet
In the midst of the coronavirus pandemic, home is the safest place to be for many seniors. But an extra level of attention is needed to make sure home is safe from falls for seniors who may be unsteady on their feet, taking multiple medications, suffering from chronic conditions, or recovering from COVID-19. Each year, one in four Americans age 65 and older falls. In fact, falls are the leading cause of both fatal injuries and nonfatal trauma-related hospital admissions among older adults, according to the National Council on Aging.
Falls among seniors happen primarily in the home, and they can lead to more than broken bones. They can erode confidence, leading to lingering weakness, decreased activity, and isolation and depression — often triggering a downward spiral in physical and mental health that can ultimately rob a senior of his or her independence.
At VNSNY CHOICE Health Plans, where I work, we are committed to helping seniors remain healthy and independent in their homes as long as possible, and falls prevention is at the core of many our members’ plans of care.
With all this in mind, the VNSNY Data Science Team developed a predictive model using an advanced machine learning algorithm to estimate the probability that a CHOICE member may experience a fall within the next 90 days. The model was built to leverage all the information captured on the Uniform Assessment System (UAS-NY) form and to rank members at highest risk for falling in order to support preventive clinical decision making. This UAS-NY assessment model is part of a new Falls Prevention program being piloted by the VNSNY CHOICE Quality team, in which a dedicated Falls Prevention clinical navigator uses the model to identify high risk members for potential clinical interventions such as physical therapy or support from a para-professional. Details are discussed with each member individually and also with the member’s primary care physician (PCP) before being implemented in the member’s customized plan of care.
When needed, Licensed Home Care Service Agency (LHCSA) partners receive a checklist that is completed in the home of each member to assess for common fall risks related to durable medical equipment (DME), and home safety issues such as clutter, absence of grab bars, adequate lighting and rugs, electrical cords or other obstacles that create a risk for falls.
With many seniors being more isolated than ever due to the risk of coronavirus, these assessments and ongoing conversations with clinical care coordinators are particularly high stakes right now. Even before the pandemic, one in four older Americans reported feeling isolated, according to a national study by the University of Michigan. But now, family members who previously visited their frail or elderly loved ones regularly are staying away to avoid exposing them to the risk of COVID-19. Besides the emotional toll, that means many missed opportunities for family members to notice obstacles on the floor, a burnt-out light bulb, or dizziness from a new medication.
Anyone with an elderly loved one living in the home, in a nursing home, or especially living alone during this time of prolonged social distancing should pay attention to signs and symptoms that may indicate a risk for falls. It is important to observe — whether virtually or in-person — your loved one’s risk for falling. Go from head to toe, beginning with eye health. Regular check-ups and up-to-date glasses prescriptions are imperative. Glaucoma and cataracts, as well as diabetes symptoms, can interfere with vision, which elevates the risk of a fall. Keep loose clothing out of the way, and, when supporting people with pronounced weakness due to illness, injury, surgery or stroke, provide support on the weak side, at the person’s center of gravity. Proper footwear, with a closed toe and back, should be worn at all times, even indoors.
Preventive strategies also include remaining as active and strong as possible; following an appropriate exercise regimen that has been approved by a physician; and positioning one’s body “nose over toes” to avoid leaning back or tilting to one side. Be aware of medication side-effects or changes in medication that could increase imbalance or dizziness. Older people recovering from coronavirus must be especially careful, as weakness, shortness of breath, extreme fatigue and other symptoms can linger for weeks or months. In New York City, where one in three older adults lives alone, the Department of Health has a resource page to help older adults prevent falls while adhering to important stay-at-home recommendations.
As a society, we have all come to better appreciate what those of us in home health care have long known — that while older Americans are an at-risk population and isolation adds to their vulnerability, strategic action can help keep them safe in the sanctuary of their home.
