Every 12 to 15 seconds an older adult in this country has a fall. Though not every fall results in injury, the older a person is, the greater the risk of injury, even death. Falls are the leading cause of fatal and nonfatal injuries among older adults, according to the Centers for Disease Control and Prevention. People 85 and older are up to 15 times more likely to sustain hip fractures than individuals under 65. Such an injury often precipitates a cascade of events that diminishes independence and increases medical care and costs.
“Unfortunately, two-thirds of those who experience a fall will fall again within six months,” said Allen County Commissioner of Health Dr. Deborah McMahan, noting falls are the cause of 80 deaths a year, on average, in Allen County. One out of five hip fracture patients dies within a year of the injury, a CDC report shows. But even among older adults who fall but do not require medical care, fewer than half will talk to their healthcare provider about the incident, McMahan said.
Parkview's new Center on Aging and Health will debut in early April with a Fall Prevention Clinic. The center is on the second floor of the Randallia campus Emergency Department, which was the previous home of Parkview Heart Institute. Other collaborating partners in the Fall Prevention Clinic currently include: Aging and In-Home Services of Northeast Indiana; Fort Wayne Neurological Center; and Manchester University School of Pharmacy.
In a recent 12-month period, more than 11,000 fall-related emergency department visits were made at the six Parkview hospitals, said Mike GeRue, senior vice president of Cardiovascular Services and interim senior vice president of Neuroscience Services for Parkview Regional Medical Center and its affiliates. He is also COO of Parkview Heart Institute and is overseeing development of the Center on Aging.
The Fall Prevention Clinic — and other clinics and services that will follow — is “modeled after the Mayo Clinic, with a multidisciplinary team approach,” said Dr. Fen-Lei Chang, a neurologist with Fort Wayne Neurological Center. He is medical director of the Center on Aging and the Fall Prevention Clinic. Falls often have multiple causes ranging from neurological to cardiac to side-effects of medications.
Many reasons for falls
About 70 percent of falls among older adults occur in their place of residence. Environmental conditions such as steps and throw rugs can be hazards. The family may blame the throw rug for causing Grandma's hip fracture, but other reasons may go undetected without a comprehensive assessment, which is what the Fall Prevention Clinic will offer.
“It is really centered on the patient and not the providers,” Chang said. The team — physical and occupational therapists, neurologists, pharmacists, neuropsychologists, social workers and others — assess the patient during the same clinic visit, eliminating the need for multiple doctor appointments. If additional testing is needed, it will be scheduled within a few days. The goal is to have the patient and family return within a week for a debriefing that includes recommendations on therapies, medications and prevention strategies.
“It's important for a quick turnaround to prevent the first fall or a subsequent fall,” GeRue said. “This is not just a one-time thing. We're going to follow these people for a number of years.” Research is a strong component of the Center on Aging. Outcomes will be tracked, trends identified and evidenced-based practice changes implemented. Though phone calls will initially be the means of continued follow-up, GeRue said more high-tech methods that enable virtual face-to-face contact will be used in the near future.
Aging and In-Home Services (AIHS) will provide home safety assessment as well as a certified aging-in-place specialist who is trained to look at the big picture of older adults' needs, explained Chris Forcucci, senior vice president for Integrated Services and Research at AIHS.
“Some folks may know they need something, but they really don't know what it is,” she said. An AIHS social worker, called an options counselor, will discuss with the individual and the family available community services and help them access those services.
Research shows the more co-existing health problems at the time of a fall, the greater the risk of injury leading to hospitalization or a nursing home.
“If you get a fracture, then you sometimes start on that downward spiral,” Forcucci said. According to data from the Agency for Healthcare Research and Quality, more than 50 percent of people with fall-induced fractures require inpatient hospitalization; 41 percent of those individuals subsequently require admission to a long-term care facility.
Reducing suffering and cost
While the chief goal of the Fall Prevention Clinic is reducing pain, suffering and loss of independence, saving healthcare dollars is also a factor. Total direct medical costs of fall injuries for people 65 and older in 2010 was $30 billion. By 2020, the annual direct and indirect cost of fall injuries is projected to reach $68 billion, according to the CDC.
“The financial investment in building a (fall prevention center) and staffing with (the multidisciplinary team) is a better investment for us,” GeRue said, than having patients hospitalized or re-hospitalized due to a fall.
Under Affordable Care Act provisions, Medicare could reduce a hospital's reimbursement rate for all Medicare patients if the facility has a high rate of readmission for patients who were discharged within the previous 30 days. The rules say patient frailty and co-existing health conditions are taken into account, but even if a patient was hospitalized for cardiac care initially, for example, a readmission within 30 days for a hip fracture could increase the hospital's risk for a Medicare penalty.
The Fall Prevention Clinic, which charges an aggregate fee for team assessment rather than a per-doctor fee for most services, opens to patients on April 4, and other clinics such as cardiac care and memory care are in the plans. For more information on Parkview Center on Aging and Health and its Fall Prevention Clinic, call 373-4443.