Our aging population is one of the biggest challenges facing the nation’s health care system. Satellite Beach, Fla., a haven for retirees from colder climates, is facing this issue head on. More than one-fourth of the population is over age 65, according to a recent city survey. That number is projected to rise to more than 30 percent in the next few years.
One result of the aging population is an ever-growing number of 911 calls from seniors who have fallen. Last year, nearly 15 percent of all emergency calls were fall-related, said Don Hughes, deputy chief of operations for the Satellite Beach Fire Department.
Hughes decided to do something about it. “If we do nothing, the numbers are going to get higher,” Hughes said. “We had to come up with a strategy that would actually make an impact.” Two years ago, he spearheaded the Elder Fall Prevention Program in the city.
Falls are a leading cause of injury-related death for adults over the age of 65 in the United States, according to the Centers for Disease Control and Prevention. About 1.8 million people ages 65 and older were treated in emergency rooms for falls in 2005, and 15,800 died from their injuries. As people get into their 80s and 90s, the risk of falling increases.
“Falls in the geriatric population are a very, very serious problem,” said Dr. James Young, chairman of physical medicine and rehabilitation at Rush University Medical Center in Chicago. “The costs are enormous and the outcomes can be very serious. A hip fracture has a 20-percent mortality rate, and 30 percent who fracture a hip are never able to walk without a cane, crutch or walker again.”
A Preventable Injury
The good news is that many falls are preventable. The Satellite Beach program began with firefighters conducting anti-fall education programs at senior centers, churches and restaurants where older people gathered. In 2009, firefighters held four fall-prevention fairs that drew nearly 2,000 people.
Hughes felt they needed to do more, however, to be effective. Since nearly 90 percent of falls occurred in homes, Hughes said, “We needed to get into the environment where people were falling.”
With the help of several county and state grants, his department began offering free in-home, 90-minute risk assessments, during which firefighters go room to room, identifying and removing hazards. Among the measures they employed were placing fluorescent tape at the edge of steps into sunken living rooms, rearranging furniture to ensure clear paths and rearranging shelves so frequently used items were in reach and seniors did not need to stand on a chair or stepstool.
Firefighters installed low-level lighting, rerouted electrical cords and removed throw rugs and other tripping hazards. “Sometimes, people won’t get rid of rugs, so we secure them with double-sided tape,” Hughes said.
The city also partners with Brevard County Community Services Council to install railings and handrails at low cost or no cost. “A lot of them come from a generation that doesn’t want anything for free,” Hughes said.
“We had a lady who had several handrails installed that would have cost $350 or $400 if she had a contractor do it,” Hughes said. “She made a donation of $75.”
During home visits, firefighters also administer the “timed up-and-go test,” which measures how fast seniors can get up from a seated position and walk 10 feet. Seniors who perform poorly are informed that they are at higher risk of falling and should be cautious.
Goals Are the Same but Programs Can Differ
At the same time, in Alberta, Canada, another astute EMS educator was growing increasingly concerned about the nearly 6,000 fall-related calls coming into the city of Edmonton’s Emergency Medical Services.
Led by Jennifer Fernandes, then a community educator for Edmonton EMS, the city launched a fall-prevention pilot program in the fall of 2007. Paramedics and EMTs responding to emergency calls from seniors who did not require, or who refused, transport were trained to identify those at risk of falling. Responders then taught willing seniors about preventing falls and how to safely get up after a fall.
During about 100 in-home interventions during the one-year pilot program, paramedics and EMTs completed a fall risk-assessment on scene, including the “timed up-and-go test,” which was then returned to Fernandes for evaluation. Fernandes and her team also developed leave-behind materials about fall prevention along with a list of community resources that seniors could contact for assistance.
Seniors were taught to get up by rolling onto their stomachs, getting to their knees and crawling to a sturdy chair or table to brace themselves. “The crews would go down on the floor and show the senior how to get up,” Fernandes said. “The seniors really liked that. They said that instead of focusing on what they shouldn’t be doing, the focus was on what they could be doing to help prevent another fall. It was a refreshing approach for them.”
Before the program was instituted, EMS responders could do little more than help the senior into a chair or bed and leave if he or she refused transportation.
“The crews were feeling a little helpless,” Fernandes said. “The person might not be injured enough to go to the hospital, but they knew this person would be at risk for another fall.”
Integral to the program was offering referrals to other agencies and services, including in-home meal delivery, snow shoveling, home repairs and a diabetic foot clinic.
Though teaching EMS responders to prevent accidents requires a shift in how they approached their jobs, the effort pays off. “We are used to running in and treating injuries,” Fernandes said. “Preventing injuries is a totally different way of thinking.”
Although the fall-prevention pilot program ended in 2008, Edmonton EMS, now renamed Alberta Health Services EMS—Edmonton Zone, is scheduled to start a more comprehensive program in January 2010, through which paramedics and EMTs will help identify seniors at risk of falls, as well as other aging-related issues such as diabetic complications and dementia. At-risk seniors will be referred to various agencies that can offer assistance. The program is being funded through a provincial grant.
The Satellite Beach and Edmonton programs differ, but both are examples of EMS identifying a problem and reaching out to their communities to help solve it.
“We are a fire department that is adapting to the needs of its residents, and finding ways to keep people safer, healthier and happier longer,” Hughes said.
If you are interested in starting a fall-prevention program in your area, you can use Satellite Beach Fire Department’s materials (including training manual, fall assessment tool and checklist of what to look for in the home), which is available at satellitebeachfire.com/FallPreventionMaterial.aspx.