And that is where the storyline
changed. She could have been transported to an emergency department with a
short hospital stay and then a few weeks in a rehab facility, which even with
the best of care would have increased her risk of falls even further. But
instead, the paramedics checked her out, put her back in her chair and with her personal safety alarm notified her
daughter who arrived promptly and then made an appointment for her PT and her
MD.
That was three years ago. Since then
her family has convinced her to have day time help, periodic physical therapy
-included a fall prevention protocol - to maintain her strength which has
resulted in her remaining at home and doing all the things she really likes.
Long Beach has established a new
baseline for fall prevention. Falls are no longer an inevitable part of aging. Fall
prevention is no longer a simple awareness campaign or installation of grab
bars upon hospital discharge. The causes and prevention of falls are better
understood by organizations, hospitals and older adults.
With little or no financial support the
purpose and vision of re-thinking fall prevention came from our ranks. Serendipity
played as much a role as 'planning'. Heart of Ida, local non-profit, was able
to take the need for a training site by the California Department of Public
Health and turn it into a larger scale analysis of what should be occurring in
a city of our size. This led to developing relations with SCAN Independence at
Home, St. Mary's Medical Center, Long Beach's Department of Parks, Recreation
and Marine Senior Center, and the Long Beach Department of Health and Human
Services, and that was just the beginning.
Three years ago there was not a
single evidence based fall prevention strategy offered in the city limits of
Long Beach; and almost none in LA County. Today the city is populated with a
series of proven and highly regarded programs to reduce falls, fall risks and
fear of falling. Throughout the year fall risk assessments are offered free at several
convenient community locations. The city now boasts 7 community fall risk
screeners. These screens are essential for older adults to understand the
nature of their fall risk - a personalized assessment that helps direct their
next step.
By 2014 we had developed a fall
prevention faculty: 2 master trainers and 8 leaders with on-going classes all
done at the community level. Mapping these opportunities shows that an older
adult in LB is within 5 miles or less of a fall prevention program. Most are closer.
Physicians and seniors alike are
relieved but more importantly empowered with these changes. Seniors can arrive
at their physician's office with a completed fall risk assessment that includes
test data and solutions available in the community. The physician can confirm
and discuss issues with their patient while their patient doesn't have to
struggle trying to describe their concerns about falling and potential injury.
At the same time this means older
adults are no longer stymied by denial and avoidance. With very little
prompting an older adult realizes that falls and loss of function as we get
older are no longer inevitable.
Seniors are not stubborn! But they
seem so resistant to change, why is that? Older adults need personal
information with their own action plan. Studies have proven and the Centers for
Disease Control programs reinforce that personal action plans are key to
reducing fall risk. Whether the issue is 'fear of falling'; or experiencing
multiple fall risk factors; or just not taking care of oneself a personal
action plan based on readiness to change is the tipping point. At a recent
evidence based Tai Chi class at Houghton Park, older adults expressed that they
no longer accept that "getting older means getting weaker" or the
impossible task of remaining "independent" which translates to being
alone and compromised. They believe that getting informed is the key to
successful aging.
A
new way of thinking is emerging. In June, the Long Beach Department of Health
and Human Services hosted a Call to Action conference – rather than just
complaining about what we didn't have, the 100 attendees were energized to
plunge forward to create a falls prevention pathway. More community nurses have
been trained in Fall Risk Assessment, more evidence based programs are being
offered and supported. Hospital environments are considering how they can refer
to the community. People are thinking outside of their box. "Our
community has the all the right ingredients to offer fall prevention to our
older adults", Pam Shaw, RN, MSN/MPH, Nursing Services Officer, Long Beach
Department of Health and Human Services.
There are pathways for each older
adult to follow. Some involve medical procedures e.g. joint surgery, while
others are as simple as a wellness check-up and continuation in routine
exercises. At specific times, such as after an infection or bout of depression,
there is a risk for a loss of function, leading to an increased risk for a
fall. Families and friends can now, with confidence and care, encourage their
family member to develop a personal action plan for fall prevention, and get
back out there and enjoy life.
To be sure Louise had family and
resources that not all our older adults have. However, she posed, like so many,
a series of seemingly insurmountable problems that in the old way of thinking
inevitably lead to falls. By taking Louise's personal risk factors into
consideration and making the necessary changes, she is able to remain at home
without subsequent falls, injuries or hospitalizations. "Families are an important member of the
fall prevention team. In Long Beach, family members serve as advocates and
identify resources to help their older family member remain independent", Nancy Blair,
Patient Family Adviser, Long Beach Memorial, Miller Children’s Women’s
Hospital, Community Hospital Long Beach.
And the partnerships that have been
forged still need a track record and refinement. "Long Beach has made great
strides in fall prevention and our older adults and their families will reap
the benefits for years to come", Kit Katz, Director of Community Benefits,
Bazzeni Wellness Center, Dignity Health.
Plans continue to be made by our
City's Department of Health and Human Services to host and facilitate work
groups to identify the gaps and solutions in our fall prevention system. These
discussions will offer community institutions and older adults a way to
re-think the inevitable fall and establish sure footing on a course of
prevention.
No longer are we confined to the
'help help' scenario of being trapped and panicked after a fall. LB's fall
prevention programs teach older adults how to get up and recover. Watch out
Long Beach - there is a tsunami coming of seniors ready and willing to stay
healthy.
