Screening and Intervention to Reduce Falls in Older Adults in Primary Care

An estimated one of three adults over 65 years of age falls each year, and this proportion increases to one in two by the age of 80 years. Falls are extremely costly, both in terms of the economic burden on society and the physical, financial, and emotional toll on the individual and his/her family. By 2020, the total cost of falls among older adults is projected to reach $43 billion. According to the North Carolina Department of Health and Human Services, unintentional fall-related injuries and deaths are increasing in North Carolina, and falls are the leading cause of accidental death among older North Carolinians. Even in the absence of physical injury, a fall may induce a downward spiral of increased fear of falling, self-imposed activity restriction, functional dependence, and reduced quality of life. This project will implement a validated process to identify, risk stratify, and provide intervention for patients at risk for falls, and ultimately to decrease risk of falls and fall-related injuries among older adult patients. We will initially test implementation in the UNC Family Medicine Center (FMC) as a model to subsequently spread throughout UNC Primary Care Improvement Collaborative (PCIC) practices. The intervention will start with a defined process to identify modifiable risk factors for falls before or during an FMC clinic visit using the CDC’s validated Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. Patients who screen positive will subsequently be offered an evidence-based intervention, the physical therapist-managed Otago Exercise Program. Various methods for implementing the initial STEADI assessment will be tested, including pre-visit mailings and evaluation, in-clinic CMA evaluation (with CMA training), Epic BPA refinement, and provider training. We also will test best strategies for engaging physical therapists at point of care and through Epic referrals to facilitate implementing the second step of the intervention, the Otago program, by training therapists at three UNC outpatient physical therapy clinics. We will then disseminate these best practices through UNC PCIC and UNC outpatient physical therapy services, ultimately affecting more than 35,000 eligible patients.