Many in emergency medical services have faced the frustration of responding to a fall-related call at a senior’s home, only to pick the patient up off the floor and have the person refuse transport to a hospital. In most cases, the responders drive off, knowing there’s a good chance they’ll be back after another fall.
Don Hughes, deputy chief of operations for the Satellite Beach Fire Department in Satellite Beach, Fla., decided he didn’t want to sit idly by as the number of fall-related calls continued to swell in his community of 11,800. His firefighter/EMTs already took the lead in fire prevention in the city. Why not also have them use their expertise to take the lead in injury prevention?
With 25 percent of Satellite Beach’s population over the age of 65 and expected to rise to more than 30 percent in the next few years, the town’s demographics are a glimpse into the city’s—and indeed the nation’s—future. Baby boomers, or those born between 1946 and 1964, will start turning 65 in 2011. The over-65 age group is projected to be twice as large by 2030 as it was in 2000, growing from 35 million to 71.5 million and representing nearly 20 percent of the U.S. population, according to the Federal Interagency Forum on Aging Related Statistics.
Satellite Beach is feeling the impact, with some 15 percent of all emergency calls fall-related. So two years ago, Hughes led an effort to launch an elder fall-prevention program in the city. Now, each time his firefighters respond to a call for a person over age 65, whether the call is fall-related or not, the resident receives a get well card from the fire department with a sound card that says, “I’ve Fallen and I Can’t Get Up!” along with information about strategies to prevent falls. (Hughes designed the cards on his computer and has them printed at a local shop.) A few days after residents receive the cards, they get a letter from the fire department letting them know that a fall-prevention specialist will be following up to offer a free 90-minute home visit to assess their risk of falling.
“We let them know the name of the person who will be calling so they know this is not a solicitation and it’s trustworthy,” Hughes says. “About 20 to 30 percent agree to let us do the assessment.”
During these assessments, firefighters administer the “timed up and go test,” which measures how fast seniors can get up from a seated position and walk 10 feet. Firefighters also look for trip and fall hazards in the home, such as poor lighting, throw rugs, low-lying furniture and excessive clutter.
If the hazards involve simple fixes such as taping down electrical cords, replacing light bulbs or moving furniture, the firefighters do it on the spot. For more extensive fixes, such as installing grab bars in bathrooms or railings on staircases, the fire department partners with Brevard County Community Services Council to arrange for the installation at low or no cost. One woman, for example, had several handrails installed—which would have cost about $400 had a contractor done it. Instead, she made a “donation” of $75.
A critical component of working with seniors is sensitivity to their values, Hughes says. Many would feel embarrassed to accept something for free but are hesitant to shell out hundreds of dollars, so they work out a deal that makes everyone happy. “With injury prevention, you can’t tell them what they need to do and then leave,” he explains. “You need to show them different ways of doing something and then ask if they are interested, or they can get stubborn. If we just went into a lady’s home and said, ‘That rug needs to go. This cord needs to be moved and you need to get these steps fixed,’ she is going to get on the phone and say to her friend, ‘You know how much money they say I need to spend?’ You have to help them do it.”
A growing problem
Elsewhere in the U.S., aging experts are grappling with many of the same issues regarding the increase in falls and how to most effectively, and efficiently, go about dealing with them. Consider the facts: Falls are the leading cause of injury-related death for adults over the age of 65 in the U.S. Some 1.8 million people ages 65 and older were treated in emergency rooms for falls in 2005, and 15,800 died from their injuries, according to the U.S. Centers for Disease Control and Prevention. As people get into their 80s and 90s, the risk of falling increases, says Lynn Beattie, vice president of injury prevention at the National Council on Aging’s Center for Healthy Aging.
Though data on the burden of fall-related calls on EMS is scarce, the New Hampshire Task Force for Falls Prevention did a study that looked at all calls to 911 over two separate months in 2009. During both months, calls from seniors who had fallen were the single most common reason for a 911 call. A significant proportion of the time, the resident just needed help getting up and did not want transport, according to Beattie.
Programs such as the one in Satellite Beach are admirable efforts to do something about the growing problem, which costs more than $19 billion in direct medical costs each year. But for EMS to be able to make a difference on a larger scale, there needs to be a multi-pronged approach that involves community-based agencies, primary care doctors and hospitals, Beattie says.
Doctors, for example, often follow up with patients regarding a head injury or fracture caused by a fall, but rarely does anyone follow up to deal with what caused the fall in the first place. That’s where EMS comes in.
“The first responder can act as a gatekeeper to connect seniors with community services or link them to a primary care doctor or somebody who will follow up and determine what’s causing the fall, whether it’s medication or blood pressure issues, gate and balance issues, or an unsafe home environment,” Beattie says.
The trouble is, it’s not always clear which agency can be tapped to assist in follow-up. Beattie suggests that first responders could ask a senior to sign a HIPAA release giving permission to call the primary care doctor on his or her behalf. EMS could also contact a local Area Agency on Aging or a visiting nurse agency to determine what other resources might be available in the community.
A call to action
Dealing with the issue of coordinating care is one of the goals of the National Action Plan, established in 2004 by the National Council on Aging’s Falls Free Initiative. The Initiative now also includes a State Coalitions on Fall Prevention Workgroup, which includes 23 state fall-prevention coalitions as members. EMS leaders are encouraged to get involved with their state coalitions as well, Beattie says.
In the meantime, Satellite Beach will continue to do fall prevention on its own, visiting from 10 to 15 houses a month. The program has garnerned overwhelming community support and received several awards, including being listed as a “Best Practice” by the Florida State Department of Elder Affairs.
“Someone once said, ‘Every time you do something for a citizen, you are making a deposit in the bank of community equity of trust,’” Hughes says. “The seniors tell us they are happy somebody took interest in them. They are happy somebody took the time to fix the problem.”
To learn more about the National Council on Aging’s Center for Healthy Aging, visit healthyagingprograms.org/content.asp?sectionid=98 or send an e-mail to fallsfree@ncoa.org.
