Fall Prevention – Learn about Falls and Tips to Minimize Risk

SUMMARY
As a contractor for Medicare, Kepro serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Kepro provides BFCC-QIO services in 29 states, the general information is relevant to everyone who has Medicare (including Medicare Advantage) and everyone who works with people who have Medicare. 

This episode is a conversation with our guest, Swati Guar, Medical Director for Alliant Health Solutions QIN-QIO.

Swati Gaur, MD, MBA, CMD, AGSF, is the Chief Medical Officer for Senior Care Office and Chief Executive Officer for Care Advances Thru Technology, advancing innovations in geriatric care. She is medical director for post-acute care at Northeast Georgia Health System. She is also a medical director for Alliant Health Solutions, a CMS Quality Improvement Organization. She is a member of Georgia Strike and Support Team with Georgia Department of Public Health and University of Georgia. She is medical director with Center of Excellence for Behavioral Health in long term care. She is a clinical assistant professor for Geriatrics at the Augusta University, where she enjoys teaching the principles and art of geriatrics to medical students, internal, and family medicine residents. 

In this podcast, Dr. Gaur will share information about fall prevention. She will share information on why fall prevention is important, common causes of falls, and tips for minimizing fall risk.

For more information about Kepro BFCC-QIO, please visit www.keproqio.com.

KEY TOPICS

00:29: Overview, introduction of guest, Swati Guar, MD, MBA, CMD, AGSF
 02:13: Why fall prevention is important
 04:00: Common causes of falls
 08:28: Tips for minimizing fall risk
 14:55: Final thoughts

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RESOURCES

BFCC-QIO Information for stakeholders: www.keproqio.com/partners

BFCC-QIO Information for people who have Medicare: www.keproqio.com/bene

Music: Motivational Upbeat Corporate by RinkevichMusic
https://soundcloud.com/rinkevichmusic
Video Link: https://youtu.be/U78mgVaM12M

Transcript

Welcome to Aging Health Matters, a podcast from Kepro, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. Information in today’s show may help you or someone you know in their healthcare journey.  Thanks for joining us. Now let’s get started.

Kia Weaver

Hi everyone and welcome to another edition of our podcast, Aging Health Matters. This is Kia Weaver, Outreach Specialist, here to introduce today's topic. Just as a reminder, being the QIO for 29 states, we have three key services for people who have Medicare: appeals, quality of care complaints, and Immediate Advocacy services.

We also work with many outstanding partners to help spread information about the Medicare program and its benefits. While we greatly appreciate their partnerships, we also want to be clear that the opinions and guidance expressed by them in this podcast are solely theirs or their agencies and not necessarily those of the QIO, CMS, or the Medicare program. Please keep in mind that state-by-state guidance may differ as well.

So today we'll be talking to our guest, Dr. Gaur from Alliant Health Solutions, about fall prevention. Dr. Gaur, can you please describe a little bit about your background and your positions held?

Dr. Gaur

Of course. First of all thank you for inviting me to talk about falls, which is such an important topic, in your podcast. My name is Swati Ghar. I am an internal medicine physician. I'm a geriatrician by profession, and I work with older adults. And I have been in this field for about 25 years, I am a medical director for post-acute long-term care facilities. I also am medical director for Alliant Health Solutions, where I primarily work with improving the quality of care of older adults.

Kia Weaver

Thanks so much. Can you talk a little bit about why we need to address fall prevention with seniors? Why is this topic important?

Dr. Gaur

Absolutely. This is actually a very, very important topic. Just to go through the numbers, first, more than one out of four Americans aged 65 years falls each year. So that is one out of four people. Falls are a leading cause of fatal and non-fatal injuries among older adults. The cost of care of injuries caused by falls is projected to be over 101 billion by year 2030. Further, half of all nursing home residents will fall annually. And when it comes to specifically the person who falls, it causes an incredible amount of change in the quality of life of the person who falls. A fall predicts future falls, and so one in three of the people who have fallen will fall more than two times a year in the future.

And as we have spoken, one in 10 will suffer from serious injury. Not only that, once a person falls, there is this real, we call it syndrome or instance of a fear of future falls, that can seriously curtail their quality of life.

Kia Weaver

Thank you so much for explaining that. It definitely sounds like falls are pretty common in this demographic. Can you talk about what are some common causes for falls?

Dr. Gaur

Absolutely. So when we think about falls, we think about two different things. And I will divide it into those two different things. As physicians or geriatricians, we think of two causes. One is the person-related cause, what is happening inside of an older person's body, and the other is what we call environmental. So there is intrinsic, which relates to the medical conditions that I will be talking about. The other one is extrinsic, which is the environment that is around the person.

When we think of intrinsic causes, which is what is happening inside an older person's body, there are many, many reasons, I often tell the residents, the medical students and residents that I teach, that when you assess for falls, you will find the number one, two, and three reasons for falls within the medication list of an older adult, and that often comes true. Why I teach them is that medication use and the propensity of some of the medications that could increase a person's risk for falls is common and often overlooked.

So it's incredibly important for us to look at the medications that people may be on that could make the chances of fall higher. Further, what we call deconditioning or losing muscle either due to age or chronic medical problem or frailty is another common leading cause of falls.

Problems with balance and walking can also happen in neurological diseases or diseases that are related to the nervous system, and some of those are Parkinson's disease for an example. Vision issues are a huge factor, which can lead to falls as well.

When we talk about medications, we also look at medications that will lower your blood pressure, and sometimes lowering of blood pressure can lead to dizziness, especially when a person describes that when I go from sitting to standing or getting out of bed, they feel unsteady and dizzy. That is an instance that we need to really worry about, the fact that the blood pressure may be dropping, and look at the causes of that.

When a person starts falling suddenly, it is incredibly important to see the doctor because the person may be going through an acute medical problem that may lead to falls, repeated falls especially, which needs more urgent attention. Memory loss itself can lead to poor safety awareness and instances of falling as well.

So these are intrinsic factors that is happening inside of a person. The extrinsic factor or the environmental factors could be things like spilling of water, that a person slips and falls, cords, phone cords, or other cords that they may be tripping over, unsafe equipment for mobility. Sometimes we are using a certain walker or a cane that may not be appropriate and that may in fact lead to falls.

Hazards like small throw rugs, even the thresholds, raised thresholds, can lead to people tripping and falling over it. Further, there is footwear that we worry about that could lead to falls as well. So those are some of the extrinsic or environmental threats that could lead to falls.

Kia Weaver

Thank you so much for that explanation. I'm sure it's really helpful for our listeners. And since there are so many different causes of falls, can you discuss some ways that seniors can prevent falls?

Dr. Gaur

Absolutely. So the number one thing that we talked about was medications in the last section where we talked about causes of falls. I think it is incredibly important to candidly ask this question of your primary care physician when you go and have that visit to ask them if they are on any medications that could actually lead to falls or could be worsening the falls.

If our older adult person is experiencing what I described when they get up from the bed and they have this dizziness and a feeling that they might fall, it is incredibly important to discuss that with the primary care physician, so that they can check the blood pressures in different positions to see that they may be having low blood pressure and rule that out.

Further, vision issues need to be dealt with, and vision issues could be cataracts or just a change in prescription, and that is something that is fixable. Now if they do have chronic medical problems, deconditioning or losing muscle mass due to age is a serious problem. We know that as we get older, we start losing muscle mass.

So that is something that we need to be proactive about and continue to do exercises like walking every day and continue to be functional and functioning in making sure that we are doing the daily activities and continuing to be active. Sometimes chronic medical problems can make us so weak that we may need physical and occupational therapy services, and that is something that your primary care physician could recommend or write for you.

So those are some of the ways that we can prevent falls. When I talk about exercising and staying active, the exercises need to be not just walking, which is a great exercise, but also some balance exercises, in the form of Tai Chi and yoga, have been shown to be beneficial.

Now when we talk about environmental factors, sometimes it is important to talk to your doctor again and see if there is an occupational therapist who can come and do even home visits to assess the home for any environmental hazards that we can eliminate from home to make our homes much safer.

Similarly, if there is use of assistive devices like canes or walkers, it is important for us to make sure that they are appropriate for the older adult person. Some of the common things that you can even do without having an occupational therapist come to your home is ensure that the cords for charging or other things are actually tethered properly, out of the way of people walking over it. Throw rugs, especially those small rugs that we tend to put in our homes, could be a huge hazard that people could slip and fall on, and these things can be cleared by the person themselves. So those are some of the areas where we can really make a difference by changing these practices.

Kia Weaver

Thank you so much, Dr. Gaur. Do you have anything else that you'd like to share with our listeners?

Dr. Gaur

One of the things that I would say is that people who have had a fall do need a comprehensive assessment, to make sure that all these complex reasons why a person might be falling have been assessed and things optimized.

One of the things that I actually forgot to mention in the past is something as simple as vitamin deficiencies can sometimes cause falls. So vitamin B12 deficiency can sometimes cause falls, and it's a simple fix, so I think it is very important to go and talk candidly with your physician and get yourself assessed for some of these reasons and really optimize our balance and be proactive in our care of ourselves, so that future falls are mitigated or minimized.

Further, fear of falling, as I said, is a huge part of the whole distress around falls that we see and what we have seen and what the studies have shown is fear of falling is helped by getting appropriate physical therapy over a period of time. In addition, your primary care physician may prescribe some medications for that as well. So while falls are common, there are many, many interventions that we can do to mitigate future falls and also assess and treat for a true fear of falling, and therefore, I feel very hopeful that even when someone has had a fall, there are many interventions that we can do, so that they can have a very, very functional life with minimizing future risks of falls.

Kia Weaver

Great. Thank you so much. I'm sure this information has been really helpful for our listeners that are seniors or the ones that have a loved one that is a senior. So thank you so much for discussing this topic with us today, and to our listeners, if you would like more information about our services, please feel free to sign up for our newsletter as well as subscribe to our YouTube channel. All of our resources can be found on our website, and they will be available in the show notes as well.

Thank you again, Dr. Gaur, and thank you for listening. And please stay tuned for our next episode.

Dr. Gaur

Thank you so much for having me again.

Kia Weaver

Thank you.

Dr. Gaur

It's a pleasure.