In King County alone, more than 14 percent of Emergency Medical Services (EMS) responses for patients age 65 and older are attributed to falls in the home.
Moreover, there is a greater number of accidental deaths each year attributed to falls than there are deaths attributed to motor vehicle accidents within this population.
Two of the strongest risk factors for falls are older age and a prior history of falls, according to Dr. Brad Younggren, medical director of EvergreenHealth Emergency Preparedness and associate trauma medical director at the hospital.
He says, “The elderly have a greater risk of falling because as we age, we lose our balance and fine motor skills. And then there are also other factors, such as certain medical conditions, that add to this risk.”
Dr. Younggren notes that falls in this population can result in fractures, broken hips, hemorrhages and more, adding, “Almost half of the emergency department trauma visits we see from patients over 65 years old are a result of falls.”
With this statistic in mind, Dr. Younggren began looking at ways to prevent or reduce the frequency of such accidents from happening.
He discovered One Step Ahead, a program of King Country EMS, which began as a pilot a few years ago with Northwest Hospital
The program provides free assistance to patients who experience trauma due to a fall and are seen at a local emergency room.
“It’s a really good program,” comments Dr. Younggren, “and I felt that it would be something Evergreen could easily get involved with as a collaborative effort.”
In One Step Ahead, a trained specialist from King County does an in-home assessment to determine the patient’s risk factors.
According to Dr. Younggren, EMS can refer the patient to the program, as well as staff members at Evergreen’s emergency rooms in its Kirkland and Redmond locations.
To qualify, patients need to be older than 65, ambulatory, living independently, at risk for a fall or have fallen in the past six months.
They cannot be suffering from Alzheimer’s or any other form of dementia nor can they be living in subsidized housing, retirement facilities or nursing homes.
Once the patient opts into the program, the intervention specialist makes a home visit to identify the exact set of risk factors and design a prevention action plan.
The specialist evaluates the individual’s physical balance and strength, surveys the home for fall hazards and reviews medical conditions and medications in order to customize a course of action.
He/she also frequently arranges for the installation of safety equipment around the home to reduce fall risk.
“To successfully prevent the next fall, you need to identify which specific risk factors each individual may have,” explains Alan Abe, program manager for Injury Prevention at King County EMS. “One Step Ahead uses successful fall-prevention strategies that match the individuals’ risks with specific interventions so that the individual receives a personal program.”
The program has had success, evidenced by a study conducted by King County EMS, which noted that participants experienced 36 percent less risk of suffering a fall in the home than those not enrolled in the program.
“It’s a very individualized program,” says Dr. Younggren, “and you’re working with the patient right in his or her home to make it a safer environment. You’re educating the participant while providing a very specific plan. And you’re connecting the patient to resources in the community, such as classes in Tai Chi or yoga, for example, which will help with balance and strength.”
Dr. Younggren emphasizes that the program is the first step toward creating more of an umbrella network of such services at Evergreen. He explains that the hospital already has an inpatient falls program.
“The idea is to catch those at risk who are “pre-hospital,” he says.
“They might be going to our senior health clinic or our anticoagulation clinic, for example. And if they’re on blood thinners, it’s very important to reach them because if they fall, it can be extremely serious. When that happens, they’re treated with a modified trauma protocol.”
Evergreen began its collaboration with King County EMS in January and according to Dr. Younggren, upwards of 20 patients have been referred to One Step Ahead.
He adds, “We’ve seen some great results with those who participate.”