MULTIFACTORIAL SCREENING FOR FALL RISK IN COMMUNITY-DWELLING OLDER ADULTS IN THE PRIMARY CARE OFFICE: DEVELOPMENT AND VALIDATION OF THE FALL RISK ASSESSMENT & SCREENING TOOL (FRAST)

Background: Unintentional falls are an increasing public health problem as incidence of falls rises and the population ages. The Centers for Disease Control and Prevention reports that 1 in 3 adults aged 65 years and older will experience a fall this year; 20% to 30% of those who fall will sustain a moderate to severe injury. Physical therapists (PTs) and other primary care practitioners (PCPs) caring for older adults are usually engaged with these patients after the first injury fall and may have little opportunity to abate fall risk before the injuries occur. Purpose: This manuscript describes the content selection, development and validation of a simple-to-administer, multifactorial Fall Risk Assessment & Screening Tool (FRAST). The FRAST is designed specifically for use in primary care settings by minimally-trained staff to identify those older adults with heightened fall risk requiring PCP intervention. The FRAST incorporates previously validated measures within a new multifactorial tool and includes targeted recommendations for intervention. Methods: Development of the multifactorial FRAST used a 5-part process: identification of significant fall risk factors, review of best evidence, selection of items, creation of the scoring grid, and development of a recommended action plan. The FRAST was then validated via data collection across Montana in 2010 and included 99 subjects fitting specified inclusion/exclusion criteria: aged 65+, community-dwelling, independent ambulators (with or without assistive devices). Results: FRAST has been developed and validated to assess fall risk in the target population. Many fall risk factors have been considered and 15 items selected for inclusion. FRAST includes four previously validated measures to assess balance, depression, falls efficacy, and home safety. Conclusion: Fall risk for community-dwelling older adults is an urgent, multifactorial, public health problem. Providing PCPs with a very simple screening tool is imperative. FRAST was created and validated to allow for safe, quick, and low-cost fall risk screening by minimally-trained office staff with interpretation and follow-up provided by the PCP

Validation of evidence-Based Fall Prevention Programs for adults with intellectual and/or developmental disorders: a modified otago exercise Program

Introduction: Evidence-based fall prevention (EBFP) programs significantly decrease fall risk, falls, and fall-related injuries in community-dwelling older adults. To date, EBFP programs are only validated for use among people with normal cognition and, therefore, are not evidence-based for adults with intellectual and/or developmental disorders (IDD) such as Alzheimer’s disease and related dementias, cerebral vascular accident, or traumatic brain injury. Background: Adults with IDD experience not only a higher rate of falls than their community-dwelling, cognitively intact peers but also higher rates and earlier onset of chronic diseases, also known to increase fall risk. Adults with IDD experience many barriers to health care and health promotion programs. As the lifespan for people with IDD continues to increase, issues of aging (including falls with associated injury) are on the rise and require effective and efficient prevention. Methods: A modified group-based version of the Otago Exercise Program (OEP) was developed and implemented at a worksite employing adults with IDD in Montana. Participants were tested pre- and post-intervention using the Center for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents Deaths and Injuries (STEADI) tool kit. Participants participated in progressive once weekly, 1-h group exercise classes and home programs over a 7-week period. Discharge planning with consumers and caregivers included home exercise, walking, and an optional home assessment. Results: Despite the limited number of participants (n = 15) and short length of participation, improvements were observed in the 30-s Chair Stand Test, 4-Stage Balance Test, and 2-Minute Walk Test. Additionally, three individuals experienced an improvement in ambulation independence. Participants reported no falls during the study period. Discussion: Promising results of this preliminary project underline the need for further study of this modified OEP among adults with IDD. Future multicenter study should include more participants in diverse geographic regions with longer lengths of participation and follow-up