The purpose of this paper is to describe and analyze the OA-11 problem from the Healthy People 2020 objectives. OA-11 stands for reduction of the rate of emergency department (ED) visits due to falls among older adults (Healthy People, 2018). Falling presents many dangers to elderly populations, as their bodies are fragile and susceptible to injury from falling. According to the National Hospital Ambulatory Medical Care Survey (NHAMCS), the incidence of falling is over 5,200 ED visits per 100,000 older adults (Healthy People, 2018). In Florida, falls are considered to be the leading cause of fatal and non-fatal injuries among older adults (Healthy People, 2018).
In medical studies, falls among elderly adults are associated with previous falls, chronic health conditions, mobility limitations, poor nutrition, sensory deprivations, and side effects of medicaments. Traumatic falls in elderly patients are associated with several negative consequences, such as forced relocations from home, loss of independence, family stress, and financial costs. According to CDC (2015), the average cost of a fall injury treatment is over 30,000 dollars. In addition, recovery rates in elderly patients are much slower when compared to young and middle-aged adults.
Target Population and Program
One of the policies implemented by the Florida government aimed at reducing the number of ED incidents related to falling is the “Stepping On” program. The program was developed and promoted by Dr. Lindy Clemson and is available in thirteen states. The program is identified as a multifaceted fall-prevention problem aimed at increasing the patients’ autonomy and ability to care for themselves safely and without additional assistance (NCOA, n.d.).
Although it is available for all elderly persons, its primary target population includes people who have already experienced a fall-related trauma. As a result, these people lose their confidence and limit their movement and social interactions, which leads to further isolation and the loss of muscle mass (NCOA, n.d.). As a result, elderly patients become even more susceptible to falling and repetitive injury. Stepping On is a complex of strategies aimed at engaging patients with limited mobility and preventing falls.
The program includes several options that can help elderly patients improve their own physical health as well as mobility and autonomy. These include a physical education regime aimed at building up strength and improving balance, information on medications and their drawbacks, safety strategies during community interactions and travels, criteria for choosing the right footwear, and a checklist for home modifications in order to reduce safety hazards (NCOA, n.d.).
Policy, Practice, and Outcomes
The Stepping On the program is of a preventive nature, meaning it largely occurs outside of the existing healthcare facilities. Nevertheless, it involves healthcare providers in numerous ways, as they are required to provide training and educational materials to hospitalized and homestay patients, as well as various groups attending the program. The policy influences clinical practices in a positive way, as it reduces hospital readmission rates, decreases chances of repetitive injury, improves the overall physical shape and safety of elderly patients, and decreases fall-related healthcare costs. Inter-professional teams can cooperate in order to deliver the best patient education possible.
For example, nurses can handle introductions into the program as well as general matters, physical therapists can instruct the elderly patients on possible exercises, and a pharmacist can educate them on the potential side effects of polypharmacy as well as answer any questions regarding the patients’ current treatments and medicines.
Comprehensive Review of Literature
The interventions provided in the scope of the Stepping On the program are supported by numerous accounts in the peer-reviewed medical literature. Mansfield, Wong, Bryce, Knorr, and Patterson (2015) have analyzed randomized control trials regarding the effectiveness of perturbation-based training in elderly patients, with a total of 404 individuals involved. According to their analysis, perturbation training reduces the chances of falling in elderly patients as well as patients with Parkinson’s disease, which is often found in adults aged 65 years or older (Mansfield et al., 2015).
Okubo, Schoene, and Lord (2016) support these findings and add valuable insights into the effectiveness of step training, which is used as part of the Stepping On program. According to the researchers, reactive and volitional stepping techniques taught to elderly patients decrease the incidence of falling by about 50%. These results are connected to improvements in reaction and gait times rather than with the overall strength of the body, meaning that they are equally effective for all elders regardless of their musculature.
Lastly, an article in Sports Medicine by Lesinsky, Hortobágyi, Muehlbauer, Gollhofer, and Granacher (2015) adds to the existing information on balance training and performance in relation to dose-response relationships of programs. The results indicate that the optimum BT for balance and training exercise for elders is 90-120 minutes per week for the duration of 12 weeks. This coincides with Stepping On’s training schedule, as the program is intended for 3 months, with 2 hour-worth of sessions per week. The article also provides evidence for the importance of strength training as means of improved physical performance as well as injury reduction, as muscles form a protective layer around bones and can reduce the impact of trauma and potentially prevent fractures.
CDC. (2015). Costs of falls among older adults. Web.
Healthy People. (2018). Falls prevention: Interventions and preventive medication in older adults. Web.
Lesinsky, M., Hortobágyi, T., Muehlbauer, T., Gollhofer, A., & Granacher, U. (2015). Effects of balance training on balance performance in healthy older adults: A systematic review and meta-analysis. Sports Medicine, 45(12), 1721-1738.
Mansfield, A., Wong, J. S., Bryce, J., Knorr, S., & Patterson, K. K. (2015). Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Physical Therapy, 95(5), 700-709.
NCOA. (n.d.). Stepping on. Web.
Okubo, Y., Schoene, D., & Lord, S. R. (2016). Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis. British Journal of Sports Medicine, 51(7), 586-593.