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IHS and CDC Implement Fall Prevention Strategies

by U.S. Medicine

December 17, 2009

WASHINGTON, DC—As part of an initiative to reduce injuries among its beneficiaries, the IHS is working to prevent falls. Nationwide among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma, according to the Centers for Disease Control and Prevention. The IHS Injury Prevention Program began about 30 years ago to decrease the incidence of severe injuries among its population. Injuries are the leading cause of death for American Indians and Alaska Natives between the ages of 1 to 44. The program collaborates with the CDC and other state and federal agencies.

Currently, fall prevention is one of the IHS prevention program’s focus areas since it is one of the leading causes of morbidity among American Indian and Alaska Natives, according to Capt Nancy Bill, USPHS, the IHS Injury Prevention program manager. “We chose falls because that has been an area that has been misunderstood with very little focus, at least within the American Indian population,” she said. Preventing falls among the elderly is especially important to American Indians and Alaska Natives because the elders of the community have an important role in preserving the culture and language of Indian communities, Capt Bill said.

Reducing Falls

A fall is a common occurrence, but it can have serious consequences, causing hip fractures and other severe injuries in the elderly. It is not often recognized that many falls, and their attendant issues, can be avoided. “Some people don’t understand that you can do something to prevent falls. When we say fall prevention, they say what does that mean?” said Capt Bill. As a way to help build fall prevention programs, the Injury Prevention program provides funding for the Aberdeen, Billings, Navajo and Phoenix IHS Areas for fall prevention initiatives. The program also has cooperative agreements with 22 tribes that work on injury prevention projects. At least nine of these programs include an unintentional elder fall prevention component.

IHS data from the Navaho Area, for example, shows that a “great percentage of injury-related hospitalizations” there are due to falls, and that about 58% occur in the home. The approach taken by the fall prevention programs in the four IHS Areas incorporates a clinical component, an exercise component and home safety assessments. As part of the program, each of the four areas has an Injury Prevention Specialist or Injury Prevention contact.

CDC recommends exercise as one of the most important ways to improve strength and balance in order to reduce falls. Programs in the four IHS Areas promote exercise either by their involvement in an active exercise community program with local senior centers, or by promoting or collaborating with exercise instructors in the area.

The IHS programs also help beneficiaries receive home safety assessments.Ahome assessment is a checklist to find any issue with the structures in a home that may cause the resident to fall. A physician who treats a patient who has fallen at home could, for example, work with the patient and the IHS Injury Prevention staff person in that area to have an assessment conducted of the patient’s home to prevent future falls.

On the medical side, providers are encouraged to review medications of patients to reduce interactions that could cause dizziness, and administer eye exams, among other things. “When they see patients who have had a fall, they can evaluate the physical aspects of the challenges the patients have. For example, if they are diabetic and they need more physical therapy because they had an amputation, they can evaluate and refer to those areas,” said Capt Bill.

Captain Bill emphasized that fall prevention requires collaboration between many agencies and local entities. “Fall prevention is an area where we need collaboration with other people, we can’t do it by ourselves,” she said.

Educating on Falls

The IHS also offers injury prevention training that addresses fall prevention. The injury prevention training practitioner level courses teach participants about components of a public health approach to reducing injuries among American Indians and Alaska Natives. In addition, a year-long advanced injury prevention fellowship program is also offered. It provides an epidemiology track geared to conducting community-based injury studies, and a program development track to implement community-based interventions. “It provides an approach to preventing injuries, a better understanding in developing programs and evaluation,” noted Capt Bill.

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