“Fall Prevention for Older Adults: Intervention and Strategies”. A
Transborder European Project to Prevent Hip Fractures.
Preliminary Report
R. De Rosa MD*, F. Gherlinzoni MD^, A. Boschin PS*, D. Colledani PS*
*SOC Ortopedia e Traumatologia, Ospedale Cà Foncello, Treviso
^SOC Ortopedia e Traumatologia, Ospedale S. Giovanni di Dio, Gorizia
The Project “Small Project Fund, Kärnten – Friuli Venezia Giulia – Veneto” has been approved in the frame of the
Operational Program Interreg IV Italy-Austria 2007-2013 with the objective of increasing the awareness of the
advantages offered by cooperation, as well as improving the integration process of the boundary area, both
regionally and locally.
BACKGROUND AND SIGNIFICANCE
“Population Ageing is a triumph of humanity but also a challenge to society”(1).
World demographic projections indicate that the number of people over sixty will triple, increasing from 737
million in 2009 to 2 billion in 2050.
"In the aging population, the number of older people grows faster than higher is the age range considered.
Therefore, it is expected that the number of people over sixty will triple, furthermore it is expected that over
eighty (older) will quadruple, to reach 395 million in the 2050".
Today, only around half of the older people lives in developing countries, but they are expected to reach 69
percent in 2050 (2).
Life Expectation
In its report, Health at Glance 2010, OCSE provides an overview of health indicators in Europe 27. The report
shows that life expectancy at birth has lengthened to 6 years since 1980, reaching 74.3 years for men and 80.8
years for women, on average. France has the higher life expectancy at birth for women (84.4 years) and Sweden
for men (78.8 years). The difference between man and woman is then 6.5 years.
Healthy Life Years Expectation
The evidences about life lengthening must also be compared to a new indicator, the "Healthy life years". This
indicator is defined in the study as the good health life expectancy, the number of years of life during which
individuals are not limited in daily living activities by diseases or health problems. According to a biological
classification(3) there are three types of ageing: a) Ageing Associated with Disease: most older adults; b) Usual
Ageing: older adults without any disease/s but with age related impairments; c) Successful Ageing: Older Adults
without any disease, and with physical and mental performance similar to those of younger adults.
The healthy life expectancy on average is 61.3 years for women and 60.1 for men. The gap between women and
men is significantly reduced compared to life expectancy; that means women live long periods of life with
limitations in their daily activities.
Healthy Life Years Expectation over 65
The life expectancy after 65 years is significantly increased: 15.9 years for men and 19.5 for women, on average.
France has the highest values for both, men (18.1) and women (22.6), while Latvia has the lowest for men (12.7)
and Bulgaria for women (16, 3). As well as for life expectancy at birth, for life expectancy after 65 years the
expected values for healthy life have much smaller differences between men and women, with a slight advantage
for men 8.4 years against 8.1 for women.
Falls
1
In this demographic context we must include falls and hip fracture phenomena, which particularly affects people
aged over 65. Preventing falls means fighting one of major threats to the physical and mental health in the aging
population.
Risk of fall increases with age
Falls are among the most common and serious problems facing elderly persons. The risk of falling and sustaining
an injury as the result of a fall increases with age.
For this reason, the WHO(1) believes that a significant number of over eighty will trigger a substantial increase of
injuries from falls, like hip fracture, that together with spinal cord injuries, in the last three decades, have
increased 131%(4). Females appear to be more exposed to hip fracture events. Specifically the rates of
hospitalization for fracture injuries begin their exponential growth around 55 years for women and over 65 for
men; more than a third of women suffer an osteoporotic fracture that in most cases is determined by a fall (5). The
greatest risk of falling in women is also reported from a Barcelona University study where is shown that in a
over 65 population the incidence of falls in females was 37% compared with 25.1% in males, the multiple falls
are observed in 10.9% of women compared to 3.8% of men(6).
Numbers: 30-40-50
In Europe 30% of community-dwelling people over 65 fall at least once a year(7). For seniors over 75 the rate is
40%. The rate increases to 50% for the over 80. In USA from 2001 to 2008 the estimated number of of fallrelated hospitalizations in older adults has increased to 50% reaching 559,335 cases(8).
OMS Europe reports that between 20% to 30% of those who fall suffer injuries that reduce mobility and
independence and increase the risk of premature death. The rate of people falling and requiring medical
treatment for suffered fractures is significantly smaller. After an year from a fall, 20% of hospitalized people or
are still living in hospital, with full-time care, or have already died(9). Unless action is taken, the number of falls
and fall related injuries is likely to increase over the next 25-30 years (Tinetti, 2003).
Fear syndrome
30% of older adults incurring in a first fall develop a fear syndrome, this is an invisible effect of falling, consisting
in reduction of daily activities, social life, physical exercise and therefore producing an increased risk of falling(10,
11). A previous fall, even non-injurious, represents a relevant risk factor. Older adults who fall once are two to
three time as likely to fall again within a year.
In Europe falls represent the most common cause of death due to accident for 75% of the population.
From falls to fractures
The path from falls to fractures has not been fully explored so far. Research shows data only from the admission
in an Hospital Emergency Room. It’s commonly accepted that these numbers are largely underestimated since
most of the falls are not reported because apparently they don’t need medical attention. Incidence figures for
falls in the community setting are largely dependent on self reported recalls of the event. Therefore an accurate
falls/fractures rate according to country/age/gender/type of fracture/ is not yet available. Despite this issues
there are a number of broad conclusions about fall incidence that can be drawn from literature.
Moving to fractures from falls every possible epidemiological information becomes available.
Fractures
6% of falls for people over 65 ends in a fracture(12).
The most devastating fall related injury, in terms of morbidity, mortality, reduction of overall functioning, and
early admission to long term care facility, is the hip fracture which represents about 1% of total falls related
injuries. While the proportion of falls resulting in fractures is low, the absolute number of older people suffering
fractures is high and impressive, placing heavy and costly demands on health care systems. In Europe, this small
proportion, represents 790.000 fractures per year, 179.000 males and 611.000 females.
In USA a total of 310,000 individuals were hospitalized with hip fracture in 2003.
In Italy 100,000 hip fractures are registered every year.
Mortality
The mortality rate of hip fractures is 20% within one year(13). It has also been reported that in Western Countries
mortality due to HF has outnumbered gastric and pancreatic cancer, and the risk of experiencing a HF is higher
than being affected by breast tumor in women and prostatic tumor in men (14, 10).
Morbidity
2
Approximately, half of the fallers who fracture their hip are never functional walkers again. 25% of the operated
patients is obliged to at least one year of Hospitalization. Only 30% of older adults experiencing a hip fracture
autonomously resume daily activity. In other words the phenomena of hip fractures sweeps away from active
aging more or less 70% of the fractured. Let’s call it an Epidemic.
Costs
Costs are already unbearable. The estimate cost of HF in 2002 in Italy was over one billion euro (15) to cover
direct and indirect expenses about aproximately 90,000 HF. In 2006 in the USA there were more than 380,00 HF
or about 1,050 HF a day. $ 20 billion is the annual treatment cost of injuries and complications associated with
falls (16). Most of it covers HF. In Europe is estimated that 179,000 men and 611,000 women are experiencing
every year a HF for an overall cost of Euro 25 billion(17).
For older community residents, an effective fall prevention program has the potential to reduce serious fall
related injuries, such as hip fractures, together with the cost related to the emergency department visit,
hospitalization, nursing home placements, and functional decline.
Falls and hip fractures morbidity, mortality and cost, here above described, change the way that Policy Makers,
Social and Health Operators, Communities are dealing with this issue.
The steady shift from the category of ASSISTANCE-CARE to the category of PRIMARY PREVENTION, which is
intended to avoid or limit the exposure to harmful events, is not anymore a choice, but a must in order to answer
to the increasing quest of Social and Health Well Being.
This is the scenario where the Project takes place.
3
PROJECT LINES
The project life span is from November 1, 2010, to April 30, 2012. The final Conference will be held in Treviso on
March 29, 2012. This is a budget project, 100% funded for a total amount of Euro 75,000.
Starting Situation: The project tries to answer the issue of fall prevention in aged people, which is common to the
three Regions (Carinzia [Austria], Veneto and Friuli Venezia Giulia [Italy]), with particular regard to the most
severe fall-related injuries in terms of mortality and morbidity: hip fracture.
A long term strategy for effective Elderly Fall preventions programs can be simplified in the scheme represented
here below.
The INTERREG small budget Project partially match to the quest for an effective EEFPP as shown from the
interaction between Green boxes [EEFPP] and the Blu boxes [INTERREG]
GOAL
A 15-18% DECREASE
OF HIP FRACTURES
INCIDENCE FOR THE
OVER 65
IMPLEMENTATION
OF PEER TO PEER
COURSES, IN THE
COMMUNITY, ON
THE FALLS AND HF
ISSUE
REDUCING
HOME AND
ENVIRONMENT
AL HAZARDS
MEDIUM-LONG
TERM FALL
PREVENTION
PROJECT
INCREASING THE
DEDICATED
PHYSICAL
ACTIVITY IN
ORDER TO
REDUCE FALLS
COLLECT DATA
FROM COURSES
AND VERIFY THE
OUTCOME TO
EVALUATE THE
EXPECTED
DECREASE OF
HF
INCREASING THE
AWARENESS
ABOUT THE ROLE
OF DEDICATED
PHYSICAL
ACTIVITY TO
REDUCE FALLS
ANALISY OF
EXISTING DATA OF
HF FOR 2009
FOCUSING ON
CAUSES OF
FALLS.
SHORTTERMS
IMPACTS
SPF Interreg IV
Fall Prevention for
Older Adults:
Intervention and
Strategies
Figure 1: The project
A 15-18% reduction in HF is empirical but not random. More data are required to confirm whether strategies
apparently effective in significantly reducing the numbers of individulas falling are also effective in reducing
more serious sequelas of falls as fractures ( 18). A very few papers focused on the ratio between Fall Prevention
Programs and HF decrease are available ( 19). Mary Tinetty is reporting an 11% HF decrease in her 1997
Multifactorial Targeted Prevention Program for Falls.
4
It’s been assumed, however that any reduction in falls will be directly reflected in a similar reduction in hip
fractures (20). For example, if 20 % of falls are avoided, then there will be 20% less HF, given the fact that has
been estimated that around 90% of HF are a result of a fall (21).
THE PROJECT AND OBJECTIVES
The project is mainly organized into two macro sections:
•
OBJECTIVE 1.
THE EDUCATION SECTION [PEER TO PEER COURSES]
•
OBJECTIVE 2.
DATA ANALYSIS ON FALLS AND HF
The three main goals under the project lines are:
Under Objective
1
Under Objective
2
To train 24 Peers (Trainers) about the issue of Fall Prevention. They’ll be
asked to run locally Fall Prevention Courses for Peers (Trainees) on a
schedule yet to be defined. Peers will be trained with a 4 modules course
lasting 4 half days. The modules will address: biological, behavioural,
environmental and socio-economics and lack of physical activity risk
factors and the relative prevention measures.
To create two Formative Packages [Manual, Slides, Pamphlets,
Questionnaires, Articles from Literature]
The first dedicated to the Trainers Course
The second, to be used from the Trainers for their Trainees Classes
To determine the cause of fall and HF for the patients hospitalized in 2009
in the three Project Regions
Summary table 1
OBJECTIVE 1
EDUCATION AND FORMATIVE SECTION: ELABORATION AND TEST OF A SHARED MODEL OF PEER TO
PEER COURSE ON FALL PREVENTION
The project answer to the need to implement and test a shared model to prevent elderly falls, offering a shared
model based on a PEER to PEER approach, in collaboration with the no-profit elderly associations (ANTEASAUSER in Treviso, ANTEAS in Gorizia and a Team of individual elderly participants in Klagenfurt.) For many
older adults, the advice and support of another senior who has had many of the same life experiences is the most
accepted and successful approach to promote healthy aging (22); a comprehensive strategy to foster the
empowerment and accountability.
This model foresee the implementation on a Community Based Approach of Peer to Peer courses on Fall
Prevention. The target is the population over 65 and their caregivers. The peer to peer approach is mainly
used for educational programs with younger age-groups but recently there is growing evidence of the
opportunity to use
older people as peer educators.(23)
Recently, for example, to encourage the recognition and prevention of abuse on older people a peer education
project for over 65 was implemented in Tuscany(24), while at an international level prevention and information
programs have been implemented and they are related to: Osteoporosis and arthritis (25) , wellness and quality of
life (26), to encourage healthy eating (27) and increased physical activity (28).
The trainees (classes of 20 plus the caregivers) will be taught about the risk factors which leads to a fall, and how
to assess these risks focusing on the two pillars of Fall Prevention that are Home Hazard Control and Physical
Activity. That will be a one, four hour class to be repetated after 6 months in order to evaluate the expected
awareness increase, about this issue, and hopefully the change of behaviour.
5
The original project and the original project numbers
18 aged people have been selected; 6 for each Region. They have attended a common course for trainers called
“identification and control of risk factors in elderly fall”. The course took place in Treviso. A 4 half-day lessons
lead by specialized staff with the help of cartoons, video and other interactive materials has been submitted; the
course has been evaluated with professional instruments. In the next three months the trainers will be asked to
run, each of them, n.2 classes of 30 elderly in their own territory. The purpose of these classes is to increase the
Trainer confidence, and to provide them with a real feedback, before the scheduled implementation that will
take place at the end of the project.
The project as originally designed should have the participation of 18 peers to train.
6 elderly in each area: 6 volunteers for Treviso Anteas, 6 volunteers for Gorizia Anteas, 6 chosen volunteers for
Klagenfurt.
The test classes would involve about 180 people: Treviso 2 classes of 30 trainees each, Gorizia 2 classes of 30
trainees each and in Klagenfurt 2 classes of 30 trainees each as well.
The original plan should then have 18 trainers and 180 trainees as reinforcement classes for a total of 198
elderly involved in the process.
Actual Project Numbers
The original general plan was to involve just one Elderly Association in two Regions: ANTEAS. With the project
already ongoing we’ve been asked to admit a second Elderly Association: AUSER just for the Treviso region with
further 6 candidates for training.
The Peer number to be trained was, therefore 24 with a new 240 trainees goal to be reached.
A new shorter (2 days) course for the Auser group has been held in Treviso.
A strong quest for getting acquainted with the informative package, and the communication technique, has
requested two further reinforcement meeting. Furthermore the Anteas and Auser trainers have yet carried out 4
test courses with 88 volunteer trainees in Treviso and Gorizia for making experience with the package and
requested activities. The Carinzian Trainer also have completed 3 test courses for a total of 60 trainees.
By now before the implementation of the 8 actual expected final Classes that will involve at least 240 voluntary
trainees in the next 3 months, the project has recruited 24 Trainers who have already run test classes with 148
trainees.
The final expected number than will be 24 trainers and 388 trainees
TOTAL : 412 ELDERLY, the number has almost doubled
Original plan
Peers to be Trained
Total
Trainees Classes
•
•
•
Treviso 6 Anteas
Gorizia 6 Anteas
Klagenfurt 6 chosen volunteers
18
• Treviso 2 for 30 trainees each
• Gorizia 2 for 30 trainees each
• Klagenfurt 2 for 30 trainees each
Test Trainers Classes
Total
Original plan
Summary table 2
180
• 18 Trainers
• 180 trainees
Total: 198 Elderly involved in the process
Actual Project Numbers
•
•
•
•
24
•
•
•
•
Treviso 6 Anteas
Treviso 6 Auser
Gorizia 6 Anteas
Klagenfurt 6 chosen volunteers
Treviso Anteas 2 for 30 trainees each
Treviso Auser 2 for 30 trainees each
Gorizia 2 for 30 trainees each
Klagenfurt 2 for 30 trainees each
• Treviso 1 for 21 trainees
• Gorizia 3 for 67 trainees
• Klagenfurt 3 for 60 trainees
240+ 88+60= 388
• 24 Trainers
• 148 trainees as reinforcement classes
• 240 trainees
Total: 412 Elderly involved in the process
6
Preliminary comments.
The Peer to Peer approach is the core of this small project fund. For the Peer Trainers It matches with the
process to move from the category of Ageing with Disease or Usual Ageing to the more compelling Successfull
Ageing. At the same, with the implementation of the Fall Prevention Courses on a Community Basis, will provide
to the trainees the basic information to recognize and control the main risk factors that lead to a fall.
It would appear so far, that in the making of the project there has been an underestimation for both: the
enthusiasm of Peer enrolled to become trainers and the possibility to offer a basic set of information in only a
four half day course. Preliminary numbers in Summary table 1 show a strong quest for reinforcement training
sessions. Moreover the three Peer groups have been discussed the course information package in further 7
review presentation and check group meetings. The preliminary conclusion is that for an effective educational
strategy in order to train for a basic fall prevention course will imply the participation on at least two 4 half days
courses. The second one totally dedicated to review the informative package: Booklet, questionnaires, slides,
communication technique. The Reinforcement sessions will be held on demand.-uio
Formative Packages
Two educational packages has been produced [work in progress], one for the Trainers and one for the Trainees.
The questionnaires are carrying the same title for both, but they slightly differ in contents.
1.
The Manual (Booklet), [work in progress] 130 pages, so far.
The frame and the content have been discussed thoroughly with Dr. Nimali Jayasinghe, Assistant
Professor of Psychology in Psychiatry at Weill Medical College of Cornell University. In the Booklet are reported
an interview,with Dr. Jayasinghe, and one with Celeste Carlucci and July Kardachi of FallStop…move strong,
New York,: on the Psycological impact of falls and fractures and about the relevance of the Physical
Activity in later life.
Only for Trainers
2.
“What we know about falls” a pre course test questionnaire
One for Trainers and one for Trainees
3.
“What we have learned about falls” a post course test questionnaire
One for Trainers and one for Trainees
4.
“Is your Home Safe” Home Hazard Check List”
Same for Trainers and Trainees
5.
“How do you feel Safe” , test questionnaire
Same for Trainers and Trainees
6.
“How today’s meeting has been useful to you”
Same for Trainers and Trainees
7.
“How to grow up well after 70” Leaflet about Fall Prevention
Only for Trainees
7
OBJECTIVE 2/Goal 3
HOME HAZARD AND ENVIRONMENTAL RISK FACTORS: DETECTION FOR ASSESSMENT
The main goal under the project lines is to finally determine the major causes of falls and HF for the patients
hospitalized in 2009 in the three Recruited Hospitals: Ca’ Foncello Treviso, Gorizia general Hospital and Klinicum
Klagenfurt General Hospital.
There have been around 700 HF in Treviso, Gorizia and Klagenfur. All patients treated in 2009 will undergo a
phone interview in order to detect, among others info:
1.
2.
3.
4.
5.
6.
Cause of fall
Place of fall
Previous falls
Following falls
Mobility pre and post fall
Autonomy pre and post fall
We tried to have a telephone contact with 140 out of 700 Patients that have experienced a HF in the 2009 in
three Regions.
The interview has been completed in 73 cases, 17 people were not traceable, and after 5 tries have been
canceled from the sample, 9 people don’t like give answers, 41 are unavailable because we can’t have the right
phone number or addres and 15 people are removed from our sample because theirs fractures have been caused
by road accidents, during an hospitalization or because they have been hospitalized for previous fractures or
because they need the substitution of older prosthesis, then for causes different from those we like to prevent
with our project. This is so far a small sample but the results are not meaningless.
Below we present some important result.
Falls causes and places
CAUSES OF FALL
%
n.
FALL PLACE
STUMBLES- TRIPPING
8
15,38
LOW MASTERY WITH LOCOMOTION
INSTRUMENT(BICYCLE ...)
FALLING OUT OF BED
6
11,54
5
9,62
STEPS OR OBSTACLES
5
9,62
POTHOLES OR SIDEWALKS RUGGED
STUMBLES GETTING DRESSED OR
UNDRESSED
SPONTANEOUS RUPTURE
4
7,69
4
7,69
4
7,69
STUMBLES DUE TO DEAMBULATION
AIDS
SLIPS
3
5,77
3
5,77
FALLS DUE TO CARPETS
2
3,85
UNWELL-SYNCOPE
2
3,85
POOR LIGHTING
2
SLIPS ON WET FLOOR
2
%
34
62,96
KITCHEN
10
18,52
BEDROOM
12
22,22
LIVING-DINING ROOM
4
7,41
INTERNAL STAIRS
3
5,56
BATHROOM
3
5,56
GARAGE - UTILITY ROOM
1
1,85
EXTERNAL STAIRS
1
1,85
outdoor
20
37,04
GARDEN
4
7,41
3,85
SIDEWALKS
4
7,41
3,85
ROAD
7
12,96
5
9,26
54
100,00
indoor
ICE-SNOW
1
1,92
PUBLIC AREAS
AGE INCONGRUOUS MOVEMENTS
1
1,92
Totale complessivo
52
100
Tot.
N.
Table 3. Fall places
(54 people give an answer to this question)
Table 2. Causes of fall that lead to HF
(52 people give an answer to this question)
8
Preliminary Comment
In the aggregate the main cause of fall is stumbling or tripping. It’s followed by falls from the bike and very
important are also causes related to slippery floors (potholes or sidewalks rugged, falls due to carpets, slips on
wet floor, ice-snow). A slippery floor is whithin the category of the Home Hazards to be controlled with an home
assessment in the first place, but is also related with wearing totally inadequate footweare. This aspect will be
further inquired with the following interviews. We are facing, if this preliminary data will be confirmed, as major
Risk Factor, a poor Physical Condition which doesn’t allow the correct response to any causes leading to an
unbalanced event. The Physical Activity is the answer to manage this percentages of falls. Falling out of bed
(9,62%) is an intriguing issue that can be figured it out with a design effort able to combine the function with
the safety. It’s also interesting to note that the most part of our sample falls at home, (bathroom, bedroom,
kitchen, living-dining room, garage - utility room, internal and external stairs) 62,96%.
OBJECTIVE 2.
1.
HOSPITAL ASSISTANCE DATA ANALYSIS ON HF . DATA COMPARISON IN ORDER TO IDENTIFY
COMMON GOOD PRACTICE
Analysis of the existing data on hospital care for hip fracture: this objective aims to identify healthcare best
practices about hip fracture management, through the collection and compared analysis of demographic,
epidemiological, clinical and economical data. Demographic data make understand the population ageing trend
and the related impacts. Epidemiological data underline mortality and morbidity associated to hip fracture and,
in particular, the expected incidence for over70. From the risk factor perspective, data regarding hip fracture
causes are particularly relevant. Hospital clinical data will draw a picture on how three different healthcare and
social structures face the common problem of elderly hip fracture. Finally, data on costs related to
hospitalization will provide food for thought on costs limitation and system efficiency
Among others, the following pointers will be valuated and compared
•
•
•
•
•
•
•
Number of HF
Man/Women rate
Hospital mortality rate, mortality at 1 year and 2 years
Morbidity
Length of Hospitalization
Time between admission and surgery
Hospitalization cost of HF
Critical situations will be deeply analysed in order to finally share a validated common validation on best
practices in hip fracture’s hospital care.
Some preliminary data are already available and rely on the data at the moment available that come mainly from
Treviso’s and Goriza’s hospitals.
NUMBER OF HF
Hospital
N.
Treviso
Gorizia
393
125
Data at the moment non
available but estimated
around 180 people
Klagenfurt
Total sample
700
Tables 4. Number of HF
9
GENDER DISTRIBUTION GRAPHS AND TABLES
Gender
N.
FEMALE
392
MALE
126
Total sample
518
Gender
N.
FEMALE
94
MALE
31
GORIZIA’S
SAMPLE
125
Gender
FEMALE
MALE
TREVISO’S
SAMPLE
N.
298
95
393
Tables 5,6,7. Gender distribution in total sample, Treviso’s and Gorizia’s samples.
Graphs 1,2,3. Gender distribution in total sample, Treviso’s and Gorizia’s samples.
THE GENDER ISSUE WITHIN THE HIP FRACTURES ISSUE
The well known women higher Estimated Life is true and controversial at the same time. Among older adults,
non fatal fall-related injuries disproportionately affect women. The central message from the papers says that in
the older adult samples treated in EDs for unintentionally fall injuries, more than 70% are women. Furthermore
women who fell are at risk of hip fractures with the same unfortunate rate of about 70/30.
In the United States the incidende of fractures for women is extimated to increase from 2 episodes per year
every 100.000 inhabitants aged 35, to more than 3000 episodes at 85. Among men the incidence is extimated in
4 episodes at 35, every 100.000 inhabitants, to 2000 episodes above 85 years of age. The rate between women vs
men is confirmed at 3 to 11. This is an accountable data registered in the WHO/European/National/Local
papers. The 70/30 rate is confirme for our preliminary survey.
Even if the mortality rate for those who are undergoing surgery after hip fracture is less favorable for men, we
can reasonably stress that the magnitude of the hip fractures issue falls within the women gender. Surprisingly
plans and models used to prevent falls are addressed to older adults with no consideration about gender even if
the population at risk is mostly represented by older women. In the existing studies (29, 30)on fall prevention for
older women the policy intervention used is the same that would be used with an older man sample. More work
is needed to possibly fill this gap in order to find appropriate intervention just for older women, if any will be
found out to be effective!
10
Additional research is needed to tailor interventions for different population and to determine gender
differences in the underlying causes and/or circumstances of falls. This information is vital for developing and
implementing targeted fall prevention strategies to be offered to the Policy Makers in charge for the redefining
process of Active Ageing.
HOSPITAL MORTALITY RATE
Gorizia’s General Hospital mortality rate
MORTALITY RATE
N°
%
% cumulative
DEATH DURING HOSPITALIZATION
6
4,80
4,80
DEATH WITHIN YEARS
34
27,20
32,00
DEATH WITHIN 2 YEARS
10
8,00
40,00
DEATH AFTER TWO YEARS
2
1,60
41,60
ALIVE
73
58,40
58,40
Tot.
125
100,00
Table 8. Gorizia’s General Hospital mortality rate
Cà Foncello Hospital mortality rate (Treviso)
MORTALITY RATE
N°
%
% cumulative
DEATH DURING HOSPITALIZATION
25
6,36
6,36
DEATH WITHIN YEARS
64
16,28
22,65
DEATH WITHIN 2 YEARS
38
9,67
32,32
DEATH AFTER TWO YEARS
10
2,54
34,86
ALIVE
256
65,14
65,14
Tot.
393
100,00
Table 9. Cà Foncello Hospital mortality rate (Treviso)
One of the most relevant pointer about the life expectation on HF is the the time span from hospitalization to
surgery.
Research shows that performing surgery within 48 hours from fall has a strong impact on reducing the mortality
and morbidity rate for patients experiencing a HF(31). For the Orthopaedic Community this acquisition is solid
and yet not recent having been presented in several papers at least since 1989(32). Earlier surgical repair is not
possible when patient medical condition are unstable, though. Available evidence suggests that waiting up to 72
hours to allow time to stabilize the patient, doesn’t adverse the outome(33). Evidences on this issue might not
fully match with consolidated and common sense based opinions. On top of that the economic downturn and the
increasing cost of the Social Health System, doesn’t often allow the Operative Surgery Units to answer promptly.
Here below are listed preliminary data from two out of two Regions that will be subject to further evaluation.
Treviso: 35 patients out of 393 have the treatment within 48 hours (10,05%)
Gorizia: 56 out of 125 have the treatment within 48 hours (44,8%)
11
TIME BETWEEN ADMISSION AND SURGERY
People with surgery undergone within 48 hours
Hospital
n. patients
%
Treviso
Gorizia
35
56
10,05%
44,8%
Table 10. People with surgery undergone within 48 hours
Average days between hospital admission and treatment
Hospital
Days
Treviso
4,91
Gorizia
3
Table 11. Average days between hospital admission and treatment
LENGTH OF HOSPITALIZATION
Average length of hospitalization
Hospital
Days
Treviso
18,42
15,36
Gorizia
Table 12. Average length of hospitalization
Other information will be elaborated and presented at the end of the project, when all data will be available and
when we’ll know completely the required information from all 3 hospitals.
A public crossborder conference will be scheduled on elderly falls. During the conference, a friendly website
created to disseminate projects results will be presented. The activity results will be illustrated with regards to
the common models (elderly fall prevention and hospital care management of hip fracture). Furthermore, the
conference will present the shared and validated instruments, and the future perspectives on model
dissemination and instruments use at local and regional level, in order to create an transborder network on
elderly fall prevention.
PRELIMINARY DISCUSSION
About OBJECTIVE 1. Formative Packages and Course Structure are work in progress, and minor modifications
will be undertaken as necessary, during the project lifespan and after that, according to the Elderly Association
involved and the region represented. An Example. The Physical Activity together with the Home Hazard
assessment, represents one of the two pillars of the Fall Prevention. In the Manual is represented by a full
Chapter, it’s teaching material for one of the four modules presented to the Trainers class. The Treviso and
Gorizia Trainers has used 20 out the 24 slides available for their test class. The Karinzian trainer group has used
only 4 slides. That’s because in the Karinzian Region, contrary of whit is happening in Treviso and Gorizia, the
Physical Activity for the elderly is part of the older adults’ everyday. Flexibility in managing the formative
material is a must! The work in progress nature of the education section in not under discussion. So far the
major issue for Trainers is represented by not having a solid background to support them in the presentation of
the HF and their medical/social consequences. The step from Falls to HF are the milestone of the project, and
some work must be done to make the Trainers comfortable with the medical terms and contents about the HF
hospitalization and rehabilitation path.
The training model (contents and timing) has been repeatedly discussed. The Preliminary Conclusion would
confirm that to be effective, a training session must be reinforced with a timing yet to be defined. Moreover, it’s
clear to the Management Project Group that besides the Reinforcement session, a twice a year scheduled Course
12
should represent a reasonable goal to keep the Trainers updated on the Fall Prevention Issue. Others
considerations to follow in the final Project Article.
ABOUT OBJECTIVE 2. The Final Conference is intended to be a further teaching activity addressed to our
Trainers. This approach is linked with a data disclosure aimed to be comprehensible and easy to be transmitted
in a Fall Prevention Class for elderly. The full and comprehensive data disclosure will be presented with a final
article that will be prepared before the end of June 2012, two months later the Project Expiring Date.
In the end, in literature there is not a strong evidence to indicate just one Fall Prevention Model as the Gold
Standard. There are different approaches, models(34), and guidelines(35). A number of interventions targeted to
individuals have been shown to work, but population-based strategies have not been properly evaluated(36). But
a large number of core principles that can frame local variation in design and implementation, are yet available
(14).
The saying by Abe Lincoln “It’s not the years in your life that count. It’s the life in your years!” is totally in line
with any accountable action addressed to recognize and implement the core principles that fit with the
Community need of an healthy ageing.
13
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