Spectrum of Prevention
A unified response to
challenges in an aging community
2015 Aging in Texas Conference
Austin, Texas
July 30, 2015
Objectives
• Distinguish how a public health framework is critical
to developing multidisciplinary collaborations
• Utilize a public health framework to address complex
and urgent challenges of an aging population
• Develop a strategy using the Spectrum of Prevention
to address a public health concern
Presented by:
Jennifer Jurado Severance, PhD
Senior Citizen Services of Greater Tarrant County, Inc.
Why apply a public
health approach?
• Good health is key to
independent living and quality
of life
•Demographic and
epidemiologic shifts impact
medical and social services
•Disparities exist among
subgroups
•Health promotion and
disease prevention can
prevent or delay onset of
acute and chronic conditions
What Makes Us Healthy vs. What We Spend on Being Healthy, Tuesday, June 5, 2012 Retrieved
from http://bipartisanpolicy.org/
“This spectrum tool
was derived
from practice and
developed out of
the conviction
that complex
problems require
comprehensive
solutions.”
Retrieved from http://www.preventioninstitute.org on October 13, 2010. Model
originally developed by Larry Cohen director of the Contra Costa Health Services
Prevention Program, the Spectrum is based on the work of Dr. Marshall Swift in
treating developmental disabilities. It has been used nationally in prevention
initiatives targeting traffic safety, violence prevention, injury prevention, nutrition,
and fitness
Larry Cohen and Susan Swift, 1999
in Injury Prevention
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Presented by:
Amanda Robbins, MS, APRN, GCNS-BC
NICHE Coordinator
Texas Health Harris Methodist Hospital Fort Worth
World Health Organization
Collaborating Center for Prevention
• 1989 - First World Conference on Accident and Injury
Prevention, held in Stockholm, Sweden
• No single approach to injury prevention and safety
promotion can be as effective as a collaboration among
community organizations and community members
▫ The leading role is played by the community itself, an
entity that is larger than any of its parts.
▫ “All human beings have a right to health and safety”
Criteria as Established by the
World Health Organization
• Demonstrate partnership and collaborations with all
community sectors that are responsible for promoting
safety within the community.
• Long-term and sustainable programs covering both
genders, all ages, environments, situations, and
include emergency and disaster preparedness.
• Collect data on number and causes of injuries.
Criteria (cont.)
• Programs target high-risk groups and
environments, and promote safety for
vulnerable groups.
• Evaluate the programs, processes, and the
effects of change.
• Participate in National and International
Safe Communities networks.
Safe Communities America
National Safety Council
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Sponsoring agency in America
Nonprofit organization
Leading safety advocate for >100 years
Vision: Making our world measurably safer
Unintentional injuries fifth leading cause of death in
U.S.
• Safe Communities overall have a 8-10% decrease in
injury related deaths
Becoming a Safe Community
• Form Coalition
• Audit safety and injury prevention programs
• Contact Safe Communities America
Fort Worth Safe Communities Coalition
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World Health Organization
National Safety Council
Conceived November 2011
Steering Committee
Born February 2013
300th worldwide
‘New gold standard”
Fort Worth Safe Communities Coalition
Task Forces
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Child Injury
Domestic Violence
Motor Vehicle Crash
Drug Overdose
FW Drowning Prevention Coalition
Elder Abuse
Sports Injury
Disaster Preparedness
Bicycle Safety
Take 20 for Life
Falls
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Public Health Problem: Elder Abuse
• Elder Abuse is under reported. 1 in 14 elder abuse cases are
reported to authorities.
• Elders who experienced even modest abuse, had a 300% higher
risk of death compared to those who had not been abused.
• ~ 50% of people with dementia experience some kind of abuse.
• The fiscal impact:
▫ direct medical costs from violent injuries > $5.3 billion
▫ financial loss by victims of financial exploitation > $2.9 billion
http://www.ncea.aoa.gov/Library/Data/index.aspx
NYS Elder Abuse Prevalence Study; Weill Cornell Medical College, NYC Department for the Aging;
Lifespan; (2011)
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Texas Data
• Since the 1980s, states have been enacting laws related to the
abuse, neglect and financial exploitation of elderly residents.
• As part of the Patient Protection and Affordable Care Act (PPACA)
on March 23, 2010, the Elder Justice Act (EJA) was the first piece
of federal legislation passed to authorize a specific source of
federal funds to address elder abuse, neglect and exploitation.
• In 2014, Population of Older Adults aged 65+
 Total APS In-Home intakes
 Total Completed Investigations
 Validated APS investigations
n= 3,086,103
103,024
81,681 (79% of intakes completed)
54,731 (67% of validated investigations)
http://www.ncea.aoa.gov/index.aspx
https://www.dfps.state.tx.us/About_DFPS/Data_Books_and_Annual_Reports/2014/
http://www.americanbar.org
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Tarrant County, Texas
• 4th highest number of Validated In-Home APS Investigations
• As a portion of Region3, Tarrant and Dallas counties contribute
greatly to the region’s status:
 Highest volume of older adults per Region
 Highest volume of Validated In-Home APS Investigations
(11,507 – 14% of those in TX)
Population Data Source: Texas State Data Center, University of Texas (San Antonio). Based on Census
2010 data.
Source: https://www.dfps.state.tx.us/About_DFPS/Data_Books_and_Annual_Reports/2014/
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Risk Factors for Abuse to an Older Adult
Dementia and Cognitive Impairment
Increased caregiver burden
Domestic Violence Grown Old
Relationships with a history of domestic violence continue
Personal Problems with Abusers
Financial, Medical/Psychiatric, Dependency
Living Arrangements – group settings and social isolation
http://www.ncea.aoa.gov/faq/index.aspx
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Strategies
Level
Strategy
FWSCC Elder Abuse Prevention Task Force
Strategies
6
Influencing Policy and
Legislation
Established County’s Adult Fatality Review
Team, Involvement of the TSHL
5
Changing Organizational
Practices
Create and studying a screening tool for first
responders, Improved tool for investigation
4
Fostering Coalitions and
Networks
3
Educating Providers
•Develop task force membership
•Active participation and coordination among
existing collaboratives re: Elder Abuse
Determine need for education to care
providers about assessments and reporting
2
Promoting Community
Education
Promote through community events
1
Strengthening Individual
Knowledge and Skills
Identify resources for available to the public
for individual use
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Results
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Expanded task force
Provider education
Enhanced Awareness
Support Stress Buster Classes for Caregivers
First Responders involvement
Grant Activity
Adult Fatality Review Task Force
Public Health Problem: Falls
• Every 29 minutes an older adult dies from a fall
• 1 in 3 community dwelling adults ≥65 yrs fall each year
• Those who fall are 2-3 times more likely to fall again
• Each year, over 2 million older adults are treated in
emergency departments for nonfatal fall injuries, with about
30% requiring hospitalization
• The annual cost of injuries from falls in those ≥65 is estimated
at $30 billion
Source: CDC, Retrieved at http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
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Texas Data
A fall is the leading cause of
injury in for ages 45+ (Texas
EMS/Trauma Registry, 2013)
• 60,692 hospitalizations
due to a fall
• Falls make up almost
half of all injuries
reported to the registry
• 45% were male, 55%
were female
• Over half were 65 years
old or older
Source: CDC.gov/injury/wisqars
Fort Worth: JPS Health Network
• In 2013,
▫ 701 total admits for fall
▫ 67 average number of
falls per month
▫ 29% of all trauma
admissions
• In 2014,
▫ 850 total admits for falls
▫ 73.4 average number of
falls per month
▫ 31% of all trauma
admissions
Source: JPS Health Network Trauma Registry 2013 and 2014
Modifiable Risk Factors
Biological
Leg weakness
Mobility Problems
Balance Problems
Poor Vision
Behavioral
Environmental
Psychoactive medications
Clutter & tripping hazards
Polypharmacy
Risky behaviors
Absences of stair railings
or grab bars
Inactivity
Poor lighting
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Cross-sector
collaboration
Falls Prevention
Task Force
• Texas Health
Resources
•JPS Health Network
•UNTHSC
•Healthsouth
•PCPs
Healthcare
Systems
First
Responders
Public
Health
•FWFD
•FWPD
•MedStar
Tarrant County
Public Health
Dept.
Judge Whitley’s
Office
Aging
Services
•SCS
•AAA
•United Way
•MOW
County
Government
Higher
Education
Univ. of North Texas
Health Science Center
(UNTHSC)
Strategies
Level
Strategy
FWSCC Falls Safety Task Force Strategies
6
Influencing Policy and
Legislation
Letter to local government to introduce task
force, falls impact, need for falls prevention
5
Changing Organizational
Practices
Create opportunities for hospitals and
providers to directly connect patients to
community programs
4
Fostering Coalitions and
Networks
•Develop task force membership
•Active participation and coordination among
coalitions regarding falls prevention
3
Educating Providers
Education to providers about evidence based
practices and community-based programs
2
Promoting Community
Education
•Geomapping of target areas
•Promote programs at community events
1
Strengthening Individual
Knowledge and Skills
•Identify gaps in services
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Results
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Expanded task force
Provider education
Community education
AMOB classes
Home Meds screenings
Geomapping
First Responders program
Prescription Pads
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Problem: Mental Health Needs
• 20% of people age 65+ experience some type
of mental health concern.
• The most common mental health concerns
are anxiety, severe cognitive impairment and
mood disorders.
• Older men have the highest suicide rate of
any age group.
• Older adults with depression have higher
health care and medication use, and longer
hospital stays.
• Older adults are less likely to receive mental
health services than younger and middle
aged adults.
APA Office on Aging at http://www.apa.org/about/gr/issues/aging/mental-health.; “State of Mental Health
and Aging in America” CDC, 2008, Retrieved at http://www.cdc.gov/aging/pdf/mental_health.pdf
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Narrow Focus: Suicide in the Elderly
• Older adults make up 12% of the US population but account for 18%
of all suicide deaths
• Elder suicide may be underreported by up to 40%
• Most elder suicide victims live with relatives or are in regular contact
with friends and family.
• 70% if elder suicide victims die within
one month of a primary care visit.
• Community agencies are often focus on
independence or self-sufficiency
American Association for Marriage and Family Therapy
http://www.aamft.org/iMIS15/AAMFT/Content/Consumer_Updates/Suicide_in_the_Elderly.aspx
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Activity
• Using the handout,
▫ Assess current interventions
▫ Identify gaps in each level
▫ Brainstorm possible strategies
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Strategies
Level
Strategy
Examples
6
Influencing Policy and
Legislation
Funding and legislative initiatives to
address this preventative tragedy
5
Changing Organizational
Practices
4
Fostering Coalitions and
Networks
Utilize screening tools for early recognition
of depression, mental health concerns
•Develop task force membership
•Active participation and coordination
among existing collaboratives
3
Educating Providers
Assess and recognize of risk factors for
self-harm, offer treatment for person and
support system
2
Promoting Community
Education
Campaign on mental health awareness,
depression not normal aging, prevention
strategies
1
Strengthening Individual
Knowledge and Skills
Empower person and support system with
tools for recognition, management and
prevention
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Amanda Robbins MS, APRN, GCNS-BC
NICHE Coordinator, Texas Health Hospital Fort Worth
817.250.5088
AmandaRobbins@texashealth.org
Jennifer Severance Ph.D.
Program Manager, Senior Citizen Services of Greater Tarrant County, Inc.
817.413.4949 ext 226
JSeverance@scstc.org
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Resources
• www.cdc.gov/injury
• www.stopfalls.org
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CDC.gov/homeandrecreationalsafety/falls/adultfalls
www.preventioninstitute.org
www.who.int/en/
www.nsc.org/pages/home.aspx
www.ncea.aoa.gov/index.aspx
www.dfps.state.tx.us/About_DFPS/Data_Books_and_Annual_Reports/
www.americanbar.org