Ohio State experts and community partners are working to prevent falls while redirecting resources to respond more efficiently.
The growing problem
Seniors today increasingly live apart from their families, but they want to continue living independently rather than in assisted-living facilities. Those circumstances put them at higher risk for falls.
Though Americans are living longer and are better able to manage chronic illnesses, they still fall down: Medical costs for fall injuries in the U.S. are expected to reach $55 billion by 2020.
A recently published, 10-year study of a typical American suburb showed that at least one in 10 EMS calls were related to falls in people 60 and older.
Leading the study was Carmen Quatman, MD, PhD, an orthopedic surgeon at The Ohio State University Wexner Medical Center who specializes in fractures from these falls.
Researchers found that, from 2007 to 2017, the number of fall calls increased significantly, though fewer callers were transported to hospitals for injuries.
The calls not only divert attention from other emergencies, but they’re also expensive. Between $825 and $1,500 is spent per run on “lift assists” for adults who can’t get up easily, but who are essentially uninjured.
Yet the calls can’t be ignored.
“Falls can lead to profound changes in mobility and overall life expectancy. They are a huge deal in the elderly – if there is actually a fracture, we want to get them to the operating room within a few hours because the mortality risk increases the longer we wait.”
Identifying solutionsQuatman collaborated with other Ohio State fall experts (including her twin, physical therapist Catherine Quatman-Yates, PT, DPT, PhD) to construct better prevention strategies.
The first step: addressing a communication breakdown between first responders and physicians.
“We see patients at the hospital when they need emergency fracture care, but we don’t see their homes,” Quatman says. “Do stacks of newspapers present a fall risk? Is the patient limited to one area of the house because of barriers?”
Paramedics get to see the patients’ living conditions, Quatman points out. They get to know their frequent callers and notice risks.
“We’re connecting what first responders are seeing with the whole system, so that health care providers can be alerted to issues and make good decisions through discharge. Based on paramedics’ reports, we may hold onto a patient before discharging them, for example, until the risks at home are figured out.”
Fixing a fractured system
In 2017, Quatman and Quatman-Yates partnered with an Upper Arlington paramedicine program called CARES (Community Assistance, Referrals and Education Service) to design a community fall-prevention plan.
“CARES were excellent, enthusiastic partners to help Ohio State drive the idea forward,” says Quatman-Yates.
Using development and research grants, CARES paramedics perform in-home patient screenings and risk evaluations. CARES provides education and safety tools, such as new lighting or grab bars.
“These can have immediate impact,” Quatman says. “One patient felt unable to even walk downstairs. Having CARES install one grab bar meant she had the safety and confidence to move freely around her home.”
The CARES program has spurred first responders throughout central Ohio to create similar efforts, such as in Delaware County and Pickerington.
Quatman-Yates credits the quickly spreading projects to a joint effort among clinicians with multidisciplinary expertise, and knowledgeable research coordinators Elizabeth Sheridan and Jessica Wiseman.
The Ohio State team also formed the Community FIT (Fall Intervention Team) and, in 2018, began connecting health care providers, first responders and community members.
The casual meetings have seen collaboration from providers at other central Ohio healthy systems and from first responders in communities across Ohio, where programs similar to CARES are being explored.
“If we can get additional funding, it changes everything,” Quatman says. “These fall-prevention initiatives could spread well beyond central Ohio.”
Those who want to support current prevention efforts can donate to The Ohio State University Foundation’s Orthopaedics Special Initiatives Fund to help sustain paramedicine partnership work and research.
Ohio State researchers are continually examining 911 fall calls, paramedicine relationships and other fall data over time. But Quatman says that, ahead of publishing research, the team is focused on reaching at-risk populations as quickly as possible, increasing communication with primary care providers and planning more care coordination between hospitals and community paramedics.
“The goal is to influence health care policy and to make sustainable change,” she says. “And to serve as connectors so that fewer people get hurt.