Quality Improvement, Community Involvement, Injury Prevention

State: KS Type: Neither Year: 2015

Our local health department is located in Hutchinson, Kansas.  Reno County is one of the geographically largest counties in Kansas (1,255 square miles) with a total population of: 64,511.  It is home to Hutchinson, the county seat, with a population of 42,000 and several small communities.  The median household income for both the county ($41,431) and city of Hutchinson ($38,880) considerably lag the state’s rate ($49,424). (2007-2011 American Community Survey 5 year Estimates) Rural Reno County is home to a significant number of Amish families who are quite dependent upon agriculture and value a simpler lifestyle.  Hutchinson has three state prison facilities (minimum, medium, and maximum security) that provide steady employment for many, but draws a number of transient families to the area that are in need of a variety of social services. The greatest population increases were in the 45-59 years age groups.  This increase also reflects the increased need for health care services as the population ages. (MMWR 1/14/11 Vol. 60) Our public health issue is falls affecting the over 60 year old population.  Our goal is to decrease falls in this age group in Reno County. Our objective is to offer the evidence-based fall prevention program, Stepping On. In April, 2014, we sent our older adult coordinator to become certified as a Stepping On Instructor.  After completion of the first class, an article was written and published on the front page of the Hutchinson News (newspaper) which resulted in offering three classes for the next session on the same day instead of only one.  We also have over 30 people on the waiting list for the next classes. The initial participants were quoted in the article about how the classes gave them new information and means to decrease or eliminate falls and related injuries. One participant reported that he had not had a fall since starting the class. Others reported feeling safer in their homes and having alternative devices to assist with mobility. Feeling safe and having resources gave them courage to walk and increase their activity level. Group participation increased as individuals shared falls and other occurrences of injury. The program encourages the participants to discuss what has happened to them as they are aging. After the seven week session, a follow up to their homes was completed to help focus on individual changes suggested for their home environments.  We have our first follow up booster class (three months after the first session) scheduled for the first week in November.  At that time, I will be able to gather data concerning their balance, strength, exercises, and any falls. Website: Fall prevention and elder health are the two objectives for the model practice, Stepping On program.  As we age and have a decrease in agility and resilience, balance and strength needs can be factors for falls in the older adult.  
Falls prevention is a community issue that is costly in terms of quality of life and dollars spent on healthcare.  We are targeting the over 60 year old population.  Due to the recent initiation of this program, we have completed only one session and are in the process of a second session. The types of fall prevention programs that have been available in the past did not address the concerns relative to fall prevention. The programs addressed how falls occur and the incidents that can results. The Stepping On program is more hands on, exercise based for balance and strengthening. Participants use leg weights for exercise and are given instructions for use by a professional OT/PT in the initial class and exercises are performed at every class meeting. Demonstrations are given by the leader and a previous class participant on different devices to assist with mobility and safety, such as walking sticks, canes, spiked type shoes for over the shoe wear, and many others. Home safety and lighting are discussed; vision and hearing; pharmaceuticals are discussed by a pharmacist; and foot wear use, type and wear is presented by a local shoe business. Local businesses are consulted on the types and costs of products that are demonstrated in the classes. The Stepping On program has been shown to reduce falls by 31%. One of every 3 adults age 65 and older suffer falls every year. Injuries from falls are the number one cause of death for people in Wisconsin and this number is higher than automobile accidents. 40% of people who enter nursing homes had a fall 30 days prior. 35% of those who fall become less active. These factors alone are definite reasons why the Stepping On program will help older adults learn ways and means to prevent falls. Falls are not a normal part of aging and they can be prevented. The simple act of learning strength and balance can help to prevent falls and muscles can get stronger.  Our new evidence-based class will make a difference giving the participants confidence and eliminating fear as the barrier to doing the things they want to do in the home and community. Yes, Stepping On is an evidence based program.  Our program is based on the Stepping On, Wisconsin Institute for Healthy Aging ( Our outcomes have not been measured at this time.  The first class session involved eight participants and the follow-up process has just started.  Articles and editorials in the Hutchinson News applauded the program and participation.  The second session of classes has tripled, with a waiting list for the next session.  Initial participants are followed for three months to ascertain information about the balance, strength, falls, and exercise continuance. At this time we have reached a very small percentage of the over 60 age group, but with the positive feedback and the number of current attendees, 42, and over 30 on the wait list, we see a positive response from the county population. We plan to offer this in the smaller communities through out the county in the future. We are a medium sized health department in Kansas, but our goal is to improve the lives of our older adults and to help them remain active in their community and safe when mobilizing. Keeping the older adult healthy and safe is putting prevention at the forefront for the health care battle.
Nutrition, Physical Activity, and Obesity
Goal:  To decrease the falls statistics for the elderly in Reno County. Our nurse taught 1 session (7 weeks) and three more class sessions are being taught at this time. The Stepping On program is targeted for the over 60 year old population. We are just starting to provide the preventative classes.  The classes are taught weekly for seven weeks and are two hours in length. The program curriculum collaborates with therapists, nurses, vision experts, pharmacists, footwear specialists, and peer support.  They are volunteers who provide services to support the community. Meeting with the professionals on a personal basis strengthens relationships if, and when, they might need help. The cost of the program to start up and maintain are relatively low.  We had a community member donate a $500 personal check towards start up costs.  The supplies for the classes include ankle weights, flashlights, pill crusher, rubber gripper mat, door opener, calcium with vitamin D, project board, cane, shoe grippers, step stool, lights of various kinds, notebooks, medication dispensers, and snacks.  The client cost is $35 each for the required ankle weights. We have also worked with local businesses for purchase of items and availability of products within the community. This is a relatively small community in a large rural area and with this location it is not always possible to obtain the assistive devices, so having a working relationship with businesses has helped in multiple ways. Fall prevention is a considerable cost savings for the individual and the county. Falls are one of the greatest expenses as adults age, and can cost the United States health care system over 47 billion dollars a year. The savings of one fall can save a life and keep an older person in their home far longer. The cost to the community can be measured in dollars saved but also allow the individual to have a higher quality of life and feel comfortable in their own environment.
Our objectives to educate and prevent falls has just begun, but the response has been positive. The first class generated an article in the local paper that is county wide and the number of individuals who have responded increased 9 fold. At this time we have not enough data to state how the program affects falls in the community. The model that we are following has a 31% decrease in falls. A performance measure that we are proposing is to work with the local providers, and hospital to determine if the incidence of fall injuries will decrease with education and strengthening.
The sustainability of the program is secure due to our county board of health's commitment to the elderly. The program is supported by Public health dollars in the county budget and local contributions of support. The program is very low cost for participants and staff time is allocated through the elderly program. The community consultants donate their time to the program and state that this is a need for our community. As we continue with the program we have found that we need more than one staff member to instruct and manage the classes. We will be adding staff to this program and utilizing our health department resources more fully.  
Colleague from another public health agency|NACCHO website