judith a. metcalf, aprn, bc, ms director, une maine geriatric education center

University of New EnglandMaine Geriatric Education Center:

Overview of Project Goals and Activities

June 8, 2012The 22nd Maine Geriatrics Conference

Where Policy Meets PracticeBar Harbor, Maine

Judith A. Metcalf, APRN, BC, MSDirector, UNE Maine Geriatric Education Center

Nurse Practitioner, UNE Mature Care

DisclosureThe presenter does not have an interest inselling technology, program, product, and orservice to CME/CE professionals

Funding for this presentation is provided by the UniversityOf New England Maine Geriatric Education Center whichis sponsored by the U.S. Department of Health and HumanServices Health Resources and Services Administration(HRSA) Grant # UB4HP19207-02

Objectives

• Create awareness of the mission of the federally funded (HRSA) Geriatric Education Centers (GECs)

• Discuss five UNE-MGEC project goals and initiatives

• Identify UNE-MGEC programs and resources and how to access them

• Network of 45 Geriatric Education Centers

• Funding – Title VII

• Education and TrainingProvide hundreds of hours of CE programs in geriatrics for practicing health

professionals

Overview of the GEC Network in 2012

• Education and TrainingProvide didactic and clinical training

opportunities in geriatrics for health professional students and promote interprofessional, team based approaches to care and care coordination

Overview of the GEC Network in 2012

• Education and TrainingCollaborates with acute care, long term care, and community-based service

providers on evidence based practice programs to designed to reduce rates and improve outcomes of care relating to delirium, depression, falls, pain, and diabetes in older adults

Overview of the GEC Network in 2012

• Education and TrainingBetween July 1, 2010 and June 30, 2011, the GECs provided educational programs for approximately 40,000 health care

professionals and students from disciplines such as medicine, nursing, allied health, health services administration, social work, and psychology

Overview of the GEC Network in 2012

UNE-MGEC INITIATIVES

• Geriatric Intraprofessional Health Literacy Collaborative Team Training

• EBP Intraprofessional Falls and Quality of Falls Care Team Training

• Strategies to Nurture Aging People (SNAP) an Inter- professional Academic and Community Initiative

• Arts in Aging

• Emergency Preparedness

Geriatric Health Literacy Learning Collaborative Team Training

• Southern Maine Medical Center

• Franklin Community Health Network

• Penobscot Community Health Center

• Statewide Faculty Team

Health Literacy IP Team Training

Four Teams

Health Literacy

Health Literacy IP Team Training

EBP Intraprofessional Falls and Quality of Falls Care Team Training

WHY falls and quality of falls care based training?

• Concentrations of older adults in targeted rural counties higher than U.S. average (12.6%)

% of Population Over 65 in Maine by County

Maine 15.10%Androscoggin 14.5%Aroostook 18.0%Cumberland 13.9%Franklin 14.8%Hancock 16.6%Kennebec 14.9%Knox 17.9%Lincoln 19.2%Oxford 16.2%Penobscot 13.9%Piscataquis 17.6%Sagadahoc 13.9%Somerset 15.7%Waldo 15.1%Washington 18.6%York 14.6%

Maine 15.10%Lincoln 19.2%Washington 18.6%Aroostook 18.0%Knox 17.9%Piscataquis 17.6%Hancock 16.6%Oxford 16.2%Somerset 15.7%Waldo 15.1%Kennebec 14.9%Franklin 14.8%York 14.6%Androscoggin 14.5%Sagadahoc 13.9%Penobscot 13.9%Cumberland 13.9%

Alphabetical Sorted from high to low

Source: U.S. Census Bureau: State and County Quick Facts. Data derived from Population Estimates, Census of Population and Housing – Accessed 2/18/2010

Falls is a Major Public Health Issue

• Constitute major reason for traumatic deaths in older adults

• Most frequent cause of hospital admissions due to injury

• 1 in 3 (age 65 >) fall each year

• Of those, 20% - 30% suffer moderate to severe injuries

Hausdorff JM, et al. Gait Variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8): 1050-6

 $$ Falls Cost Billions $$

Among community-dwelling older adults, fall-related injury is one of the 20 most expensive medical conditions.

In 2000 total direct cost (age 65>) exceeded  $19 billion

In 2002 Medicare $$ per fall averaged between $9,113 & $13,507

In 2008 over 18,000 older adults died as a result of a fall event

Carroll NV, et al. The cost of falls among the community-dwelling elderly. Journal of Managed Care Pharmacy. 2005; 11(4): 307-16.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.Web-based Injury Statistics Query and Reporting System (WISQARS) [ online]. Accessed November 30,2010.Shumway, et al. Falls in t he Medicare population: incidence, associated factors, and impact on health care.  Physical Therapy 2009.89(4):1-9.Stevens JA, et al.  The costs of fatal and nonfatal falls among older adults.  Injury Prevention 2006;12:290-5

 Falls Cost Billions $$

In 2009 ERs treated 2.2 million nonfatal fall injuries among older adults; 582,000 of these patients had to be hospitalized

In 2010 Total direct cost-all falls injuries 65 and older exceeded $28.2 billion

In 2020 annual/direct/indirect cost $54.9 billion (in 2007 $$)

Carroll NV, et al. The cost of falls among the community-dwelling elderly. Journal of Managed Care Pharmacy. 2005; 11(4): 307-16.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.Web-based Injury Statistics Query and Reporting System (WISQARS) [ online]. Accessed November 30,2010.Shumway, et al. Falls in t he Medicare population: incidence, associated factors, and impact on health care.  Physical Therapy 2009.89(4):1-9.Stevens JA, et al.  The costs of fatal and nonfatal falls among older adults.  Injury Prevention 2006;12:290-5

    Evidence Based Practice (EBP)

Educational Intervention with ER Health Professionals - MDI Hospital

• Educational sessions to improve the quality of falls care for older adults utilizing the 12 validated ACOVE-3 quality indicators, initiated an ongoing.

• Training is based on (EBP) for improving the quality of falls care for older adults using 12 validated quality indicators. (Chang JT, Ganz DA, Quality indicators for falls and mobility problems in vulnerable elders. J Am Geriatric Soc 2007; 55:327-334).

(ACOVE-3 Quality Indicators, Chang & Ganz, 2007)

12 QUALITY INDICATORS (CORE CURRICULUM)

Screening for falls Exercise program

Fall history Cognitive evaluation for fall

Fall examination- orthostatic (BP, pulse) Home hazard evaluation

Fall examination- optometry Benzodiazapene discontinuation

Fall examination-gait, balance, strength Assistive device for balance disorder

Gait and balance evaluation (continued difficulty)

Assistive device review

Chang, J.T. & Ganz, D.A. (2007) Quality Indicators for Falls and Mobility Problems inVulnerable Elders, Journal of the American Geriatrics Society, Vol. 55 (S2), S247-S487

Mount Desert Island, Maine

Mount Desert Island, Maine

EBP Falls IP Team Training

EBP Falls IP Team Training

Multifactorial Risk Assessment

Fall Footwear

When you least expect it !!

Strategies to Nurture Aging People (SNAP) an Inter-professional

Academic and Community Initiative

(SNAP) an Inter-professional Academic and Community Initiative

Living Art - Living Well Studio4 part Seminar Series

Molly Neptune Parker, Passamaquoddy basket

maker

Thomas Cote, Acadian wood carver

John Connors, Bateaux boat builder

Franco House Party French songs and music

UNE-MGEC “Living Art-Living Well Studio” 4 Part Seminar Series

February 9, March 8, April 12 & May 10, 2012 St Mary’s d’Youville Pavilion, from 5:30 –7 pm

Seminar 1

Seminar 2

Seminar 4

Seminar 3

Tom Cote & apprentice

John Connors & apprentice

Studio #4 Franco House Party

Emergency Preparedness

Educational DVDAssessing Elder Abuse in the Clinical Setting: Asking the Difficult Question

UNE-MGEC Resourceswww.une.edu/mainegec

Complimentary online courses

• Assessing Elder Abuse in the Clinical Setting

• Advance Directives• Health Literacy/Plain

Language• Emergency Preparedness

Planning for Long Term Care and Assisted Living Communities (in progress)

• Resources for Health Professionals

• Falls Prevention• Preparing for an

Emergency Disaster• Elder Investment Fraud• Living Art - Living Well 4

Part Seminar Series• Health Literacy• Continuing Education

Opportunities

UNE-MGEC Resourceswww.une.edu/mainegec

Resources Older Adult Resource

Toolkit (OAR) Teaching DVDs – Assessing

Elder Abuse in the Clinical Setting; Driving & Advance Directives

Health Literacy Teach Back (in progress)

UNE-MGEC Educational Needs Assessment 2010

Financial Exploitation of Older Adults-Red Flags in Clinical Practice: Evidence-Based Screening Tools to Assess for Vulnerability and Resources for Appropriate Referrals --- A Clinician’s Toolkit (EIFFE)

Speakers Robert E Roush, EdD, MPHJudith M. Shaw, JDEIFFE video on YouTube

http://youtu.be/ISNK9zlHQEc

•National Institute on Aging– www.nia.nih.gov/health/agepages/falls

•American Geriatrics Society– www.americangeriatrics.org/education/forum

•Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (NCIPC)

– www.cdc.gov/ncipc/factsheets/falls

American Geriatrics Society, British Geriatrics Society, American Academy of Orthopedic Surgeons Panel on Falls Prevention. Guidelines for the prevention of falls in older persons. JAGS.2001;49:664-672

Resources and References

•Summary of the Updated American Geriatrics Society /British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. JAGS. 2011;59:148-157

•Primary Care-Relevant Interventions to Prevent Falling in Older Adults: A Systematic Review for the U.S. Preventive Task Force. Ann Intern Med. 2010;153:815-825

•Quality Indicators for Falls and Mobility Problems in Vulnerable Elders. JAGS,2007; 55:S327-S334

•Quality Indicators for the Management and Prevention of Falls and Mobility Problems in Vulnerable Elders. Ann Intern Med. 2001;135 (8 Part 2): 686-693

Resources and References

Thank You !

Judith A. Metcalf, APRN, BC, MSDirector, UNE Maine Geriatric Education Center

Nurse Practitioner, UNE Mature Care716 Stevens Avenue, Portland, Maine 04103

T 207-221-4459 F 207-523-1922jmetcalf@une.edu www.une.edu/mainegec

FMI : email mamoroso@une.edu or 207-221-4460