EBP Programs
There are two important things to remember when it comes to the health issues of older adults. First, older and senior adults account for the lion’s share of healthcare problems and costs as compared to the younger groups. This makes sense as the body is aging and/or shutting down not to mention that the bad habits (if any) of a person in their younger years truly start to take hold and render their effects once a person reaches their 50’s, if not before. Second, there are common sense and evidence-based ways to handle these issues and help improve healthcare outcomes. Rather than try to “reinvent the wheel” and/or go with unproven methods in general, it is generally better to go with what is known to be effective based on past research and initiatives. While the older groups of Americans will always have more health problems than the younger ones, there are ways to stem the tide and limit the drags on quality of life and health in general.
Analysis
The root and biggest part of this assignment is to seek out a program that is encouraged or administered by a group that is known as the National Council on Aging, or NCOA. For the program that is selected for this report, there will be a description of the program, what specific intervention is being administered, the problem that exists and that is being addressed, the evidence that the problem is genuine, the proof that the program works and how evaluation is done to verify the same. With all of this said, the program that will be covered and centered on in this report is the prevention of falls. While there are certainly other health issues and problems such as heart disease, diabetes and COPD, falls are also very nasty and can lead to broken bones or even death. Further, the amount of senior that fall and that sustain injuries from the same is alarmingly high. Given all of that, there is a ton of incentive to help prevent or at least mitigate the number of falls through things like layout of rooms, self-assistance devices and so forth (NCOA, 2016).
With the above in mind, the NCOA released a program in 2015 called the National Falls Prevention Action Program. The NCOA website about the program echoes what is noted generally above. Indeed, they note that one in three of all American over the age of 65 fall every year. Beyond that, about 25,000 people die after a fall. The amount of non-fatal falls is rather high itself, coming in at about 2.5 million falls per year. The last of those figures is based on emergency room data collected from hospitals around the country. As for the intervention that is suggested and is being employed by the program, there are a few important facets that they have put forth. Some are tangible action steps and education for seniors while some are based more on advocacy and getting the message out via other means. Among the interventions and actions endorsed and put in motion by the NCOA are physical mobility enhancement, proper medication management (e.g. for arthritis, pain, etc.), home safety measures, environmental safety in the community, funding/reimbursement arrangements, expansion of evidence-based fall prevention programs, public awareness and education and public policy and advocacy (NCOA, 2016).
As for very specific interventions that the NCOA advocates in terms of preventing falls, they suggest finding a good balance and exercise program, talking regularly to a healthcare provider, reviewing current medications with a doctor or pharmacist, keeping one’s home safe, talking to family members and checking vision/hearing so as to make sure that hazards and challenges are both visible and hearable as they should be (NCOA, 2016). The amount of money that results from falls is rathe significant. As of 2013, the total medical bills relating to falls were $34 billion and more than three fourths of that was paid by Medicare. Beyond that, even when falls do not end up in injury, there is increased fear of falling, more physical decline, depression and social isolation. This can rack up even more medical costs as well as human and quality of life costs. Even if those amounts are hard to quantify and measure, they are most certainly real. As for results from the programs that the NCOA offers, they have absolutely been good and have been measured to prove that the programs work (NCOA, 2016).
For example, one subset of the NCOA’s body of work is the A Matter of Balance program. The results of that program found that 97% feel more comfortable with talking about their fear of falling, 99% of the people in the program plan to continue exercising and each person saved about $938 USD a year when it came to unplanned Medicare-related costs. Similarly, there is a program called the Otago Exercise Program. Specifically measured results of that program found that falls were reduced by over a third (35%), there was a $429 net benefit per participant and the overall return on investment for the program was 127%. Lesser, but still positive results, were found with the Stepping On program. Falls were reduced by thirty percent, there was a net benefit of $134 per person and there was a return on investment of about 64%. The crown jewel of the NCOA’s major programs would have to be their Tai Chi program. There was a reduction of falls of more than a half, there was a $530 net benefit per participant and the return on investment was more than fivefold, coming in at 509%. In short, there are costs and investments involved in reducing falls but the benefit garnered from those programs is clear and obvious and thus this is simple proof that the programs should continue and be expanded. There is the reality that older adults do fall and there is no real way to stop all falls. Even so, they can be lowered and mitigated through better practices, education and exercise and the existing NCOA programs prove that and then some (NCOA, 2016).
The manner and method that the NCOA uses when it comes to falls, measuring how much they happen and what (if any) difference is seen from programs similar to what the NCOA does is very important. The NCOA is very clear in that they use a logic model to underpin their programs and associated analysis. The precise manifestation that the NCOA uses is known as the Falls Free Logic Model. The major parts of that model are the resources, activities, products, reach and outcomes. Resources would include funding, the existing organizations that are in play, the potential collaboration partners, the existing organizational and interpersonal networks, the staff that are available, the volunteers that are available, the facilities, time, equipment, supplies and other assets that can be used. Activities would include the processes, techniques, tools, events, technology and actions of the planned programs. The products are the direct results of the program and its activities. The reach is the audience or audiences that the program intends and wants to impact. The outcomes are the specific changes in attitudes, behaviors, knowledge, skills, status, level of function expected and beyond (NCOA, 2016).
One major tool in the toolbox for the NCOA would be their surveys. Rather than just focus on their target group of people, that being seniors, they actually query a number of different groups. Those groups are older adults, children of older adults, primary care providers (doctors, nurses, etc.) and state legislators. The inclusion of the other groups is important as they are all stakeholders and people that impact the stakeholders and seniors. For example, the methods that primary care doctors use and the feedback they get from patients is important to know. The impacts and knowledge that is housed within the minds of the grown children of elderly adults is also important. Lastly, the legislators that are involved with healthcare are also a huge part of the process and thus they should be queried as well. Beyond that, Congress could really be in that loop given that they are a huge part (although not all) of what impacts Medicare. In addition to surveys, the NCOA makes use of focus groups so as to get more completely and open-ended responses rather than just yes/no answers or a point value on a scale (e.g. Likert) (NCOA, 2016).
Lastly, the author of this report will focus on the “nuts and bolts” of the logic model that was mentioned earlier. Indeed, the inputs that go into their programs, the outputs and the outcomes are all important to look at. For example, just a few of the inputs would include data about injuries, deaths, hospitalizations, ED, EMS, program costs and healthcare costs. There would also be looking at partnerships like those with people in the public health sphere, people that are focused on aging (like the NCOA) and healthcare providers in general. Programs and services that would be looked at would include exercise programs, medication reviews, vision screening and home assessments. The reach of this data collection and review would necessarily encompass the actual adults that are 65+, consumers, healthcare providers, children of elderly adults, caregivers, community service providers, policymakers and state coalition makers. Finally, there are the aforementioned outcomes. The NCOA is prescient enough to know that some outcomes render and come out sooner than others. With that in mind, they have short-term outcomes, medium-term outcomes and long-term outcomes (NCOA, 2016).
Conclusion
Just as is the case with the management of chronic healthcare conditions and the prevention of the same, falls are a huge issue that has very real costs that include possible death. With that in mind, whatever can be reasonable done to lower falls, improve quality of life, lessen the chance of depression and social isolation with seniors and beyond should be tried. Rather than just parking people in nursing homes at the first sign of problems, there should instead be intermediate solutions that uphold health and fitness standards.
References
NCOA. “Infographic: 6 Steps To Prevent A Fall.” NCOA, 2016, https://www.ncoa.org/healthy-aging/falls-prevention/preventing-falls-tips-for-older-adults-and-caregivers/take-control-of-your-health-6-steps-to-prevent-a-fall/.
NCOA. “Measuring Impact Of Falls Prevention Programs – NCOA.” NCOA, 2016, https://www.ncoa.org/resources/toolkit-evaluation-guidelines-to-measure-the-impact-of-state-and-local-coalitions-on-fall-prevention/.
NCOA. “National Council On Aging (NCOA).”NCOA, 2016, https://www.ncoa.org/.
NCOA. “NCOA Provides Nationwide Blueprint For Preventing Falls – NCOA.” NCOA, 2016, https://www.ncoa.org/news/press-releases/falls-action-plan/.
NCOA. “Value Of Evidenced-Based Falls Prevention – NCOA.” NCOA, 2016, https://www.ncoa.org/resources/falls-prevention-programs-saving-lives-saving-money-infographic-3/
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