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  • Senate Report Calls for More Emphasis on Falls Prevention

    The US Senate Select Committee on Aging has released a report on falls prevention that presses for more concerted efforts to prevent falls among the elderly—including wider access to physical therapy and community-based programs. APTA 's comments submitted in advance of the report helped to shape the committee's final recommendations.

    Writing that "the statistics are staggering, and the stakes are high," the committee asserts that despite ample evidence supporting the effectiveness of falls prevention strategies, such programs aren't used widely enough in the country's health care system. The lack of attention to falls prevention comes at a cost to public health, the report states, with an estimated 25% of adults 65 and older experiencing a fall each year, resulting in falls now being ranked as the leading cause of death from unintentional injury among older adults in the US. And the costs are literal as well, according to the report, which cites estimates that falls-related health care spending topped $50 billion in 2015.

    The report calls for improvements in 4 broad areas: raising awareness, screening and referrals for preventive care, addressing modifiable risk factors such as home safety, and better understanding of the impacts of drugs—and drug combinations—on falls risk. Specific recommendations include a call for the Centers for Medicare and Medicaid Services (CMS) to better incorporate falls risk screening and medication review in its Annual Wellness Visit benefit, more research into the effects of polypharmacy on falls risk, and "continued investment in the development of and expanded access to evidence-based falls prevention programs."

    On the day the report was released, the committee held a special hearing on the topic that included representatives from the National Council on Aging (NCOA), the National Osteoporosis Foundation (NOF), and MaineHealth, a hospital system that has incorporated an effective falls prevention program throughout its facilities and in communities. Nearly every speaker mentioned the importance of physical therapy and physical therapists (PTs) in effective prevention and rehabilitation programs, with NCOA Senior Director for Healthy Aging Kathleen Cameron calling for expanding payment to physical and occupational therapists in the Welcome-to-Medicare and Annual Wellness Visit programs, and the witness for NOF describing physical and occupational therapy as "critically important" to recovery from a fall.

    "The evidence is clear that falls prevention efforts work, and there are a host of prevention programs out there that have a potential to make a difference in what is becoming an increasingly alarming trend," said Justin Elliott, APTA's vice president of governmental affairs. "We're extremely pleased to see that the select committee not only understands the need for change, but sees the role physical therapists and physical therapist assistants can play in responding to this public health challenge."

    That understanding of physical therapy's role after a fall wasn't just theoretical, at least for Committee Chair Sen Susan Collins (ME).

    Before entering all stakeholder remarks—including APTA's—into the record, Collins recounted her own experience of recovering from a broken ankle she sustained after a fall a few years ago. "I am forever grateful to the [occupational therapist] and PT who helped me gain function again," Collins said. "It was the [occupational therapist] and PT who really got me back on my feet and walking again."

    APTA offers a wide range of resources related to balance and falls. Check out this PT in Motion News article from September for links to tests and measures, learning opportunities, patient-focused resources, and more.


    • Re: MaineHealth program You have stated that "MaineHealth [is] a hospital system that has incorporated an effective falls prevention program throughout its facilities and in communities." If the program to which you refer is "A Matter of Balance", there is evidence that it improves balance self-efficacy and reduces fear of falling, but unless I am mistaken, there is no evidence that it reduces falls or fall-related injuries. The MoB program is a lay-leader program and includes almost no exercise of the sort known to reduce fall risk. There is evidence to show that MoB participants eport they are more willing to begin to exercise after completion of the program, but no evidence that they actually do so. In summary, the MoB program is a good program to improve balance self-efficacy, but should not be considered a stand-alone program to reduce falls or fall-related injuries. Respectfully, Leslie Allison, PT, PhD

      Posted by Leslie Allison on 10/23/2019 6:56 PM

    • It is good to see Congress and the agencies mentioned recognize the significance of PT and OT in falls prevention. There are a number of falls programs that provide good education on factors related to falls and fall prevention, but most are inadequate in terms of exercise selection, instruction, and dosing to make an impact on strength, flexibility, and balance to improve function and reduce fall risk. CMS should reimburse for PTs and OTs to do individualized assessment, exercise, and education. The Adult Functional Independence Test (AFIT) for Optimal Aging is a comprehensive tool that could be performed by a PT as part of the Welcome to Medicare visit. Those results could be used to establish an individualized intervention program that may also include participation in group exercise and/or fall prevention programs. Respectfully, Debra Gray, PT, DHSc, DPT, MEd, GCS

      Posted by Debra Gray on 10/25/2019 7:47 AM

    • Leslie Are you able/willing to share your falls prevention strategies/tactics and measures in the interest of translating an effective program into other facilities? We are struggling to adequately "measure" the effectiveness of our falls prevention program, especially when it is focused on community falls. We have many providers of hospital-based care in our community without a collective repository for falls data. I would be interested to see how you measure effectiveness both inside and outside a facility walls. Respectfully, Karen Frederick, PT, DPT

      Posted by Karen Frederick on 10/25/2019 8:44 AM

    • There seems to be a disconnect between physical exam, functional screens and preventive exercise programs because of access barriers that limit primary musculoskeletal care by PTs in the Medicare system.

      Posted by Rick Wickstrom on 10/26/2019 7:12 AM

    • I'm 60 years of age, disabled and at high risk of falls. The best advice I can offer is, Classes that teach "Balance" is one of most helpful and important things to learn to prevent falls!

      Posted by Barbara Bellinger on 10/30/2019 11:53 PM

    • I find it very frustrating that Medicare will be reducing our ability to provide comprehensive therapeutic interventions in Home Health (with PDGM), while simultaneously making a statement about how critical therapy is.

      Posted by Nita Schilperoort on 11/18/2019 11:50 AM

    • I too am so conflicted and frustrated with the new PDGM changes and the contradictory actions by CMS in the face of the overwhelming evidence well supported in the literature and even in the CDC website advocating for screening, education, and programs such as Otago that move us towards falls reduction. It is time for aggressive solicitation to the public regarding the extreme measures of rationing care through changes brought about by PDGM. Greg Patterson PT,DPT,GCS

      Posted by Gregory Patterson on 11/23/2019 10:07 PM

    • I have been preaching this for years!! As a PTA who is certified in 2 courses of Tai Chi for therapeutic balance programs I use it in my every day treatment programs and have offered it to senior living facilities outside of work with great results. I would love to see screening done on elderly during yearly exams at their primary physician's office and would love to be a part of this. Thank-you!! Cheryl Hagelund.

      Posted by Cheryl Hagelund on 12/2/2019 3:53 PM

    • Ditto to all of the above but especially to the comment by Gregory Patterson. It is time 'for aggressive solicitation to the public..' Our patient's value the role of PT's and we need them to get behind the measures to increase not decrease their access to us.

      Posted by Ruth Haefner on 12/11/2019 12:37 PM

    • It’s is very good information and approached , I am a physical therapist over 40 years and life member of APTA , wish I could be any help to this committee? Thanks

      Posted by Habib Abbasi on 2/1/2020 4:33 PM

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