Nationally, there are millions of non-fatal falls requiring medical attention each year. These non-fatal falls account for hundreds of millions of dollars in emergency response alone and account for over 8 million DALYs (disability adjusted life years) lost.  The largest morbidity occurs in people aged 65 yeas and older.

While large amounts of research has been done on falls over the last 20 years, its prevalence nationally, on senior campuses, and in local communities continues to rise year over year. A careful examination of the information surrounding falls reveals a repeating discussion of the same general contributing factors and limited options to deal with them. The unabated rate of falls within the existing senior population shows that no effective solutions or responses have been developed from understanding these large generic factors.

On the front lines dealing with the results of this epidemic is our dedicated EMS and Fire Department personnel. A review of the literature put out by fire department and EMS organizations shows discussion of the same problems faced across the country. Additionally, there are numerous secondary problems associated with responding to this epidemic of “lift assist” and “non-emergency” calls such as increased response times to overlapping calls and lack of funding for critical departments needs.  No one has yet made a meaningful impact on the problem or changed the conversation locally. It appears that if this problem is going to be solved, it will have to be led by FD/EMS services. This project is a major step forward in solving this challenge.

In the search for understanding key levers to success, it is becoming clear that the current systems in place are not working. The general understanding of seniors who are at risk for “lift assist” and “non-emergency” calls has not generated effective solutions. Effective being defined as a sustained, cost effective, duplicatable programming that decrease the per capita number of lift assist and other preventable calls experienced within this population.

A senior person calling for a “lift assist” or other unsafe occurrence results from a specific and unique set of risks that caused them to have the unsafe occurrence leading to the call. In a majority of the cases, the senior’s pre-call scores have already over indexed in key areas to cause the crisis. If these key areas are not understood, measured, and improved, then it follows that another event necessitating emergency care or hospitalization will occur, whether or not there are additional risk factors resulting from the previous fall or crisis. Research has proven current solutions (social programs, home health, family involvement, clinician) when brought in to support change are unable to score these individual factors or effectively deal with them, resulting in continued risk of failure. Without clear understanding of these individual factors facing at risk senior populations, seniors are at risk of escalating frequency, types, and severity of unsafe occurrences.

Research suggests that the inadequacy of the demographic and medical record data on hand to provide a clear means to achieve outcomes and manage costs, fire departments, healthcare systems, and providers are hitting the ceiling of what they can do with current information sets. These poorly defined individual specific social-demographic-environmental-patient factors and behaviors appear to be where the majority of the causes for “non-emergency” and “falls and calls” and lie. So what are these factors causing such an enormous number of assists locally and nationally, and can they be defined and measured? If these individual factors could be identified, what would effective solutions look like that could adequately address them? What if it is this lack of awareness and understanding of specific factors, as well as a lack of effective follow up care that is setting up the next tragic event, ED visit, or hospitalization?

Goal
This goals of this collaborative are to: (1) quantify, for the first time in the country, the individualized (mSDOH) risk profile of the senior “fall assist,” and frequent caller, (2) quantify the deployment of necessary and effective resources for at risk seniors, (3) measure reduced follow up “lift assists,” and other preventable calls, (4) use education to promote awareness of the program to seniors and their adult children as evidenced by increasing the number of seniors/families who seek collaboration proactively, (5) measure the subjective experience of the seniors and family.