Strategic Question: How will Chester County Hospital enhance overall quality of life for patients that present as fall risks?
Implementation Plan: Chester County Hospital will increase the Matter of Balance program through partnering with community groups.
How problematic are falls by older adults? The US healthcare system spent an estimated $50 billion on this particular ailment in 2015. This amount represented six percent of all Medicare payments and eight percent of all Medicaid payments that year, according to a study published in the Journal of American Geriatrics Society.
Perhaps most concerning, the study’s authors wrote, is that without significant improvements to falls risk assessment and prevention, costs will only climb as the Baby Boomer generation continues to grow the senior segment of our population to unprecedented proportions. As it was, the $50 billion was a 32 percent increase in spending from only two years earlier.
Chester County Hospital recognized the seriousness of this issue early on and has operated a Falls Task Force for the last 15 years. Comprised of representatives from the full spectrum of the hospital’s’ staff, including non-medical personnel, its mission is geared primarily toward preventing falls within the hospital’s walls. Now, a relatively new program at the hospital is empowering seniors themselves.
A Matter of Balance was developed during the 1990s at Boston University. Funded by the National Institute on Aging, the program trains physical therapists, occupational therapists, registered nurses, and social workers in evidence-based practices with the intent to go out into the community and teach seniors how to improve their mobility and reduce their risk and fear of falling in the process.
But the program quickly became too expensive to sustain. With a new grant from the US Administration on Aging, healthcare workers were replaced by trained volunteers, which enabled A Matter of Balance to spread across much of the country. Today, Master Trainers, as they’re called, train new instructors for the program through a one-day course. The instructors are often medical professionals, but they can also be volunteers who are interested in simply contributing in their communities. The program itself has remained true to its original model.
A Matter of Balance was introduced in Chester County in 2011 through a Pennsylvania Department of Health (PA DOH) grant. Today, the Chester County Health Department, with support from the PA DOH, funds both the instructor training and the courses that are taught at various venues throughout the county. Over the last nine years, roughly 1,200 seniors have participated in the program in Chester County.
Chester County Hospital began offering this program in 2018. Typically, a class is offered in the spring and another is available in the fall, but the demand was so high the hospital held two classes last fall. They’re taught by Susan Pizzi, MS, RN, coordinator of Community Health Education, and Michelle Boyle, MS, community health educator.
All Matter of Balance classes, regardless of the venue, follow the same framework. They meet once a week for two hours at a time over eight weeks. The curriculum is built around these four core elements:
- Restructuring cognitive techniques that help instill the belief that falls and the fear of falling are controllable.
- Enhancing falls management by helping participants set realistic goals for increasing their activity.
- Promoting changes to modifiable risk factors, like securing loose rugs at home.
- Teaching exercises that are known to reduce the risk of falling by increasing strength and balance.
"We help them not only increase their strength and flexibility but we also work to empower them to make smart choices and become more aware of their surroundings so that they become less likely to fall," Boyle said.
The exercises are introduced in the third week, and they remain a fixture through the end of the program. "The booklet participants receive has a pretty well rounded exercise program that helps build flexibility and strength in both the upper and lower extremities," explained Christine Schweidler, PT, MDT, coordinator, Balance and Vestibular Program at Chester County Hospital, and a guest speaker at the hospital’s A Matter of Balance classes.
The exercises are low-impact and, with the exception of a chair, require no equipment. If even that regimen may sound ambitious, you’re not alone. Schweidler said she often fields questions during her guest appearances, and they generally follow the same lines: "I have a bad shoulder and I can’t push up" or "I have a bad knee and I can’t stand up."
"In those cases, we’ll try to emphasize doing all other exercises to strengthen the healthy joints, while doing as much as possible to strengthen the one that hinders participants," she shared. "One of the reasons someone can fall is because they’re losing strength and flexibility in their lower extremities. Maybe their ankles are getting tight or their quads are weak. It alters their gait, and then they could trip more easily. So, we’re just trying to emphasize the importance of maintaining their range of motion and their strength to help prevent a fall."
For many, that may mean learning to use a cane or a walker, which the program also covers. “We try to teach that the cane can help them with their balance as far as feeling where they are in space. It’s not necessarily that they need it to lean on; it’s another point of contact,” shared Schweidler.
Confidence usually grows as the participants’ physical ability improves. Just as important to that process is socialization. Though it’s not explicitly addressed in the curriculum, it’s often a natural byproduct of spending 16 hours together.
"People do not even have to fall themselves to start having a fear of falling," said Mary Jo Baldino, RN, the outreach coordinator for Penn Medicine at Home and A Matter of Balance Master Trainer. “They hear their friends, neighbors, and relatives talk about how they fell and broke this and that, and that’s enough. That fear is a risk factor itself for falling."
The natural response in such instances is to limit one’s activities to try and play it safe. But the safeguard can quickly become isolating, which inevitably heightens fear and risk of falling.
To appreciate how much of a difference the strategies promoted by A Matter of Balance can make, Baldino explained that she only needs to compare the pre and post class surveys. "They not only show a progression, they’re full of confidence."
Baldino, having taught the course all over the county, has impacted countless lives, though there’s one woman in particular who resonates with her. She uses a walker, but she spent many of her days sitting in the same spot at the Kennett Area Senior Center. When she started taking A Matter Balance class that was held at the facility, it was clear that she harbored a genuine fear of falling.
But as the weeks passed, a new woman emerged. Not only was she exercising during the classes, she also started participating in some of the fitness classes at the senior center. Along the way, she confided in Baldino that she’d always wanted to join one of the center’s bus trips, but she was too intimidated by the prospect of climbing on and off of the bus, so she never signed up.
After the course concluded, Baldino continued to visit the senior center about once a month for health screenings. The next time she encountered the woman, she couldn’t believe what she was seeing and hearing. The woman was active and outgoing--and she was organizing her own bus to Atlantic City!