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(CEMFIA)

Centre of Excellence on Mobility, Fall Prevention and Injury in Aging

The Centre of Excellence on Mobility, Fall Prevention and Injury in Aging (CEMFIA) represents a unique collaborative of researchers, health care providers and policy makers with a shared goal of improving the health and safety of older British Columbians. The Centre was established in April 2009 within the Centre for Hip Health and Mobility (CHHM) situated at the Vancouver General Hospital campus. The CEMFIA mandate is to enhance mobility and reduce the risk for falls and fall-related injuries among older British Columbians, in partnership with the BC Fall and Injury Prevention Coalition, the CHHM, the BC Injury Research & Prevention Unit, University partners, and other fall prevention stakeholders in British Columbia.

MISSION

To be recognized as world leaders in a collaborative, public health approach for mobility enhancement and the prevention of falls and related injuries among older persons.

CEMFIA’s mission is to generate, translate and promote uptake of best practice evidence for the enhancement of mobility and the reduction of the incidence and severity of falls and fall-related injuries among older persons in British Columbia.

VISION


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Who we are Governance Leadership for the CEMFIA is be provided by:

Dr. Vicky Scott, CEMFIA Director; Senior Advisor on Fall and Injury Prevention, BC Injury & Research Unit and Ministry of Healthy Living and Sport, Clinical Associate Professor, School of Population and Public Health,

BC U

In collaboration with Regional Health Seniors Falls and Injury Prevention Managers from:

• Vancouver Coastal Health

• Fraser Health • Interior Health • Northern Health • Vancouver Island Health

Dr. Karim Khan, Professor, Department of Family Practice, UBC Dr. Heather McKay, Director of the Centre for Hip Health and Mobility, Professor, Departments of Orthopaedics and Family Practice, UBC Dr. Stephen Robinovitch, Associate Professor, School of Kinesiology, Simon Fraser University

Functions

The Centre of Excellence generates and translates evidence to enhance mobility and reduce fall and fall-related injury risk among older persons in B.C. A key, and unique, role of the Centre of Excellence is to ensure that these best practices in policy and clinical care are disseminated rapidly and widely.

To this end, CEMFIA supports the following key strategies:

1. Create supportive physical and social environments across all age groups to promote healthy lifestyles and active aging to reduce the risk of falls and fall-related injuries in older age.

2. Improve the timely dissemination of fall and fall-related injury prevention evidence and related data. 3. Support the development and implementation of standardized fall risk assessment. 4. Improve access to mobility enhancement, fall prevention and fall-related injury prevention best practices across

the province. 5. Increase the integration of mobility enhancement, fall prevention and fall-related injury prevention best practices

into long term, sustainable health care practices and services for all older persons at risk. 6. Ensure that dedicated leadership exists in each B.C. Health Authority with resources to operate effective mobility

enhancement, fall prevention and fall-related injury prevention initiatives. 7. Increase effective, multisectoral collaboration among all stakeholders working on mobility enhancement, fall

prevention and fall-related injury prevention, linking policy, research and practice. 8. Ensure accountability for mobility enhancement, fall prevention and fall-related prevention actions and outcomes.

CEMFIA represents a collaborative of key stakeholders including: • BC Fall and Injury Prevention Coalition: a multisectoral alliance of individuals representing regional health authorities, the policy makers at all levels of government, non-governmental organizations, academic institutions, professional associations, and First Nations and community agencies who are concerned about the need to reduce falls and fall-related injuries among older persons in British Columbia; • University and Clinical partners: from all BC Universities, including over 100 scientists and clinicians within the CHHM and BCIRPU; these investigators have national and international prominence to improve the mobility of Canadians. Specifically, CHHM research aims to prevent, and treat limitations to mobility including fall-related injuries; • Community Partners: representatives from community organizations and private businesses who are working with older persons to enhance mobility and reduce the risk of falls and related injuries among older British Columbians.

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Coordinating Role

A hallmark of CEMFIA is the commitment to evaluating current practice and ensuring that the world’s best research discoveries are available for the benefit of B.C. residents. CEMFIA provides a novel vehicle for rapid dissemination of research and evaluation to the Ministry, Health Authorities, Health Service Providers, Health Professionals, and the Community. CEMFIA leverages the new research being undertaken in various settings and play a role to connect that research with the relevant end-users. CEMFIA also provides a way of communicating clinical needs and patient problems to appropriate researchers. Thus, CEMFIA complements and enhances major ongoing research initiatives.

As shown in the figure below, CEMFIA provides a national and provincial coordinating role so that researchers from relevant diverse backgrounds can connect with each other and with relevant stakeholders to speed knowledge translation.

Figure 1 Coordinating Role of CEMFIA

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Key Activities

The following covers only high-level overview of some of the research that CEMFIA investigators are undertaking. Current research leaders are Karim Khan, Steve Robinovitch, Teresa-Liu Ambrose, Heather McKay and Vicky Scott.

As shown in Figure 2, key activities of CEMFIA are to provide education and awareness opportunities; generate innovations in risk assessment, proven prevention strategies and new technologies; conduct environmental scans of current research and clinical needs; report on epidemiology and economic burden of injury outcomes; and facilitate the translation of knowledge to improve the health of aging British Columbians.

The important point to emphasize is that such activities provide important linkages that are currently absent. This is not a fault of the researchers or of a lack of commitment but is a result of the lack of a facilitating environment. CEMFIA provides both leadership and an environment condusive to productive research linkages with appropriate stakeholders. CEMFIA leaders all play major roles in national and provincial initiatives, and have a track record of collaboration. CEMFIA will enrich and strengthen this.

Current activities being conducted by CEMFIA members include: 1. Research

Figure 2 Key Activities of CEMFIA

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• Action Seniors – evaluating the effectiveness of a home strength and balance training program in those who have already fallen. • Falls Clinic Evaluation – a study of a re-engineered falls risk assessment and service delivery system for fallers aged > 70 years. • Improving Emergency Department flow and Addressing Bottlenecks – this study examines the course of seniors journey through the emergency department after a fall. This is a partnership with Vancouver Coastal Health and the Centre for Hip Health and Mobility.

• International hip protector research and knowledge translation group. Dr Robinovitch is the head of this 8-nation collaboration that aims to clarify the evidence around hip protectors for fracture prevention. Also, the group is investigating next-generation wearable hip protectors. • Video-based recordings of real-life falls. A major impediment to the development of improved strategies for preventing falls and fall-related injuries is the lack of objective, real-time data on the cause and circumstances of falls. Instead, current understanding is based on the recollection of the fall after the event. To overcome this barrier, CEMFIA researchers have partnered with long-term care facilities to obtain measures of body movements before, during, and after a fall, through networks of digital video surveillance cameras in common areas. • Wearable fall recorders. Wearable sensors can acquire three dimensional, high-resolution data on

• Mobility in Aging Cohort – This research addresses the question “Why do some seniors who fall have no future problems, while for others, the fall marks the start of a steady, and sometimes rapid, decline?” • Fall Risk Calculator (web-based) – This simple web-based tool is based on a well-researched algorithm that will allow the user to obtain a numerical measure of her/his risk of falling and this will be linked to guideline management advice. The innovation is that members of the public will be empowered to contribute to self-screening while being aware of resources that are available.

body segment movements during falls, without the need for the individual to be in view of a video camera. By incorporating intelligent data analysis algorithms, these devices provide a means to detect the early onset of a fall, and trigger active protection devices such as inflatable hip protectors. • A study that demonstrates CEMFIA’s logical (and existing) links with industry examines compliant flooring to reduce fall-related fractures. • Underscoring the fact that the current estimates of the burden of falls are likely under-estimates, Robinovitch is partnering with other bioengineers and clinicians to examine the biomechanics of fall-related head and neck injuries. As there are now as many paraplegia cases among seniors as there are among the traditional young male risk group, our group is examining this emerging phenomenon among seniors.

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• A randomized trial of resistance training and its role in protecting brain function in a way that is independent of aerobic training. Dr Liu-Ambrose included the novel

Dr. Karim Khan, UBC Professor, leads research that addresses fallers at particularly high risk of further falls and fall-related injuries. Current studies include:

Dr. Steve Robinovitch, Canada Research Chair, Simon Fraser University, is a world-renown biomedical engineer who holds an international reputation for linking technological advances with real-life patient needs. A smattering of his current research includes:

Dr. Teresa Liu-Ambrose, a Michael Smith Scholar, is one of very few international falls researchers focusing on the role of impaired brain function in falls and fall-related hip fractures. Although cognitive impairment is a strong risk factor for falls and fall-related injuries, the reasons for these associations remain poorly understood. Her current studies include:

‘FMRI’ (Functional Magnetic Imaging – a method to reveal brain ‘function’ rather than just structure) in this landmark study.

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• A study of 65-75 year old women that aims to prevent the onset of frailty to prevent admissions to assisted living and residential care facilities.

• An evaluation of the ability of frail seniors to better complete high-level cognitive tasks (neuropsychological testing) after joining a mild strength and balance training program.

• Resistance training study examining brain function in collaboration with the Pacific Alzheimer Society.

Dr. Teresa Liu-Ambrose continued

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• International recognition as a leader in the fields of mobility research in children, including the translation of physical activity interventions into public policy. • Awards include the Michael Smith Foundation for Health Research Senior Scholarship and the Canadian Institutes of Health Research National Knowledge Translation Award. She has published over 120 manuscripts in scientific journals related to the role of exercise and other lifestyle factors for child and older adult bone health.

• Professor McKay garnered over $44M in research operating and infrastructure funding. She is renowned for undertaking research that resonates with the public and has direct benefits for the health of children and older adults. Her ability for “moving research into action” is illustrated by her lead role in the development and implementation of Action Schools! BC – a program known for successful amelioration of a number of chronic disease risk factors in children and in partnership with provincial government ministries – in changing school policy.

Heather McKay, Director of CHHM and UBC Professor, provides valuable research contributions in the field of primary prevention and mobility across the lifespan. Contributions include:

• Strategies and Actions for Independent Living (SAIL) Program: Based on a controlled trial conducted with Home and Community Care partners in the Interior Health Authority, the SAIL program consists of multi-factorial interventions targeted towards seniors who are in need of on-going home support, but are not yet in need of institutionalized care. Core elements of the SAIL program include a fall prevention training program for community health workers and home health professionals; a falls monitoring and reporting system; the implementation of a client-centered risk assessment and prevention tool; and protocols for identifying and addressing those determined to be at high risk for falls. The SAIL program has being translated into practical application through demonstration projects in each of B.C.’s five Health Authorities and is now being integrated into routine practice across Home Health Services throughout B.C.

Dr. Vicky Scott, CIHR Knowledge Translation Award recipient and Chair of the BC Fall and Injury Prevention Coalition, has conducted extensive research in the area of fall and fall-related injury prevention for older adults, including the following recent translational research studies:

• Promoting Active Living (PAL): Initiated by the BC Falls and Injury Prevention Coalition (BCFIPC), and funded by the Public Health Agency of Canada, the BC Ministry of Healthy Living and Sport, and the Fraser Health Authority, PAL is a new project to develop the first site-specific guidelines in B.C. and Canada to prevent falls in Assisted Living (AL) facilities. Assisted living is a priority setting due to the rapid growth of this supported housing option among frail older persons in B.C. and Canada. Filling a needed gap, PAL identifies risk profiles and feasible strategies for the prevention of falls and related injuries among AL residents. The final product, based on feasibility studies at two AL sites in the Fraser Health Region, is the document, Promoting Active Living: Best Practice Guidelines for Fall Prevention in Assisted Living (Scott, Bawa, Feldman, Sims Gould & Leung, 2009), is designed for those who administer, work, reside, provide services, or otherwise support, to those who live in Assisted Living.

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• Supporting Physical Activity for Older Adults in Assisted Living Residence in BC Project (Co-supervised by Jeff Doyle and Vicky Scott): Based on a feasibility study conducted with the Fraser Health Authority Assisted Living, this project focuses on the development of a standardized model for the delivery of physical activity programs offered in B.C. Assisted Living Residences.

Dr. Vicky Scott continued These activities highlight a small

sample of research to emphasize the capacity of the Centre of

Excellence to add considerable value for the end user through

greater research productivity and dedicated commitment to knowledge translation.

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2. Education: CEMFIA members are also leading the country in the development and delivery of validated fall prevention education. Through funding from the Public Health Agency of Canada Population Health Fund and the Ministry of Healthy Living and Sport, the Canadian Falls Prevention Curriculum is now available for health care providers and community leaders across Canada.

how to integrate falls prevention programming into existing seniors’ health services policies and protocols; and c) knowledge of appropriate evaluation and dissemination techniques. The course also gives participants insight into how to involve seniors as partners in the development of effective strategies and interventions. Participants will learn about current effective programs, and the reliability and validity of existing resources and tools for screening and assessing fall risk. To ensure the potential for synergy in falls prevention along the continuum of services for seniors, the course covers a number of settings – community organizations, home support, health service delivery, long-term care, acute care, rehabilitation and emergency services.

The CFPC, and the CFPC facilitator course, are available in English and French as two-day workshops offered in most provinces in Canada. The e-learning version in English will be offered through the University of Victoria Continuing Education Department in the Spring of 2009, with the French e-learning version available at the Campus St. Jean at the University of Alberta Continuing Education Department starting in the Fall of 2009.

• Canadian Falls Prevention Curriculum© (CFPC): Designed to build on existing knowledge and skills of health professionals and community leaders working in the area of falls prevention among older adults (those 65 and over). The CFPC was developed under the leadership of Dr. Vicky Scott, in collaboration with fall and injury prevention experts, researchers, and health educators. Partner organizations for the development of the CFPC include the B.C. Injury Research and Prevention Unit (BCIRPU), the Alberta Centre for Injury Control and Research (ACICR), the PEI Centre for the Study of Health and Aging and the PEI Seniors Falls Prevention Coalition, and members of a National Advisory Committee of stakeholders. Funding for this project was provided by the Population Health Fund of the Public Health Agency of Canada, with contributions and support from the B.C. Ministry of Healthy Living and Sport. The goal of the Canadian Falls Prevention Curriculum is to give participants the knowledge and skills needed to operate from a evidence-based approach to seniors falls and fall-related injury prevention, including a) an approach to selection of interventions consistent with proven prevention strategies; b) an understanding of

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3. Clinical Practice: 4. Information Services: To complement our clinical delivery systems CEMFIA will also partner with the BC Fall and Injury Prevention Coalition and the BC Injury Research & Prevention Unit, to develop a centralized, coordinated fall prevention information service which will consist of multi-media services to increase awareness of fall risks and prevention strategies among health care providers, caregivers and seniors.

CEMFIA provides the venue for coordination of high quality fall prevention programs. These programs integrate world-best evidence with efficient delivery of care to British Columbians. The programs provide practical exemplars that can be rolled out to other sites. There are two existing programs that deliver falls prevention services to seniors aged 65 years and older. • Community-based clinics which provide fall risk assessment screening and treatment advice by allied health professionals for self-referred seniors at risk of falling (currently in Fraser Health and Vancouver Island Health Regions) • Hospital-based clinics which provide comprehensive geriatrician assessment and evidence-based treatment for patients categorized as high risk by a physician or via referral from our community-based clinics.

5. International Collaboration:

Well-established partnerships exist between CEMFIA leads and international leaders in mobility enhancement and fall and injury prevention for older adults including:

• World Health Organization • With the USA Centre for Disease Control (CDC), National Center for Injury Prevention and Control • The Falls Free Network for the USA • California Fall Prevention Centre of Excellence • Prevention of Falls Network Europe (ProFaNE) • The Prince of Wales Medical Research Institute, Australia • The University of Otago, Dunedin, New Zealand Plans are also underway for CEMFIA to adapt the Canadian Falls Prevention Curriculum for use in developing countries to be conducted in partnership with the World Health Organization and Center for Disease Control in Atlanta.

Through these extensive international connections, local discoveries can be disseminated widely. Formalizing these linkages through a Centre of Excellence will add visibility and profile to shared activities. This will extend the reach of the relationships further and likely lead to additional synergies being discovered, which in turn, will lead to improved outcomes for British Columbians.

For more information on CEMFIA go to the CHHM or BCIRPU websites at: http://www.hiphealth.ca/Home.htm or http://www.injuryresearch.bc.ca

The well-established and ongoing international connections provide

tremendous social capital that ensures British Columbians

benefit from the world’s benchmark programs in

mobility and fall prevention.

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http://www.hiphealth.ca/Home.htm

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