By Ellen Moran
Adults of all ages with intellectual or developmental disabilities have the same risk of falling as people in the general population over age 65, but most programs to prevent falls have been designed for the elderly. UMass Medical School’s Eunice Kennedy Shriver Center is studying whether a new program that uses customized care plans can reduce falls among people with disabilities.
The Shriver Center, a unit within UMass Medical School’s Commonwealth Medicine division, partnered with an outpatient rehabilitation provider, Visiting Rehab Services (VRS), to determine whether customizing care plans for individuals with intellectual and developmental disabilities will reduce their risk of falling.
“Research shows that people with intellectual disabilities have the same risk of falling as the elderly population, but experienced at much younger ages. Everyone agrees falls prevention is very important for this population,” said Courtney Dutra, MPA, a project coordinator at the Shriver Center.
The six-month pilot study is composed of 58 adults, ages 29 to 90, who live in residential homes supported by the Massachusetts Department of Developmental Services or private agencies.
About 30 percent of adults with intellectual or developmental disabilities fall annually nationwide, and about 15 percent of those falls result in serious injury. Using this calculation, as many as 3,000 people in the Massachusetts Department of Developmental Services’ residential programs are estimated to experience a fall in any given year.
Individuals with intellectual or developmental disabilities have a higher risk of falling than those who don’t have an intellectual disability, and they are more likely to be injured in a fall. Those who are taking multiple medications, have weak muscle strength, poor balance or coordination, or vision issues could have a higher risk of falling. Existing falls prevention programs are typically designed for the elderly population, who also tend to have weak muscle strength, poor balance and coordination.
“There is a cognitive piece to falls prevention programs for the elderly that might not be appropriate for this group,” Dutra said. “Degenerative changes seen in aging can also occur as early as age 35 in some individuals with ID, which further complicates falls intervention. Falls prevention in people with intellectual and developmental disabilities is a very understudied area.”
The goals of the pilot are to look at the feasibility of partnering with a community provider to study interventions in people with intellectual and developmental disability, the effect of the type and frequency of therapies provided in the customized care plan, and whether the individual’s falls risk changed, said Alexandra Bonardi, MHA, OTR/L, project lead and clinical assistant professor in UMass Medical School’s Family Medicine and Community Health.
VRS implemented Upright and Onward, a falls prevention intervention targeted for individuals with intellectual and developmental disabilities who live in residential programs. The program used evidence-based falls prevention approaches for the elderly and tailored them for individuals with intellectual and developmental disabilities and those who support them. VRS staff, who served as members of the research team, collected and recorded data.
VRS recruited individuals with intellectual or developmental disabilities living in group homes from referrals. Those who participated in the study had their falls risk assessed by a trained clinician and assigned a minimal, moderate or severe risk of falling.
The components of the pilot study included an assessment of an individual’s fall risk at baseline, three and six months, implementation and tracking of an individualized plan of care, and monitoring for falls with a weekly follow-up. The study was funded by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health & Human Services.
Dutra and Bonardi have been studying falls in individuals with intellectual disabilities for eight years within the Shriver Center’s CDDER program (Center for Developmental Disabilities Evaluation and Research). In 2011, they worked on a statewide falls prevention pilot with the Massachusetts Department of Developmental Services that led to enhanced training of staff at group homes and resulted in a statistically significant 33 percent decrease in rate of falls over a six-month period. The study concluded that fall risk factors and causes can be reduced through staff training, increased awareness and better fall assessment skills.