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Hot Meals with a Side of Prevention

Meals on Wheels Food

Volunteers who deliver Meals on Wheels are often the only people whom homebound clients see on a given day. So it's not surprising they are often the only ones to hear about accidental falls. 

In 2009, Senior Services of Winston-Salem, which delivers meals to qualifying seniors throughout Forsyth County, asked the J. Paul Sticht Center on Aging to help them address fall risks. As a result, the Fall Prevention Program was born. 

"When someone in this population suffers a fall, it is the event that most often leads to nursing home placement," said Jeff Williamson, MD, who heads Wake Forest Baptist Medical Center's Section on Gerontology and Geriatric Medicine. "Our program identifies at-risk clients, assesses their risk, and provides recommendations to help them avoid falls."

In-Home Exam

About 150 fall-risk assessments have been performed since the program began. A nurse practitioner or geriatrician and an Internal Medicine or Family Medicine resident visit the client's home and perform a fall-risk examination that includes a physical checkup, cognitive testing and assessment of walking ability and balance. 

"Seeing a patient in the home environment is an eye-opening experience for medical residents, and Meals on Wheels clients have been delighted to interact with them," Williamson said.

"Clients often comment that they have not received such a thorough exam in years. This in-depth assessment, which often lasts about an hour and a half, really makes them feel like we're taking a more holistic approach to their health care." 

If the client has a faltering gait, the in-home assessment team explains research linking it to increased fall risks and may recommend in-home physical therapy. They evaluate medications that can increase fall risks and may suggest changes to the home environment, such as removing throw rugs, installing shower grab bars or placing a nightlight near the bathroom. The nurse practitioner or geriatrician also sends a letter with recommendations goes to the client's primary care physician.

Paying It Forward

The program benefits not only homebound seniors but also doctors in training. The Medical School pairs second-year medical students with older volunteer drivers to ride along on Meals on Wheels deliveries. 

"We want to break any misconceptions that just because someone is in their 80s, it doesn't mean they're necessarily the frail, older person that students see on the ACE (Acute Care for the Elderly) unit," Williamson explained. "We ask students to interview the older volunteer drivers to find out why they have aged successfully versus the person receiving the meal." 

When third-year students enter their geriatric rotation, they accompany Meals on Wheels staffers during in-home visits to enroll new clients. The students perform a simplified fall-risk screening that gives them valuable practice and identifies clients who may need a full fall-risk assessment.

Shared Mission

For Senior Services, the Fall Prevention Program represents an extended support system for clients without draining additional time or financial resources. For the Sticht Center, the collaboration offers an opportunity to translate research into better care and to take that care out into the community. 

"The missions of both Senior Services and the Sticht Center are to help seniors remain healthy, independent and able to live at home as long as possible," Williamson noted. "This program is an effective way to further the missions of both organizations." 


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Last Updated: 08-03-2016
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