FDIHB's Injury Prevention Program proposes to implement SAIL and Home Modification interventions to help reduce the Elder Falls rate in three communities in its service area. - Fort Defiance Indian Hospital Board Inc./Tsehootsooi Medical Center is one of the P.L. 93-638 hospitals in I.H.S.’ Navajo Area administrative units. Fort Defiance Indian Hospital Board Inc. (FDIHB), provides services to 16 community chapters including: Cornfields, Crystal, Fort Defiance, Ganado, Greasewood, Houck, Kinlichee, Klagetoh, Lupton, Nahata’Dziil (Sanders), Oak Springs, Red Lake, Sawmill, Saint Michaels, Steamboat, and Wide Ruins. The service area has a population of 27,087 individuals, with 13% of the population aged 65 years and older. In a recent report titled, “Navajo Nation Hospitalization & Emergency Room Rates 2023” released by the Navajo Department of Health, it summarized that fall rates have increased since 2019. FDIHB was reportedly the second highest in falls-related Emergency Room Visits from 2019 to 2023, and was third in Falls Hospitalization Rates. Data extracted from FDIHB’s iCare system revealed that over a five-year period (2020-2024) there were a total of 1,572 unduplicated emergency room falls-related visits for all patients. Community members over the age of 65 were most affected, contributing 1,087 (69%) ER falls-related visits, rising from 123 to 430 visits from 2020 to 2024. Among the same population, women had more falls (67%) than men (33%) and the communities that showed the most reported falls incidences in descending order included St. Michaels (324), Fort Defiance (205), and Nahata Dziil (90). In order to address this health issue and decrease the incidence of severe injury, three departments in the Healthy Living and Outreach (HLO) division at FDIHB, which includes the Health Promotion/Disease Prevention (HPDP), Public Health Nursing (PHN), and Wellness, proposes to implement two fall prevention strategies in the three communities with the highest falls incidences for the 65+ aged population. The three departments will serve as the Injury Prevention Program (IPP) team. FDIHB currently employs the Stay Active and Independent for Life (SAIL) program at its Nihi Dine’é Bá Wellness Center in Fort Defiance. SAIL is an evidenced-based fall prevention program which focuses on increasing individual strength, balance, and flexibility. With enhanced physical attributes, elders are able to facilitate falls risk without complications. Classes are one-hour and taught by a trained facilitator three times per week. The IPP plans to expand SAIL to three additional senior centers in St. Michaels, Fort Defiance, and Nahata Dziil, reaching approximately 60 participants. The objective is to increase strength and balance by 25% in elders participating in the program. Secondly, the IPP will collaborate with the Navajo Nation Community Health Representative Program to conduct Home Assessment and Modifications. Utilizing CDC's or the National Council on Aging’s home safety checklist, the team hopes to eliminate conditions in the home that pose a falls risk and instruct elders how to identify these conditions and address them on their own. The objective is to reduce falls-related ER visits by 20% in the targeted communities. In order to support these activities, FDIHB plans to develop its capacity and infrastructure by hiring a full-time Injury Prevention Coordinator, multiply the number of trained SAIL instructors, and create a task force. The Injury Prevention Task Force will be responsible for increasing membership, developing an evaluation plan, a five-year plan, and a sustainability plan to ensure the continuity of the program beyond the funding period. TIPCAP funds will be utilized to hire an Injury Prevention Coordinator, contract a SAIL instructor so staff can obtain instructor certifications, purchase supplies to implement the prevention strategies, attend IHS’ annual meeting, and attend additional training to effectively administer the grant program. The overarching goal is to significantly decrease the unintentional injury rates related to elder falls.
