Falls Prevention Community of Practice

Spring 2013
The Seniors Health Knowledge Network Falls Prevention CoP Newsletter is published approximately every
second month. Please share
this newsletter with your
falls prevention
colleagues and invite them to
join our Community of
Practice
Issue 14
Falls Prevention
Message from our Co-Chair
Spring is finally here. I can’t wait for summer! Marguerite and I will be at the OGA conference in
May. We want to hear from you. Please drop by our table to let us know how we can help you
with your fall prevention efforts. This issue is about Vitamin D and Calcium, two things recommended for older adults to prevent serious injury from a fall. Canadians generally are vitamin D
deficient because we live in a northern climate, and it is very difficult to get vitamin D from
food. One new thing I learned from this issue is if you forget to take your vitamin D you can
take it all when you remember. Stay on top of the recommendations by reading this issue.
Enjoy—and we welcome your feedback. Please contact Marguerite, our coordinator, with any
suggestions you may have.
Monica Marquis BScHE CHES, Mississauga Halton Falls Prevention Coordinator
Contents
Seniors Health, Mississauga Hospital
1. Message from our CoChair and Coordinator
Phone: 647-290-0235
2. Have You Read? And
Coming Events and
Training—part 1
3. Feature: Vitamin D,
Calcium and Falls
4. Vitamin D, Calcium and
Falls (Continued)
5. More Coming Events
and Training
6. Even More Coming
Events and Training
7. News from SHKN
Library Services
8. More News from SHKN
Library Services
9. Meet a Member
HAVE QUESTIONS? Please
contact the coordinator:
Marguerite Thomas
Our membership is
now:
1,001
(April 28, 2013)
Email: [email protected]
@monicamarquis
www.findingbalanceontario.ca
Message from your Coordinator
Change is always here to stay! The Ontario Falls Prevention Community of Practice (CoP) is undergoing a change in that the Seniors Health Knowledge Network (SHKN) did not receive funding for the period of 2013-2016. However, there is a possibility of receiving transition funding
for April and May 2013 from the MOHLTC to support our CoP’s key activities. Fortunately, the
Ontario Neurotrauma Foundation (ONF) which has been the CoP’s sponsor since its inception is
committed to ensure the Falls Prevention CoP’s sustainability beyond May.
On behalf of the Core Team and all the members of our CoP, I would like to thank SHKN, formerly known as SHRTN, for assisting us to set up and maintain the CoP, which has grown from
an idea to over 1,000 members at the time of this writing.
So we find ourselves looking at how we can plan and make the transition forward. We want to
keep the strengths of the partnership and thus we will be looking at what we will be able to
keep and what we will need to create, including our own technology support. We will be conducting a strategic planning meeting at the end of April. We will become a revised community of
practice and thereby, will be assessing our current goals, objectives etc., and the way we offer
knowledge transfer and provide the linkages amongst our members. We will keep you posted as
we move forward and we want to thank everyone for your loyalty in staying with us. Again,
share your ideas and don’t go away!
Marguerite Thomas, RN., BScN., Coordinator, SHRTN Falls Prevention Community of Practice
Ontario Neurotrauma Foundation
519-887-6995
[email protected]
Page 2
Have You Read?
Earth's Elders: The Wisdom of the World's Oldest People is an inspiring book of 50 images and
stories of individuals 110+. The photographs were taken by Jerry Friedman, founder of Earth's Elders,
a partner of the Sheridan Elder Research Centre (SERC). Read more about Earth's Elders at http://
www.earthselders.org/
SERC is home to 62 large black and white photographs, most of which appear in Friedman's book. For
information about borrowing these remarkable images for exhibits or purchasing a book, please contact Pat Spadafora, Director of SERC, at [email protected]
If you are in the vicinity of Sheridan College at 1430 Trafalgar Road in Oakville, please drop by SERC
where a number of the images are on permanent display
Are you familiar with Cochrane Reviews? Check out Interventions for preventing falls in older people living in the community
(Review) by Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE: http://
www.thecochranelibrary.com/details/collection/4376241/Preventing-falls-and-fall-related-injuries-in-older-people.html
Coming Events and Training
FALLS & MOBILITY NETWORK ANNUAL CONFERENCE—JUNE 10, 2013
The Falls & Mobility Network is holding its annual 1-day conference on Monday June 10th, 2013. at Sunnybrook Health Sciences Centre from 9am-3:30pm. Registration is $40.00. Further details related to registration and method of payment will be
circulated in a few weeks. In the meantime block your calendars and plan to join us for a day of learning and networking.
Research Coordinator Jeanie Zabukovec says: “As always, we are counting on you to come share your work with your peers on
Monday June 10th . Please consider providing a short verbal update on your fall-related initiative or project. Please contact Jeanie
Zabukovec at: [email protected] with the title and brief description of your work”.

An update on Emergency Department Research in Mobility and Falls: The CETI initiative and the EDU-RAPIDI
trails Jacques Lee, Director of Research and Scholarly Activity, Department of Emergency Services and Scientist, Clinical
Epidemiology Unit, Sunnybrook Health Sciences Center
Dr. Jacques Lee is a scientist with Sunnybrook Research Institute, Director of Research and Scholarly Activity, Department
of Emergency Services. He is the Associate Director of Scholarship for the University of Toronto, Emergency Medicine Training Program. Dr Lee’s main research focus is improving the Emergency care of older persons through knowledge creation,
translation, and advocacy. He lead the “Paramedics Assessing Older Patients at Risk of Independence Loss” or PERIL study
that used information collected by 1600 paramedics in Edmonton, Ottawa and Toronto to identify older patients at risk for
adverse outcomes. Dr Lee was also funded by the Ontario Ministry of Health to develop the EnTICE toolkit, (Enabling Teamwork, Interprofessional Collaboration and Education) designed to be used by front line clinicians who want to successfully
implement any best practices in their interprofessional healthcare team. This project was awarded the Ted Freedman award
for innovations in education in 2009.

Moving ON! Using qualitative and participatory science to identify simple solutions to the complex problem of
keeping people with mobility impairments moving Paula Gardner, Research Scientist, Bridgepoint Collaboratory for
Research and Innovation, Assistant Professor, Dalla Lana School of Public Health, University of Toronto
Dr. Paula Gardner is a Research Scientist at the Bridgepoint Collaboratory for Research and Innovation in Toronto, where
she is the lead scientist on the “Moving On – Living Well with Complex Chronic Disease” research team. She is an Assistant
Professor at the Dalla Lana School of Public Health, University of Toronto, where she received her PhD in Public Health. As a
community-based researcher working in a hospital setting Paula is examining how mobility ‘works’ across the continuum
from hospital to home to enhance ‘patient-centred’ care practices, identify critical community supports and develop simple
solutions that empower people to keep moving. Paula maintains an international program of research to explore the role of
culture in healthy aging with partners from Korea, Japan, New Zealand, India, Hong Kong, and USA.
Jeanie Zabukovec, Research Coordinator
Toronto Rehabilitation Institute- University Health Network
550 University Avenue, 12th Floor
Toronto ON M5G 2A2
Phone: 416 597-3422 x 7437
Features
Page 3
VITAMIN D: AN IMPORTANT NUTRIENT THAT PROTECTS YOU AGAINST FALLS
AND FRACTURES
Vitamin D is very important for bone health. It helps build stronger bones, partly by increasing the absorption of calcium. Vitamin D
also improves the function of muscles, which in turn improves your balance and decreases the likelihood of falling. Vitamin D is
therefore doubly essential in helping protect you against fractures.
Vitamin D comes from the sun. The sun’s rays interact with our skin to produce vitamin D that can be used for bone and muscle
health. In Canada, because we live in a northern climate, we don’t get as much sun as we need; and when we apply sunscreen in
the summer, the sunscreen disables the skin’s ability to produce vitamin D from sun exposure, even in tropical vacation spots. Additionally, as we age, the skin’s ability to make vitamin D decreases and for all of these reasons, many Canadians are low on vitamin D.
There are very few food sources of vitamin D. In fact, it is impossible for adults to get sufficient vitamin D from diet alone, no matter how good their nutrition. Therefore, Osteoporosis Canada recommends routine vitamin D supplementation for all Canadian
adults year round. Healthy adults between 19-50 years of age, including pregnant or breast feeding women, require 400 – 1,000 IU
daily. Those over 50 or those younger adults at high risk (with osteoporosis, multiple fractures, or conditions affecting vitamin D
absorption) should receive 800 – 2,000 IU daily. These amounts are safe. Taking more than 2,000 IU of vitamin D daily should be
done only under medical supervision.
The best way to ensure that you are getting sufficient vitamin D is by taking a supplement. The type of vitamin D you should purchase is vitamin D3 (also called cholecalciferol). This is the most common type of vitamin D found in supplements in Canada.
Cod liver oil and halibut liver oil supplements also contain vitamin D but these sources are not recommended because they also
contain a form of vitamin A called “retinol” or “retinyl palmitate” that, if taken in excess, can cause bone loss.
Vitamin D by itself comes in 400 and 1000 IU tablets. Most multivitamins contain some vitamin D but the amounts vary quite a bit,
so be sure to read the small print on the label carefully. Some calcium supplements also contain vitamin D3 and again the amounts
vary. If you are unclear how much vitamin D your supplements contain, please check with your pharmacist.
There is something special about vitamin D that does not apply to most other vitamins or supplements. Vitamin D is fat soluble.
This means vitamin D can be “made up.” If you miss your vitamin D today, for example, you can take double the amount tomorrow. If you miss your vitamin D for a whole week, you can take all the vitamin D that you missed altogether at the end of the
week. However, you shouldn’t do this on a regular basis without consulting with your physician and this can only be done with vitamin D. It cannot be done with other medications or supplements.
And there you have it. Supplementation is the way to go to get your vitamin D. But don’t forget that calcium, ideally from food
sources, and a balanced diet with adequate protein and lots of fruits and vegetables are also essential for bone health. And there is
another reason to be out there enjoying the sun – exercise. Walking, jogging, playing tennis, throwing a Frisbee – all those weightbearing activities that can be enjoyed outdoors help to build and maintain strong bones. Have a great summer!
“This article is reprinted from COPN, the Canadian Osteoporosis Patient Network. For more information on COPN and Osteoporosis
Canada, visit www.osteoporosis.ca.”
Features (continued)
Page 4
CALCIUM AND VITAMIN D
Each
newsletter
will feature a
different falls
prevention
initiative.
If you have a
program that
you would
like
to highlight,
Please
contact the
CoP
coordinator
marguerite
@thomas.name
Calcium is often the first nutrient that we think of when “osteoporosis” is mentioned. Adults over
age 50 should consume at least 1200 mg of calcium daily, keeping in mind the Tolerable Upper
Intake level of 2000 mg/day. This total includes calcium from foods and supplements. Food
choices are the preferred method of getting your daily calcium, as calcium-rich foods also provide
many other nutrients. Try Osteoporosis Canada’s Calcium Calculator to see how your intake
measures up. Consuming milk products is an easy way to meet calcium requirements, but you
can also get your calcium from other foods and beverages such as fortified soy beverages, canned
salmon with bones, baked beans, and some leafy greens. If supplements are needed, there are
many choices available; ask your Registered Dietitian, Pharmacist or other healthcare provider for
recommendations.
Vitamin D and Calcium are the main nutrients involved in keeping bones strong, but a general
healthy diet is important to keep all the body systems operating at peak performance. When you
are well-nourished you are less likely to fall, so this also helps to prevent injuries that may be associated with osteoporosis. So what is an easy way to tell if your diet needs some help? Have a
checkup by a Registered Dietitian! An easy way for older adults to identify nutrition issues and
find resources to help choose a healthier diet is Nutri-eScreen. This short computerized questionnaire takes only about 10 minutes to complete, and will identify where you are doing well and
where there is room for improvement in your diet. There are links to resources that help you
make the changes.
In Ontario, everyone is able to access a Registered Dietitian through EatRightOntario. The dietitians can be reached by calling the toll-free number 1-877-510-510-2, or you can visit the website
to send an email and get a personal response, or browse the many resources available on the
site. All for free!
Leslie Whittington-Carter, MHS, RD
Ontario Government Relations Coordinator, Dietitians of Canada
[email protected]
519 762-0393
www.dietitians.ca
VITAMIN D RESOURCES
Interesting items from a search for consumer oriented brochures and fact sheets about Vitamin D
performed several years ago by a SHRTN Information Specialist, Nancy Roberts - c/o the Bruyere
Continuing Care Library. Nancy also searched the Cochrane Library and the Trip database and did
not find any brochures or systematic reviews for consumers that relate to the new guidelines.

IOF News Release—New levels http://www.iofbonehealth.org/newsroom/media-releases/
detail.html?mediaReleaseID=132
Is your agency
sponsoring an
event?

*MedlinePlus is a Consumer oriented database containing brochures and fact sheets all from
reliable sources: http://www.nlm.nih.gov/medlineplus/vitamind.html

Brochure reviewed in 2011 - refers to the 800 units/day if over 71 http://ods.od.nih.gov/
factsheets/VitaminD-QuickFacts/

Video clip about vitamin D, its importance, who is at risk, what sources are available and the
general recommendations http://www.facebook.com/video/video.php?v=740545619207

CADTH had done an environmental scan http://www.cadth.ca/en/products/environmentalscanning/environmental-scans/issue-12

2010—does differ from the recommendation http://www.dietitians.ca/getattachment/
e2f48b2b-5b00-4024-87f2-799ee26dc1b8/FactSheet---Vit-D--what-you-need-toKnow.pdf.aspx
Please
let us know
so we can
feature it
More Coming Events and Training
Page 5
The Alzheimers Knowledge Exchange (AKE) offers education on an ongoing
basis. Check out their website:
www.akeresourcecentre.org
Webinars
Visit our presentations page to find webinar recordings on hot topics such as Changing the Culture of Care for Persons Living with
Dementia; and BSO Capacity Building Suite.
Visit our calendar regularly for new events!
Canadian Public Health Association 2013 Annual Conference
June 9-12 in Ottawa
Moving Public Health Forward: Evidence, Policy, Practice
Ottawa Convention Centre, Ottawa
And from Baycrest:
The Dr. Ira Pollock Clinic Day
Clinical and Ethical Issues in Geriatric and Long-Term Care
Wulf Grobin Memorial Lecture on Ethical Issues
Friday, June 7, 2013
Information regarding the event is available by clicking here.
For online registration page, click here.
Additional Educational Opportunities










Annual NICE Knowledge Exchange 2013, Toronto, May 23
Ontario Home Care Association 2013 Symposium – Showcasing our Best, Mississauga ON, May 23
ER/ALC: Enhancing Quality Care Across the Health Continuum, Toronto, May 27–28\
Ethno-Cultural Care And Older Adults - ILCA Online Workshop - May 06 to Jun 02
CGNA's Personhood & Caring: Honouring the Older Adult’s Life Journey, Richmond, BC - May 29 Jun 1
Canadian Working together in Knowledge Mobilization: closing the loop between research and practice, Mississauga, ON
Jun 3 & 4
7th Annual Summit - Quality Worklife, Quality Healthcare, Niagara Falls, ON, Jun 11 - 12
OACCAC Knowledge & Inspiration 2013 Conference, Toronto, Jun 19–21
6th Congress of the International Society of Vascular Behavioural and Cognitive Disorders (VASCOG), Toronto, Jun 25 - 28
CDKTN Launches New Dementia CME For Physicians (Dates TBD)
Ongoing



The Institute for Life Course and Aging Webinars
RGP of Eastern Ontario: Geriatric City Wide Rounds
Montessori for Dementia
Even More Coming Events and Training
Page 6
Events from the Canadian Centre for Activity and Aging (CCAA):
For more opportunities check out our CCAA course calendar for 2013 training: http://ccaa-outreach.com/courses/all.htm Check out
our YouTube channel for information and resources: http://www.youtube.com/user/CCAAUWO
News Nugget
Update of Fall Prevention Locally Driven Collaborative Project
Check out the link to the latest update to the Locally Driven Collaborative Project,
“Engaging Community-Based Organizations in Fall Prevention for Older Adults: Moving
from Research to Action”. LDCP Update Feb13
What Communities are Doing
Page 7
South West Regional Falls Collaborative Update March 2013
The South West Local Health Integration Network (LHIN) is supporting a regional initiative for falls prevention and
management in older adults. This project aims to increase collaborations across the continuum of care and establish
the regional infrastructure for a population-based approach to falls prevention and management.
To date, a working group with regional representation has met twice to begin drafting a governance model and strategic framework. An environmental scan is currently being conducted to help identify all the organizations involved
in falls prevention and management across the spectrum of care and describe the work they’re doing. The results of
the scan will be used to continue to develop partnerships and the overall strategy.
For more information about this initiative and learn how you can become involved, contact Sarah Milne at
[email protected]
News from the SHKN Library Service:
(Click on the hyperlinks to get to the abstracts or full-text articles).
Moschonis G, Katsaroli I, Lyritis GP, Manios Y. The effects of a 30-month dietary intervention on bone mineral density: the Postmenopausal Health Study. BrJ Nutr. 2010 Jul 14;104(1):100-7. Abstract
Oleson CV, Patel PH, Wuermser L. Influence of season, ethnicity, and chronicity on vitamin D deficiency in traumatic spinal cord
injury. J Spinal Cord Med. 2010;Jun;33(3):202-13. Full-text article
Weiss EP, Shah K, Fontana L, Lambert CP, Holloszy JO, Villareal DT. Dehydroepiandrosterone replacement therapy in older adults:
1- and 2-y effects on bone. Am J Clin Nutr 2009 May;89(5):1459-67. Full-text article
Hamid Z, Riggs A, Spencer T, Redman C, Bodenner D. Vitamin D deficiency in residents of academic long-term care facilities despite having been prescribed vitamin D. J Am Med Dir Assoc. 2007 Feb;8(2):71-5. Abstract
Munir J, Wright RJ, Carr DB. A quality improvement study on calcium and vitamin D supplementation in long-term care. J Am Med
Dir Assoc. 2007 Mar;8(3 Suppl 2):e19-e23. Abstract
Neyens JC, van Haastregt JC, Dijcks BaP, Martens M, van den Heuvel WJ, de Witte LP, Schols JM. Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs. J Am
Med Dir Assoc 2011 Jul;12(6):410-25. Abstract
Parikh S, Avorn J, Solomon DH. Pharmacological management of osteoporosis in nursing home populations: a systematic review. J
Am Geriatr Soc 2009 Feb;57(2):327-34. Abstract
Sawka AM, Ismaila N, Raina P, Thabane L, Straus S, Adachi JD, Gafni A. Papaioannou A.. Hip fracture prevention strategies in long
-term care: a survey of Canadian physicians' opinions. Can Fam Physician. 2010 Nov;56(11):e392-e397. Full-text article
Singh S, Sun H, Anis AH. Cost-effectiveness of hip protectors in the prevention of osteoporosis related hip fractures in elderly
nursing home residents. J Rheumatol. 2004 Aug;31(8):1607-13. Abstract
Switzer JA, Jaglal S, Bogoch ER. Overcoming barriers to osteoporosis care in vulnerable elderly patients with hip fractures. J Orthop Trauma. 2009 Jul;23(6):454-9. Abstract
Viveky N, Toffelmire L, Thorpe L, Billinsky J, Alcorn J, Hadjistavropoulos T, Whitting SJ. Use of vitamin and mineral supplements in
long-term care home residents. Appl Physiol Nutr Metab. 2012 Feb;37(1):100-5. Abstract
Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J+, Simonetti RG, Bjelakovic M, Gluud C.. Vitamin D supplementation
for prevention of mortality in adults. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD007470. Abstract
More News from the SHKN Library Service
Page 8
Breer S, Krause M, Marshall RP, Oheim R, Amling M, Barvencik F. Stress fractures in elderly patients. Int Orthop 2012 Dec;36
(12):2581-7. Abstract
Chel V, Wijnhoven HAH, Smit JH, Ooms M, Lips P. Efficacy of different doses and time intervals of oral vitamin D supplementation
with or without calcium in elderly nursing home residents. Osteoporosis Int. 2008 May;19(5):663-71. Full-text article
Vieth R. Comment on Chel et al.: Efficacy of different doses and time intervals of oral vitamin D supplementation with or without
calcium in elderly nursing home residents. Osteoporosis Int. 2008 May;19(5):721-2. Abstract
Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D with or without calcium supplementation for prevention of cancer and
fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Internal Med 2011 Dec 20;155(12):827-38.
Abstract
Friel K. The effects and interactions of vitamin D deficiency, calcium and parathyroid hormone on physical concerns in the elderly: a
review. J Geriatr Phy Therap 2004 Mar;27(1):28-32. No abstract
Dinizulu T, Griffin D, Carey J, Mulkerrin E. Vitamin D supplementation versus combined calcium and vitamin D in older female patients - an observational study. J Nutr Health Aging 2011 Aug;15(8):605-8. Abstract
Doris Nussbaumer
Seniors Health Knowledge Network Information Specialist
SHKN Library Service
Library service is available, however, in light of recent changes, it may be slower than usual. The best way to obtain service from
the library until the end of May is to email your question or request to [email protected].
Doris Nussbaumer has moved on from SHKN and we welcome Lindsay Ogilvie at St. Joseph’s Health Care Group in Guelph as our
current Information Specialist from SHKN.
Page 9
Meet a Member
Meet Amber Schieck (above left), Health Promoter at the Grey Bruce Health Unit. After completing Bachelor of Science and Master
of Public Health degrees, Amber spent 2 years working in program planning, epidemiology and program evaluation in Public Health
before beginning her new position at the Grey Bruce Health Unit. Amber is now working specifically with the Grey Bruce Falls Prevention and Intervention Program and is happy to be joining the Falls Prevention Community of Practice.
The Grey Bruce Falls Prevention and Intervention Program is a comprehensive program that includes health promotion, screening,
assessment and interventions in the community to address falls risk among older adults. The program involves a number of partnerships with community organizations in the Grey Bruce area to support referrals cross the continuum of care. Future plans for
the program include continuing to strengthen and develop relationships with care providers in the Grey and Bruce Counties.
In Grey Bruce, Amber has taken over the previous role of Sarah Milne (above right), as Sarah is now working with the South West
LHIN Falls Collaborative project. For more information on the South West LHIN Falls project, see the update in this newsletter.
Not to worry though, Sarah will still stay connected with the group and remain on the Falls Prevention Community of Practice Core
team in her new role. Sarah attended university in London and Vancouver to complete a Bachelors Degree in Kinesiology. Sarah
has 5 years experience working in falls prevention and is a wealth of knowledge!