First aid training for seniors: Preventing falls and medical morbidity in the elderly

Although many first aid training programs are offered without age restrictions, participants in our program reported that many seniors do not access these programs, even though seniors are at greater risk of experiencing or encountering the medical emergencies covered in such programs and could benefit greatly from the lessons.

Justin Burton demonstrates how to use an automated external defibrillator at the South Granville Seniors Centre.	Emma Dowds teaches seniors how to integrate an automated external defibrillator into CPR protocol at the Douglas Park Community Centre.

Introduction
First aid administered by family, friends, or members of the public who happen to be present at the traumatic or medical incident is often the initial treatment an individual receives when an incident occurs, and appropriate first aid treatment can significantly impact patient outcomes by reducing overall morbidity and mortality. Currently, first aid training typically focuses on teaching individuals who are younger than 65, despite the fact that older individuals are at greater risk of suffering emergent medical events such as myocardial infarction, stroke, or traumatic falls.[1-3]

As students enrolled in year 2 of the UBC Vancouver Fraser Medical Program, we had the opportunity to create a community project as part of our program. Given our interest in prehospital medicine, and recognizing the lack of available first aid training for seniors, we set out to create a novel community-based first aid course that was age specific for seniors to improve the health and well-being of this marginalized and often isolated population.

Our curriculum
The goal of our project was to educate, engage, and empower seniors to assist themselves and others in basic medical emergencies. We initiated the design of our curriculum with oversight and equipment from the Emergency Services Institute of Canada Society. We began by reviewing literature from the Public Health Agency of Canada and the Canadian Institute for Health Information that outlined medical emergencies faced by seniors and the common reasons they present to emergency departments. Our research also involved a review of pertinent first aid literature and guidelines from the Heart and Stroke Foundation of Canada, the American Heart Association, the Canadian Red Cross, and the Paramedic Association of Canada. We refined our curriculum in collaboration with a multidisciplinary team that included a geriatrician, an occupational therapist, and a BC paramedic.

In order to deliver our curriculum to our target population of seniors, we engaged various community centres across Vancouver. The immediate responses from the centres when approached were overwhelmingly positive and confirmed our understanding that there is a need for such outreach. During the spring of 2016, we presented our curriculum at four community centres including Kitsilano, Douglas Park, South Granville, and Kerrisdale.

While traditional first aid courses focus on treatment, for seniors it is especially important to address how to mitigate the risk of having an incident in the first place. Of particular concern to seniors are the risks and repercussions associated with having a traumatic fall. According to the Public Health Agency of Canada, falls remain the leading cause of injury-related hospitalizations for seniors, with 20% to 30% of seniors reporting falls annually. For seniors who fall, one common result is a hip fracture (95% of hip fractures are attributed to falls, and 20% of patients who suffer a hip fracture as a result of a fall will not recover and will die as a result). Falls also hasten seniors’ transition to long-term care facilities and lead to numerous negative health outcomes such as loss of autonomy, isolation, and depression.[3]

Given the frequency and negative outcomes of falls, a curriculum that enables and empowers seniors to assist themselves is prudent and in keeping with principles of preventive medicine. Additionally, understanding that falls are just one of the adverse incidents associated with aging, and recognizing the value of face-to-face teaching encounters, we decided that it would also be important to teach seniors how to recognize and provide first aid for heart attacks, strokes, and choking incidents.

Our teaching experience
Our class sizes ranged from 6 to 18 female participants—with the exception of one reluctant male partner. These energetic women, who were on average 70 years old, came with many questions and an eagerness to learn and practise. Our curriculum involved a combination of teaching and practical exercises, and the participants were keen and involved in all activities, but were especially enthusiastic during CPR practice and recovery-position rolls. Their energy was palpable and contradicted the assumption that this age group is inactive, which was noted by community centre staff.

A sombre mood was felt when the topic of falls was discussed; many participants shared stories of events they had personally experienced. We presented fall-prevention strategies sourced from Vancouver Coastal Health resources such as “Stay on your feet!”[4] and “Stay in the game!,”[5] as well as demonstrating proper self- and assisted-rescue strategies that could be used in the event of a fall. Participants were thankful for the lesson and expressed that fall-prevention information had not previously been disseminated to them in an accessible manner.

In order to gauge the effectiveness of our training, we asked participants to fill out a survey before and after we delivered our curriculum. Participants were asked to rate their confidence in their first aid skills and their willingness to help in an emergency situation. Participants consistently reported an improvement in both confidence and willingness to intervene after taking part in our course.

Having an impact
It was uplifting to see the energy, curiosity, and confidence exhibited by the seniors once they were empowered with the information to be more than a bystander in first aid situations. Once given the chance to assist rather than be assisted, they excelled. This also highlights the secondary benefit of first aid training for seniors—it provides an activity that combats social isolation, which is independently important because social isolation among seniors is associated with negative health outcomes, and the issue of isolation may not be adequately addressed through current primary-care services.[6] This is not a novel concept. According to Cattan and colleagues,[7] “educational and social activity group interventions that target specific groups of people can alleviate social isolation and loneliness among older people.”

Looking ahead
This project provided first aid training to an often overlooked population and was a strong success—the overall response to our pilot sessions was positive, and we were invited to teach again as soon as possible. Our goal is to offer the course to the four original centres again, as well as to expand to additional community centres in Vancouver. Additionally, we plan to train successive medical students to teach the curriculum to ensure the program’s continuity and strengthen the link between the medical program and the community.

Despite our project’s initial success, we did note several limitations. First, because the course was a pilot program, it was limited in its reach. It was offered to a small number of participants at select community centres due to limited personnel. Second, although we attempted to include the most pertinent topics for our audience, the length of the course was limited by the time constraints of our own academic schedules. Topics that could be implemented in future iterations of the curriculum include the management of diabetes and seizures. Our aim is to grow the project, address additional topics, and reach out to a larger audience in the future.

Although our numbers were small, we felt our impact on those we encountered was lasting and meaningful. We hope this encourages others to consider exploring uncommon initiatives and to view seniors as active participants in their own care.

Justin Burton and Alex Dodd demonstrate abdominal thrusts for choking at the  Kerrisdale Community Centre.	A South Granville Senior Centre volunteer and attendee practise CPR with an automated external defibrillator.

Acknowledgments
The authors thank Jeff Watts and Bohan Hans Yang, who supported them through the Emergency Services Institute of Canada Society.

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This article has been peer reviewed.

References

1.    Centers for Disease Control and Prevention. Stroke facts. Accessed 4 October 2015. www.cdc.gov/stroke/facts.htm. 
2.    Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: A report from the American Heart Association. Circulation 2015;131:e29-322.
3.    Public Health Agency of Canada. Seniors’ falls in Canada: Second report. Accessed 5 October 2015. www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/se....
4.    Vancouver Coastal Health. Stay on your feet. Accessed 16 February 2017. http://fallprevention.vch.ca/media/SOYF_8.5x11_Book_v5.pdf.
5.    Vancouver Coastal Health. Stay in the game. Accessed 16 February 2017. http://vch.eduhealth.ca/PDFs/BE/BE.250.P928.pdf.
6.    Nicholson NR. A review of social isolation: An important but underassessed condition in older adults. J Prim Prev 2012;33:137-152.
7.    Cattan M, White M, Bond J, Learmouth A. Preventing social isolation and loneliness among older people: A systematic review of health promotion interventions. Ageing Soc 2005;25:41-67.

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Mr Burton, Mr Dodd, and Ms Dowds are third-year medical students at UBC in the Vancouver Fraser Medical Program. Mr Burton’s interests include primary-care medicine and collaboration between physicians, first responders, and the community. Mr Dodd previously completed a bachelor’s degree in biological psychology at UBC and, prior to attending medical school, taught first aid with the British Red Cross. Ms Dowds plans to pursue a career as a rural GP. Prior to attending medical school, she worked and studied in the field of Alzheimer disease and dementia.