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Falls Check in community pharmacies

Promoting awareness and screening for falls risk in older adults at community pharmacies, leveraging health check stations where available.

Photo of Michael Bishop

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Who is your idea designed for and how does it enable older adults to live their best possible life by preventing falls?

Our idea is designed primarily for older adults who visit community pharmacies. Pharmacies offer several ways to screen, identify and mitigate risk factors to prevent falls in older adults at risk: pharmacists when interacting with patients or caregivers; health check stations to provide for self-assessment and supplement an interaction with a pharmacist; screen technologies to promote awareness. All of these can lead to interventions to enable older adults to live their best possible lives.

Older adults may be unaware of their increased risk of falling. There are several risk factors for falls in older adults, including having fallen in the last six months, having an unsteady gait/balance problems, or worrying about falling. Being on three or more medications also increases risk. Promoting awareness and early screening would reduce total falls and resulting injuries, which have economic and personal costs.

Community pharmacists are highly accessible healthcare professionals, well-positioned to screen for falls risk, mitigate risk factors and promote local fall prevention programs. Community pharmacy interventions for falls prevention are not new (see attached research articles: Bartlett, Casteel, Mott); however, there are various barriers to implementation, such as time and resource constraints (see attached research article: Laliberté). 

Our idea leverages pharmacist healthcare knowledge, pharmacy technology, and information dissemination to overcome barriers and provide a comprehensive intervention: 

1. Healthcare knowledge

Pharmacists can use existing falls risk assessment tools such as the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths and Injuries) toolkit. 

STEADI provides training for pharmacists to use these tools to screen older adults at risk and suggest mitigation strategies such as medication reviews to reduce falls risk. Medications that increase the risk of falls include antidepressants, antiepileptics, antipsychotics, diabetic medications, cardiovascular medications, opioids and sedatives. Pharmacists can assess the appropriateness of current medications and recommend withdrawing inappropriate prescriptions. For example, they may recommend that psychotropic medications be withdrawn gradually in those at risk of falling from excessive daytime drowsiness or dizziness. Pharmacists can also recommend simple interventions such as adding vitamin D as deficiency has been linked to increased falls risk (STEADI training, American Pharmacists Association). 

2. healthcare technologies

Some pharmacies have health check stations that could be leveraged for falls risk screening. Currently, most health check stations in pharmacies are designed to measure and monitor sitting blood pressure only. These stations could be re-designed to integrate physical falls risk screening tests and educational materials such as:

  • Including a platform with integrated force sensors that could detect sway movement and predict fall risks (stand on platform with eyes open then shut). The Wii board by Nintendo (see image below) is an example of a sensing platform technology that can assess falls (see Check Your Balance). 

  • A platform with force sensors could also sense standing motions during 30 Second Chair Stand Test, another test to assess falls risk.
  • Re-designing the machine to measure and calculate the difference between sitting and standing blood pressures to test for postural hypotension, a known risk factor for falls in older adults. 
  • A flat screen TV could provide information on testing procedures, accompany or direct subjects through tests, provide test results, and direct users to follow-up with the pharmacist. When not in use, videos and other information could be displayed on the screen and/or a gaming technology could be integrated for other kinds of testing (e.g. reflexes) or to provide a fun way to learn about health.

In pharmacies without health check stations or without space for health check stations, alternative technologies could be available to assess falls risk, such as:

  • A stand-alone platform with force sensors
  • Wearable sensor assessment technology, such at the Kinesis QTUG™ (OpenIDEO idea in refinement stage)


3. healthcare information 

Pharmacies’ information dissemination platforms could promote falls risk awareness to patients and the public. Pamphlet literature is an established way to provide information but it could also be disseminated via electronic screens, which are increasingly being integrated into pharmacy environments, in waiting and other areas.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

A small number of community pharmacists would be approached for their opinions on STEADI's toolkit and a rough prototype or image of an enhanced health check station to identify challenges and opportunities in a community pharmacy setting.

We could observe them using these tools with their patients and identify how the process of falls screening, assessment and intervention could be optimized.

What skills, input, or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

How best to structure a falls prevention program within a community pharmacy setting? What other services could be combined with falls prevention for reimbursement models (e.g. influenza vaccination programs)? What other kinds of fall-risk detection technologies or tests could be incorporated into health check stations or offered by a pharmacist? What possibilities can be found in the use of interactive TVs/screens in pharmacies?

How long has your idea existed?

  • 0-3 months

This idea emerged from

  • A group brainstorm

Tell us about your work experience:

Michael is a policy advisor working in the area of climate change policy and program design. He also practices 3D design.

Nita is a pharmacist interested in design thinking to solve wicked healthcare problems. She will be pursuing a master's program in design for health at OCADU in Sept. 2017.

How would you describe this idea while in an elevator with someone?

Our idea is to have community pharmacists integrate falls risk assessment tools and technologies into their practices to identify older adults at risk of falls, disseminate information about falls prevention, and where possible intervene to reduce falls risk.

How does your idea demonstrate our Criteria of Affordability?

The risks assessment tools and technologies would available for free to all customers of community pharmacies. Technology costs would be incorporated as a very small incremental cost added to all pharmacy products. Pharmacy service costs could be mitigated by having a co-located health check station perform most if not all of the screening test, with the pharmacist playing the role of instigator, guide, and contact person if further questions arise or actions are needed.

How does your idea demonstrate or plan to demonstrate scalability?

In Ontario (Canada), the public drug program for older adults pays pharmacists to conduct Meds Checks annually on those taking 3 or more prescription medications. A Falls Check intervention could be easily added to this service. To reach more users, a Falls Check could also be combined with another annual existing service, such as influenza vaccination programs.

Health check station manufacturers could adopt falls assessment technologies for their clients, working with pharmacies & others.

How do you plan to measure the impact of your idea?

• Determining the no. of pharmacists taking falls prevention training
• Measuring changes in patient/caregiver awareness and actions taken to reduce falls risk
• Determining the no. of Falls Checks completed on an annual basis and the no. & type of pharmacy actions taken
• Measuring the no. of pharmacies with health check stations incorporating falls-risk assessment technologies
• Satisfaction survey with health check station users

What are your immediate next steps after the challenge?

Approach provincial government with Falls Check idea and approach health station manufacturers to inquire about feasibility and cost of station redesign.
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Attachments (14)

FallsCheck.pdf

User journey. Design by Keith Ly.

1_konstantin_grcic.jpg

Research - design concepts: new forms; private/public designs

2_various.jpg

Research - design concepts

3_multimedia.jpg

Research - design concepts: multimedia, robots

4_telephone_booths.jpg

Research - telephone booth design: public/private space

Kwok 2015.pdf

Research article: "Novel use of theWii Balance Board to prospectively predict falls in community-dwelling older adults"

Bartlett 2015.pdf

Research article: "Pharmacist Consultations: Simplifying Daily Drug Regimens and Providing Education on Fall Risk for Older Adults"

Casteel 2011.pdf

Research article: "Implementation of a Community Pharmacy–Based Falls Prevention Program"

Mott 2014.pdf

Research article: "The Development of a Community-Based, Pharmacist-Provided Falls Prevention MTM Intervention for Older Adults: Relationship Building, Methods, and Rationale"

Laliberte 2013.pdf

Research article: "The role of community pharmacists in the prevention and management of osteoporosis and the risk of falls: results of a cross-sectional study and qualitative interviews"

Questionnaire - patient and caregiver2_summary.doc

Patient questionnaire and summary of responses. 28 May 2017.

Questionnaire - pharmacist2_answers_summary.doc

Pharmacist questionnaire and summary of responses. 20 May 2017.

journey_mapping_session.jpg

Journey mapping session at OpenIDEO Toronto Chapter, 8 May 2017.

IdeasSubmission - Detecting risks of falling at health check stations.pdf

Submission at end of Ideas phase, with openIDEO community comments.

31 comments

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Photo of Duncan Yorkston
Team

Hi Michael and Nita,
I like this idea and how it aims to expand the role of community pharmacists in the primary prevention setting. As a pharmacist who has spent a number of years working in community pharmacy, I am aware of the time constraints of this job. Without some funding I could see pharmacy owners being reluctant to engage with this program.

In Australia we have some government funding for community pharmacists to perform clinical interventions and medication checks in the pharmacy under the 6th Community Pharmacy Agreement (http://6cpa.com.au/medication-management-programmes/medscheck-diabetes-medscheck/). Does the US have any system like this?

I also note that you've written 'Pharmacists can assess the appropriateness of current medications and recommend withdrawing inappropriate prescriptions.' How would your pharmacists do this? Would they call the Dr or write a letter? This is exactly the kind of thing our team specialises in over here. In this case we would request to the Dr for one of our pharmacists to perform a home medication review (HMR) which is also funded by our health care system. Do you have home medication reviews in the US? If so, could you utilise something like this as part of your idea and offer some of the proceeds to the pharmacy owner?

Photo of Nita Lakhani
Team

Hi Duncan!

Thank you for your insightful comments. I was also a community pharmacist for a while, but in Ontario, Canada, so I can't speak for the U.S. pharmacy model. I agree that pharmacy owners would be reluctant to increase services without funding/compensation.

In Ontario, we also have government funding for clinical interventions, including Meds Check and home visits; however, although there's been significant uptake of medication reviews performed in the pharmacy, home visits are trickier given that the majority of pharmacies employ only one pharmacist without technician or assistant support (pharmacies need to have a certain prescription quota to allow for more staff). Given that there needs to be a pharmacist on site and often only one pharmacist, I suspect home visits are not frequent. Pharmacists that are part of family health teams have more flexibility to perform home visits, but not all patients are part of family health teams.

In terms of interventions, if inappropriate medications are identified, pharmacists have the option to call the physician or fax a letter. There is some reimbursement for this service as part of a Pharmaceutical Opinion program funded by the Ontario government. In either case (medication review on-site or home visit), reimbursement is provided to the pharmacy, not to individual staff directly.

Are home medication reviews routine in Australia? Who conducts the majority of these - the pharmacist or physician?

Photo of Duncan Yorkston
Team

Hi Nita,

Home medication reviews have been around in Australia for some time however only a minority of doctors would routinely seek them. Pharmacists must do extra training to be accredited to perform home medication reviews in Australia.

Photo of Kate Rushton
Team

Hi @Michael Bishop

Thank you for all your hard work in this challenge and dedication.

All of the ideas posts are locked but the comments section is still open, so please feel free to look at other ideas and comment on them, seek feedback on your idea etc.

I know I have asked many ideators this question but I am asking again as some ideas pivoting in the challenge. Would you say your idea is Most Viable or Most Promising? How would the incentives associated with that Award (Most Viable/Most Promising) be helpful for you?

Photo of Michael Bishop
Team

Hi Kate,
Joanna Spoth 
We believe that our idea is ‘Most Promising’ and here is why:

Our idea is a low cost, accessible intervention that would integrate well within the current community pharmacy model. The Ontario government currently funds a fee-for-service Meds Check program that allows pharmacists to conduct medication reviews for patients. These reviews can take up to thirty minutes and are typically performed during off-peak hours. A Falls Check program could follow a similar model and take five to fifteen minutes, depending on the assessment and/or review performed. Such a program would allow for risk screening, provision of information and resources to patients and caregivers, and allow for funding of a follow-up consultation.

Our idea for integration of falls assessment technologies within health check stations does not currently exist (that we are aware of). The technological component of our idea would require engaging with one or more health check station manufacturers to gauge interest in the idea of integrating balance platforms (and potentially other technologies) into their health check stations. Integration would likely also require incorporating balance test instructions, results, and follow-up into their digital and hardware platforms. A co-funding approach could be used to incent manufacturer interest in developing a prototype. IDEO Design Services could work with the selected health check station manufacturer to design, develop, and test the balance platform technologies. Some testing and research may be required to validate its use as a falls risk assessment tool, as research to date has focused on the use of the Wii board as a stand-alone device.

Another approach would be to develop an independent balance platform that could be used anywhere in the pharmacy, or by patients and caregivers in the home. This would allow falls risks assessments to be performed in any pharmacy, not just ones that have room and/or can afford health check stations. User feedback suggested that patients and caregivers prefer to conduct assessments in the pharmacy or at home. IDEO Design Services could work with an interested technology partner to design, develop, and test the balance platform technologies.

In moving the project forward, some of the funding would be used for human resources to develop and pitch the project to potential funders (private and/or public) and interested companies/organizations.

The impact of our idea is high, given the potential to scale it up in community pharmacies (e.g. chain drugstores, grocery stores). We feel that our pharmacy intervention will be able to reach a large demographic of older adults, including those at risk of falling, those not yet at risk, and their caregivers, if applicable.

Eventually, we hope that a falls risk assessment will become just as routine, accessible, and as familiar as a blood pressure test in a community pharmacy.

Photo of Barry
Team

Hi Michael,

I really like this idea, I think it could complement quite well with our method for more accurately identifying older adults are risk of falls: https://challenges.openideo.com/challenge/fall-prevention/refinement/reducing-the-incidence-of-falls-through-improved-assessment
Crucially our solution does not require specialist expertise in fall prevention, biomechanics or physical therapy which would make it suitable for use in a pharmacy. We are currently running a pilot in a number of London pharmacies so keen to see how this turns out!

Barry

Photo of Michael Bishop
Team

Hi Barry,

Great to hear that your team is already running a pilot for the Kinesis falls risk assessment technology in several pharmacies. We in fact mention your team's openIDEO project as a potential technology for pharmacists to loan out to patients (just need to add the link). There is not much space in a pharmacy, except in the aisles, so perhaps patients could follow a fixed route outdoors, such around the block or up and down the street.

I wonder if it would be possible to relay the body sensor information by bluetooth to a health check station where an evaluation could be presented (and transmitted), rather than to a person with a receiving device. Less intervention by the pharmacist would be required, there might be more privacy, and no need for mobile computer receiving device. A mobile receiving device could be used in pharmacies without a health check station.

Michael

Photo of Barry
Team

Hi Michael Bishop ,

The technology currently uses Bluetooth so yes data could certainly be streamed to a healthcheck station (software would just need to be re-written for this purpose if the station doesn't run Android). I'd suggest a fixed route, with controlled underfoot conditions marked inside the pharmacy (possibly along an aisle) would be the best way to get an accurate measurement.

Barry

Photo of Kate Rushton
Team

Hi Barry 

It is great to find out you are testing in a number of London pharmacies. When will the testing end? Is this including some of the big chain pharmacies e.g. Boots, Lloyds etc.?

Photo of Barry
Team

Hi Kate Rushton the testing is through the NHS Innovation test bed. We are working with North East London Foundation trust (NELFT) in piloting the product in a number of primary care settings. The pharmacy testing comes under this through the North East London Local Pharmacy Committee (NELPC), the 8 pharmacies involved are members of NELFT, though some may be franchisees of the big chains. The tested programme runs until the end of this year.

Barry

Photo of Kate Rushton
Team

Hi Michael and Nita,

Are there any updates on your prototyping session?

Photo of Michael Bishop
Team

Hi Kate,

We have made some updates to our submission, including a user journey (draft) and a summary of some in-person interviews with pharmacists.

Photo of Kate Rushton
Team

I would be interested to know the perspectives of Johannes Mangane Mike Haun Joel Gingery Alex Sherman @DeletedUser Heather Roth on this idea and Harry Blossom 

Photo of Kate Rushton
Team

Hi Michael,

It would be helpful if you could mention how your solution fits in the market in the ‘full description’ section of your post. Who are your competitors and how is your idea unique?

Hope to see you on the refinement call this Friday at 9 am PST.

If you have any questions, please feel free to reach out to me, my email address is krushton@ideo.com

Photo of Kate Rushton
Team

Hi Michael,

I wonder if your solution could involve this technology from a startup in Texas - http://www.tmc.edu/innovation/companies/ishoe/

Photo of Michael Bishop
Team

Joanna Spoth suggested a similar idea, but an in-home mat version of the sensing platform (see below). In that line of thinking, I am interested to know how thin a platform could be. The last thing we want is users to trip or fall as they make their way on or off the platform, and it should be easy to clean.

Photo of Kate Rushton
Team

Hi Michael, It might be worth reaching out to the startup to find out more about how the device works. Any questions, please tag me or send me an email - krushton@ideo.com

Photo of Joanna Spoth
Team

Hi Michael Bishop ! I'm a big fan of your idea. Curious if you have thoughts on Kate's post, below, or if you're interested in making a super quick/rough version of the prototype you describe! It seems like integrating this check into place where people are already thinking about their health (pharmacies, health sections of groceries, etc.) is a powerful lever of change and would be fun to test in one of your local businesses.

Photo of Michael Bishop
Team

Hi Joanna,

I have been thinking about how to redesign a health check station. My idea stemmed from the heart test stations that you find in pharmacies and my first thought was to make the whole station more flexible, making it easier to get in and out of, and to have a screen that could move out of the way (or move up to face height) for the balance test. However, that may be too narrow of a view: perhaps the whole waiting area could be (re)considered. For instance, these areas are usually outfitted with chairs while we now know that people should be encouraged to stand more; having more area available would also increase the variety of tests that could be performed in the space.

I will try to sketch out some ideas on paper and perhaps create a small maquette.

Photo of Kate Rushton
Team

Hi Michael,

I hope you had a nice weekend. It might be worth you reaching out to the Toronto OpenIDEO Chapter, if you haven't already - https://beta.openideo.com/chapters/47/. They could be a valuable resource for help in prototyping and testing the idea.

Photo of Michael Bishop
Team

Hi Kate,

Thanks for letting me know about the Toronto OpenIDEO Chapter. I attended their meeting tonight, where we went over some of the Fall Prevention Challenge ideas submitted by various people in the group.

I received some good feedback/suggestions on my idea, such as making sure that there is some kind of stability bar for people to hold onto when they do the standing test (the closed eyes portion), resolving privacy issues when interacting with a screen (especially a talking one!), a standing station for heart monitoring (to save space), and thinking about how best to exploit new screen technologies (e.g. iPad).

There are a lot of possibilities with screen interactions (e.g., visual feedback, information on falling risks/prevention, e-mailing results and 'prescriptions' for awareness/training) and 'synchronizing' screen services with in-house help, such as with a pharmacist in a drugstore (e.g. print up 'prescription' at the store if the customer has no computer or printer).

Photo of Joanna Spoth
Team

Michael Bishop So neat to hear you attended the Toronto Chapter meeting! Sounds like you were able to bounce a lot of iterations and features around. One thing that came up for our team this week when discussing your idea was the in-home component, again similar to blood pressure cuffs people use at home. Maybe there's a in-home mat version of your idea! Sketches or a built prototype would be super helpful! Maybe some even came out of the Chapter that you could post. Looking toward the Refinement phase, it will be important to have a physical rendition of what this might look like so you can continue testing. Exciting stuff!

Photo of Michael Bishop
Team

Originally, my idea was to integrate sensors into bathroom scales but thought that it would be too expensive: a platform integrated into a health check station would be more accessible, which is one of the challenge's criteria. Also, would somebody pay extra for fall detection sensors in a scale if they did not think they were at risk of falling? The health check station serves (at least) two purposes related to fall prevention: (1) raising awareness - informing subjects about the fall-risk test and whether they would like to take it, hopefully catching at-risk people before they fall (or think that they might fall); (2) testing - subjects can take the fall-risk test without additional equipment or expense, and possibly more than one type of test can be taken, perhaps under supervision. Follow-up can be done with a terminal at the health check station (e.g. e-mail results) and/or with a co-located health care professional (e.g. pharmacist). Drugstores are a promising location since additional money could be earned by offering fall prevention services (re-imbursed by government or other entity) and selling fall prevention equipment (e.g. canes).

Photo of Joanna Spoth
Team

Great that you're keeping that focus on accessibility. The in-home version could perhaps be an optional add-on for folks, later down the line. :) Excited about your more formal collaboration with Community pharmacist intervention for falls prevention (replaced - see below) . Remember to tag me if any thoughts/questions arise that you'd like me to weigh in on!

Photo of Kate Rushton
Team

Hi Michael,

I look forward to seeing how this idea develops along with community pharmacies.

You might be interested in Rightsize (a finalist idea from our previous financial longevity challenge) -https://challenges.openideo.com/challenge/financial-longevity/top-ideas/rightsize- has a good example of a user journey and user testing.

I would also recommend taking a look at https://challenges.openideo.com/challenge/financial-longevity/top-ideas/all-generation-friendly-atm and how they used cardboard, paper etc. to create a mock ATM for older adults for user testing and maybe feedtruck if you were interested in having a mobile element - https://challenges.openideo.com/challenge/food-waste/top-ideas/feedtruck-transforming-waste-in-meals

Photo of eldy wullur
Team

Hi Michael,
Good and unique ideas, Very practical, easy and convenient to implement.

Photo of Sally James
Team

Hi Michael,
One of my commenters shared an amazing resource - the Stop Falls collaboration in California? I'm a bit surprised that IDEO did not include Stop Falls on their advisory committees, but perhaps I'm mistaken.
http://stopfalls.org/coalitions-networks/stopfalls-network-ca/ You may find some of their already-curated resources helpful for setting up teams. They have researchers right up your alley.

Photo of Sally James
Team

Hi Michael,
I like your idea. There are two others here in "Soften Stigma"
 that I think are related. We all want more awareness, and easy ways for the public to talk more about balance.
Have you thought of contacting one of the retail chains that have these devices? I've seen the Dr. Scholl machine that fits people for products in their shoes. What if you asked them about incorporating "balance" into their shoe-fitting stations?

Photo of Michael Bishop
Team

Hi Sally,

That's another interesting direction that you propose. There is a shop here called Walking on a Cloud where you can buy 'comfy' shoes and whose customers probably tend to be on the older side. This would be a good place for an intervention to assess fall risk, and a platform with sensors could be easily incorporated into a Scholl shoe-fitting station (and with a screen already at head height when standing, it would seem that little alteration would have to be done).

On the subject of putting on and taking off of shoes, I was reminded of the 5BX fitness plan that was designed originally for the Royal Canadian Air Force (http://csclub.uwaterloo.ca/~rfburger/5bx-plan.pdf) but became very popular all around the world. One of the daily tips was to encourage you to stand on one leg whenever you put on a sock or shoe, helping to strengthen the muscles that provide balance support. The Scholl machine could also provide some strengthening tips like this.

Photo of Kate Rushton
Team

Hi Michael!

Thank you for posting.

This article might interest you - http://www.chicagotribune.com/lifestyles/health/sc-one-simple-balance-test-health-0405-20170331-story.html

How could AARP Services and/or UnitedHealthcare be involved in this idea?

There are a few ideas submitted that might give you provide some inspiration e.g. SmartGait: A physical therapist in your pocket Sensor enabled walking frame 
There is an idea from our financial services challenge that might give you some inspiration on prototyping - https://challenges.openideo.com/challenge/financial-longevity/top-ideas/all-generation-friendly-atm

Are you looking to collaborate with someone to develop your idea? What sort of expertise are you looking for?

Photo of Michael Bishop
Team

Hi Kate,

Thanks for your feedback!

I had a look at the fall prevention openideo ideas that you pointed out to me. I do not quite see the connection between these ideas and mine, except possibly in the case where various fall prevention technologies could be made available at a location where there are health check stations, such as at a pharmacy. For instance, after the fall-risk test at the health check station, a more advanced test could be done with the SmartGait technology, if warranted. The first level could be a simple walk 'around the block'; the second level of testing could be to loan out the SmartGait technology for a few weeks with a 'prescription' sheet, specifying how much distance to cover each day (the SmartGait could be returned at the next visit, e.g. when the next set of medications are picked up). For those with walkers, a sensor-enabled frame could be loaned out for testing. Pharmacies are an interesting focal point since, as people age, they tend to visit the pharmacy more often and are more likely to be taking a medication (and anybody on a medication will be visiting periodically, which allows closer tracking of changes in test results).

The 30-second Chair Stand Test is a great example of a low-cost, effective test that could be easily done at a health check station. Some thought would have to go into the design of the chair at the health station to prevent injuries (and falls!).

I would mostly likely have to collaborate with someone or an organization to develop my idea, as I currently have a full-time job (!). At some point, I would need some digital/smartscreen expertise, and design and engineering specialists.

AARP Services or UnitedHealthcare might be interested in supporting this idea for people who have suffered falls and require monitoring to help prevent further falls. Those people who have not fallen but find out that they are at risk at a health risk station may not want their private health insurer to know, however... As I live in Canada, there may be interest by the provincial government (it already funds a world-class fall prevention research centre at Toronto Rehab and fall prevention networks).