Falls prevention

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Falls prevention

• in care homes and at home

Dr Raymond F Jankowski
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Why ?

• Falls are a major cause of disability and the
  leading cause of mortality in people aged 75
• 30 of people aged 65 or over are likely to fall
  at least once a year this rises to approx. 50
  in those aged 80
• Annually, 10 - 25 of fallers sustain a serious
  injury, with up to 6-8 culminating in a fracture
• Falls in majority, even without fracture, result
  in reduced independent living
• The rate of falls in institutions is almost 3
  times that of those living in the community and
  result in considerable higher injury rates

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Why ?

• In England, the number of people aged 65 is
  expected to rise by a third by 2025
• The number of people of aged 80 will double
• The number of people aged 100 will increase
  fourfold
• The direct cost to commissioners for a hip
  fracture alone is approximately 12,000 to the
  NHS plus the cost of social care
• Health and social care for hip fractures costs
  2.3 Billion (comparable with heart disease and
  stroke)

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Falls in Hertfordshire in over 65 year olds

• Estimated 52,000 falls
• 22,500 fall two or more times per year
• 19,000 ambulance 999 calls per year
• 5,000 hospital admissions
• 1,100 hip fractures
• Estimated annual cost of 40 million
• .and rising!

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Ambulance 999 calls in Hertfordshire

• 100,000 for 999 calls for ambulance in
  Hertfordshire per year
• FALLS are the NUMBER ONE reason for 999 call outs
  to ambulance service in Hertfordshire
• Falls account for 19 in call outs to over 65
  year old compared to national average of 10

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Falls in care homes in Hertfordshire

• Over 2,000 falls per year from care and
  residential homes
• 180 X variation in care homes of 999 ambulance
  calls per bed

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In Hertfordshire, falls in one year..
45-50 deaths
1,100 hip fractures
5005 emergency admissions
19,000 emergency ambulance calls
Estimated 52,000 falls in gt 65 year olds
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Hospital admissions to over 65s Hertfordshire
PCT registered patients
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Source DWP
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The lot of a frequent faller
6-8 sustain a fracture
10-25 sustain serious injury
death
Frequent faller
Reduced quality of life
Fear of falling
Loss of independence
Majority of cases
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DH Systematic approach to falls and fracture care
prevention four key objectives
NSF, TA161, CG21, Blue Book NHFD
NSF, TA161, CG21 Blue Book
NSF, TA160 CG21
NSF, LTC programmes Social care
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So what ?

• Evidence shows between 20-30 of falls are
  preventable

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Action plan for falls prevention in a care home

• Appoint a falls champion
• Keep an up to date risk register of falls
• Use of Cryer brief assessment tool to identify
  those at risk of future falls
• Initiate staying healthy measures
• Initiate appropriate staying safe measures
• Monitor

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Cryer brief assessment tool
Question Yes/No Score Action
Is there a history of a previous fall in the past year? 1
Is the patient taking 4 or more medications? 1 Refer for Medicines Review
Is there a history of stroke or Parkinsons disease? 0 Refer/inform GP
Does the patient have problems with balance? 1 Postural stability course
Does the patient have difficulty rising from a chair of knee height? 1 Postural stability course
Does the patient complain of blackouts or loss of consciousness? 0 Refer/inform GP
Does the patient have a fear of falling? 1 Postural stability course
Score 0 patient information and advice
leaflet Score 1-3 actions as listed plus
patient information leaflet Score 4-5 refer to
falls clinic for Level 2 assessment
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Simple advice stay healthy

• Stop smoking
• Healthy weight
• Regular physical activity
• Alcohol in moderation
• Diet rich in Vit D and Calcium
• Drink plenty
• Flu jab every Autumn
• Keep house warm

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Simple advice stay safe
Safe environment
Safe medically

• Safe footwear, including slippers
• De-clutter living space, including extension
  cables
• Appropriate walking aids
• Secure carpets, nonslip surfaces
• Good lighting
• Personal alarm worn round neck

• Check eyesight 2 yearly minimum
• If on 4 or more medications, need review every
  six months
• If medical conditions such as stroke or
  Parkinsons disease- need regularly review.
• If appears to have balance problems, referred for
  an assessment for postural stability exercises
• Assess for osteoporosis

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Conclusion

• Falls are not a manifestation of normal aging
• Rising national and local priority
• At least 20-30 of falls are preventable
• Staying healthy actions
• Staying safe actions

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Thank you ! Questions please?