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Falls prevention in care homes and at home Dr Raymond F Jankowski 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 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) 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! 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% 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 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 > 65 year olds Hospital admissions to over 65s Hertfordshire PCT registered patients Number of Herts PCT Falls admissions in over 65s, 2007/8 onwards and predicted for 2010/111 7000 6000 y = 475.5x + 3670 5000 4000 Actual Prediction 3000 2000 1000 0 2007/8 2008/9 2009/10 2010/11 Source: DWP The lot of a “frequent faller” 6-8% sustain a 10-25% sustain fracture death serious injury Frequent faller Reduced Fear quality of falling of life Loss of Majority independence of cases DH Systematic approach to falls and fracture care & prevention: four key objectives Objective 1: Improve outcomes and NSF, TA161, CG21, improve efficiency of care after hip Hip Blue Book & NHFD fractures – by following the 6 “Blue fracture Book” standards patients Objective 2: Respond to the first NSF, TA161, CG21 fracture, prevent the second – through Non-hip fragility & Blue Book Fracture Liaison Services in fracture patients acute and primary care Objective 3: Early intervention to restore Individuals at high risk independence – through falls care NSF, TA160 of 1st fragility fracture pathway linking acute and urgent & CG21 or other injurious falls care services to secondary falls prevention Objective 4: Prevent frailty, preserve NSF, LTC bone health, reduce accidents – programmes Social care Older people through preserving physical activity, healthy lifestyles and reducing environmental hazards So what ? • Evidence shows between 20-30% of falls are preventable 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 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 Parkinson‟s 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 1 Postural stability knee height? course Does the patient complain of blackouts or loss of 0 Refer/inform GP consciousness? 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 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 Simple advice: stay safe Safe environment Safe medically • Safe footwear, including • Check eyesight 2 yearly slippers minimum • De-clutter living space, • If on 4 or more medications, including extension cables need review every six months • Appropriate walking aids • If medical conditions such as • Secure carpets, nonslip stroke or Parkinson‟s disease- surfaces need regularly review. • Good lighting • If appears to have balance • Personal alarm worn round problems, referred for an neck assessment for postural stability exercises • Assess for osteoporosis 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 Thank you ! 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