Falls prevention

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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 !




              Questions please?

				
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posted:10/24/2011
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