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Falls prevention

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+

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Falls prevention

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  1. Falls prevention in care homes and at home Dr Raymond F Jankowski

  2. 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

  3. 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)

  4. 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!

  5. 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%

  6. 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

  7. 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

  8. Hospital admissions to over 65s Hertfordshire PCT registered patients

  9. Source: DWP

  10. 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

  11. DH Systematic approach to falls and fracture care & prevention: four key objectives Objective 1: Improve outcomes and improve efficiency of care after hip fractures – by following the 6 “Blue Book” standards Hip fracture patients NSF, TA161, CG21, Blue Book & NHFD Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care Non-hip fragility fracture patients NSF, TA161, CG21 & Blue Book Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention NSF, TA160 & CG21 Individuals at high risk of 1st fragility fracture or other injurious falls Objective 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards NSF, LTC programmes Social care Older people

  12. So what ? • Evidence shows between 20-30% of falls are preventable

  13. 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

  14. Cryer brief assessment tool 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

  15. 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

  16. 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 Parkinson’s disease- need regularly review. If appears to have balance problems, referred for an assessment for postural stability exercises Assess for osteoporosis Simple advice: stay safe Safe environment Safe medically

  17. 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

  18. Thank you ! Questions please?

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