Falls Prevention in Residential Care

1. Falls Prevention in Residential Care

2. Aims and Objectives • Identify potential causes of falling particularly in residential care • Understand the difference between intrinsic and extrinsic risk factors. • What are the implications of falling • Have an action plan following a fall

3. 275,000 per year 130,000 per year 2,700,00 per year How big a problem is falls? • Heart attacks • Strokes • Falls

4. Falls In Older People • 500 older people a day fall in the home and require hospital treatment. • Every 5 hours one older person dies as a consequence of a fall in the home • 40% of Care Home admissions are as a result of a fall • After a hip fracture 50% of fallers can no longer live independently • 20% of older people who suffer a hip fracture as a result of a fall, die within 6 months

5. What is a Fall • “An unexpected event when the person 'falls' to the ground from any level, this also includes falling on the stairs and onto a piece of furniture with or without a loss of consciousness” National Institute for Clinical Excellence 2004

6. What are the implications? • Physical injuries • Loss of independence • Psychological • Social impact • Carer impact • Cost to services

7. Group Activity – Personal Risk Factors A resident falls over. What should go through your mind when thinking about why they fell?

8. Medical Problem

9. Medical Problem • Syncope (Faint) • Postural hypotension (B.P. Drop) • Epilepsy • BPPV • Spinal Cord Compression • Diabetes • Peripheral Neuropathy (numbness of feet)

10. Medication Medical Problem

11. Medication • On 4 or more medicines • Hypnotics - temezepam; zopilclone • Anxiolytics - diazepam;lorazepam • Diuretics - bendroflumethiazide; frusemide • Corticosteroids –prednisolone

12. Blood Pressure Medication Medical Problem

13. Postural Hypotension • A drop in blood pressure sufficient to cause an inadequate blood supply to the brain. • A risk factor if there is more than a 20 mmHg drop in systolic pressure between lying and standing. • dizziness, syncope and/or falls when: • getting up quickly from lying or sitting positions • standing still for any length of time • getting out of a warm bath • standing up after a big meal • these symptoms usually ease if you lie or sit down

14. Taking a lying and standing B.P. • Patient lies down for 3-4 minutes • Blood pressure is recorded • Patients stands – B.P. measured • After one minute – measured again • After 2 minutes – measured again • Any history of relevant symptoms recorded

15. Measures to relieve symptoms • Take particular care in the morning • Get out of bed in stages. • Avoid sudden changes in posture. • Avoid sitting/standing for long periods. • Raise the head of the bed • Wear support stockings or tights. • Medical treatments • Fludrocortisone • Pindolol • Midodrine

16. Blood Pressure Medication Urinary Tract Infection Medical Problem

17. Urinary Tract Infection • Asymptomatic • Cause confusion • Cause urgency • Pyrexia • Dipstick urine if someone falls • Form from In-reach

19. Blood Pressure Medication Urinary Tract Infection Medical Problem Poor balance

20. Balance is the ability to control centre of gravity in relation to the base of support. Includes • Maintaining a position • Changing position • Reaching • Walking • Turning • Stepping up/down

21. Other Risk Factors for Falls • Chronic conditions (Stroke; Parkinsons etc) • Vision (bifocals/varifocals) • Alcohol • Diet/ dehydration • Feet • Hearing

22. Blood Pressure Medication Urinary Tract Infection Medical Problem A trip Poor balance

23. Group Activity – Environmental Risk Factors Why do older people fall? List all the environmental risk factors you think could make an older person more likely to fall

24. Trip Hazards Footwear Slippery Surfaces Risky Behaviour Environmental Risk Factors

25. What can we do to reduce falls in older people? Look for the cause!

26. Action Plan Refer Doctor Doctor Do L/S B.P. Refer Doctor Dipstick – treat Keep active; exercise Remove hazards • Medical problem • Medication • Postural Hypotension • UTI • Balance • Environmental risks

27. Falls Screening Tool • Complete when older person falls • Fill in demographics • Turn to back page • Yes or no to risk factors • Decide if action one you can do – tick when done • Turn back to front and refer appropriately • Send a copy to the G.P.

28. Falls & Balance Clinic • B.&.N.E.S. G.P. • All syncope • Unexplained falls – 2 or more in a year • Poor balance and at risk of falls • Multidisciplinary team • Investigations • Balance Exercise Course • Referral by clinician – G.P.

29. Don’t mention the F Word • Help the aged research • http://www.helptheaged.org.uk/ • Google don’t mention F word • Older people don’t acknowledge the need • Fear of consequences • Need to concentrate on the positive

30. I wonder why they fell?