Falls Prevention and Bone Health in the Long Term Care Setting

- A Management Approach

Daragh RodgerANP Care of the Older Adult Community,

St Mary’s Hospital

Overview of Presentation

Importance of : • Falls awareness• Falls reduction, prevention &

management• Bone health

In order to :• Reduce unnecessary injuries• Reduce unnecessary suffering• Reduce financial costs• Promote healthy active ageing through education

Report of the National Steering Group on the Prevention of Falls in Older People and the

Prevention and Management of Osteoporosis throughout Life (2008)

•Falls main reason for attendance at A&E departments

•7250 older adults admitted to hospital each year with falls related injuries

• 75% of all injuries are as a result of a fall

• Falls and falls related injuries cost in excess of €404 million per annum

• 1:3 over 65 years and 1:2 over 80 years fall each year

• Fractures are the most common injury

• Hip fracture is the most serious bone injury

• Fractures as a result of osteoporosis

• Osteoporosis is on the increase with our ageing population

• Osteoporosis is treatable and preventable

Incidence of Hip Fracture in IrelandFact• 16 trauma centres in Ireland

• 3000 + hip fractures a year

• 10% admitted from Nursing homes

• Cost: €35million for inpatient care

• Irish Hip fracture Database since 2012

• 2nd Annual Report 28th Feb, RCSI (Ahern, E & Brent, L. 2014)

The Irish LongitunDinal study on Ageing

30% of over 75 year olds fell last year

1 in 5 reported a fall

1 in 10 reported an injurious fall

Prevalence increases with age

Significant impact on services and economywww.tilda.ie

Phase 1: I am not falling for you!

Phase 2: Forever Autumn

Bone Health in the Park

Data collected • Number of falls in each

ward/unit• Number of falls per

person• Location of falls• Age of person who falls• Time of day of fall• Injuries sustained• Witnessed/unwitnessed• Falls per month

Review of falls in St Mary’s Campus 2011

St Mary’s Hospital

Phoenix Park Community Nursing Unit

Review of falls data 2011

• 564 falls• 75% of falls occur at the bedside• 98% of falls are un witnessed• 59% of falls occur between 8am and 4pm• 82% of falls result in no physical injury• 82% of persons who fall are over 80 yrs• 24% of falls are recurrent ( 3 or more per

person)

Development Of A Falls Prevention Programme For Residential Care

Of Older Adults

FOREVER AUTUMN

Implementation of a falls awareness programme for all staff – clinical and non clinical, illustrating the potential for falls amongst the older adults in our care.

Elements included:• Revision of St Mary’s Falls Prevention

and Management Policy

• New Falls Risk Assessment Tool• New Falls Risk Symbols • New Falls Reduction Measures

Key MessageAll staff have a role to play in

reducing the risk of falls – clinical

and non clinical – know your role!

Review of Falls Data from 2013

New Data Measurement Interventions to prevent potential falls

Evidence to staff of benefits of Forever Autumn Programme in action

*Compared to falls data pre Forever Autumn in 2011

Phoenix Park Community Nursing Unit

38% Reduction*

St Mary’s Hospital 15% Reduction*

Residential Care SettingFalls management strategies

Falls prevention and management policy involving all staff

Falls assessment on all residents with any degree of mobility

Falls prevention programme to reduce the risk of falls among residents

Falls reduction measures through regular review of medications – at least 3 monthly

Education for all staff on falls awareness

Bone Health in the ParkI am not falling for you!

DXA scan

Bone health assessment

Bone health Education

•Diet

•Exercise

•Lifestyle choice

St Mary’s Healthy Ageing Clinic

Bone Density Results – Healthy Ageing Clinic

0

100

200

300

400

500

600

700

2010

Osteoporosis 561

Osteopenia 465Normal 621

• Ageing population

• In 2030 a number of the present day work force will be over 50 years of age

• In 2030 many of us may/will fall and will be a statistic

• Through education we can help reduce these figures

Real Life Facts

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Impact on Society

• Loss to family and community

• Cost - Overstretched economy

• Provision of services home care, respite care, extended care

• Proactive approach required rather than reactive

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Bone health through the ages

1-12yrs 13-22yrs Adult Over 80 years

Peak Bone Mass

Age related bone mass Age related bone loss

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Bone Health CarePriority for residents Reduced mobility – high risk of falls Cognitive impairment – high risk of falls Frailty – high risk of falls Need continued bone protection Exercise Dietary calcium and Vitamin D Bone Health Medication Treatment for osteoporosis Calcium & vitamin D supplements

Education for all staff, relatives and their families on importance of good bone health

Role of Education Technology

Collaboration Of Health Care Professionals Through A Community Of Practice

• Sharing best practice through an accessible web based platform • Working together to reduce the risk of falls in our ageing population• All health care professionals

Forever Autum

n Comm

unity of Practice

Reactive V Proactive• System failure – too late to react at point of hip fracture

• Screening - fracture liaison services currently very poor nationally

• 50% of those who suffered a hip fracture in one site had history of previous fracture with no bone health interventions (O Connor et al 2013)

• Currently national group working towards the implementation of the 2008 strategy

• Is falls prevention and bone health on the agenda???

Education -• Bone health – lifelong process need to educate all ages

• Increase falls awareness – potential for falls

• Falls prevention and reduction across all care settings

• Goal is to reach as many as we can in the most cost effective way