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…..

Estimated 52,000 falls in > 65 year olds

19,000 emergency ambulance calls

5005 emergency admissions

1,100 hip fractures

45-50 deaths

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

y = 475.5x + 3670

0

1000

2000

3000

4000

5000

6000

7000

2007/8 2008/9 2009/10 2010/11

Actual

Prediction

Source: DWP

The lot of a “frequent faller”

Frequent faller

10-25% sustainserious injury

6-8% sustain a fracture

Fearof falling

Loss ofindependence

death

Reduced quality of life

Majorityof cases

Objective 1: Improve outcomes and improve efficiency of care after hip fractures – by following the 6 “Blue Book” standards

Hip fracture patients

Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care

Non-hip fragility fracture patients

Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention

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

Older people

NSF, TA161, CG21, Blue Book & NHFD

NSF, TA161, CG21 & Blue Book

NSF, TA160& CG21

NSF, LTC programmesSocial care

DH Systematic approach to falls and fracture care & prevention: four key objectives

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 toolQuestion 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 knee height?

1 Postural stability course

Does the patient complain of blackouts or loss of consciousness?

0 Refer/inform GP

Does the patient have a fear of falling? 1 Postural stability course

Score 0 = patient information and advice leafletScore 1-3 = actions as listed plus patient information leafletScore 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 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

Safe environment Safe medically

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?