mobility needs and footwear - hse.ie

CHAMPION PARTNER ENABLE DEMONSTRATE www.qualityimprovement.ie @NationalQI

Fiona Gilliland

Multi factorial Falls Risk

Assessment – Mobility Needs

and Footwear

Physiotherapy Manager

http://www.google.ie/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiFouybmcfPAhWJ6xoKHY1iAw8QjRwIBw&url=http://hellomynameis.org.uk/&bvm=bv.134495766,d.ZGg&psig=AFQjCNGPqExk5Pj8ltPP_WRkAhuBlREL-Q&ust=1475878203228667


Learning Objectives

• Multi factorial Falls Risk Assessment; –Mobility Assessment and Actions

– Footwear Assessment and Actions


Mobility Assessment

• Patients Admission to Hospital is as a result of a fall ?

• Has the patient had a fall in the last 12 months?

• Patient reports a fear of falling?


Mobility Needs Assessment

• Patient reports or Staff note unsteady gait – require assistance/supervision to mobilise?

• Does the patient require assistance to stand?

• If YES to any of the above consider the Following Actions


Actions to Consider

• Refer Physiotherapy

• Ensure patients Walking Aid is available and Accessible

• Refer to Occupational Therapy

• Provide patient with Falls Prevention leaflet

• Ensure Call bell is accessible


Physiotherapy • Physiotherapists assess gait, transfers and balance and

provide tailored exercise programmes and walking aids to improve mobility.

• Recommended Measures include Berg balance Scale, TUAG, 30 Second Chair Sit – Stand, 4 stage balance Test

• Physiotherapists also lead out on many exercise programmes and provide individual exercise and goal based interventions in the community and residential Units

• The Physiotherapist will link with colleagues in the community to continue improving the patients strength and mobility


Occupational Therapy

• The OT will assess ability to carry out activities of Daily living eg dressing, Showering and provide advice/strategies/aids to improve independence

• The OT will link with colleagues in the community to follow up on discharge (Louise expand please!!) Community OT will complete Environmental assessment of access and independence in the home to prevent falls

• Provision of specialised equipment for transfers eg Grab Rails/Standing Hoists for discharge home

• Liaise with PHN/Home Support/Physio regarding transfers and mobility in the home


Cycle of Falls – fear of falling

Fall

Fear of Falling again

Less Activity

Increased Risk of Falling

Decreased Muscle Strength and balance


Talking about Falls Prevention

• Falls just happen when you get old

• It was an accident – I will try to be careful

• I would like to exercise – I am too tired

• My neighbour fell and ended up in a nursing home

• What can I do to keep myself from falling and stay independent?

• About 1/3 of older people fall each year – you do not have to fall there are things you can do to prevent falls

• Lets look at some factors that may make you likely to fall and talk about what you can do – here is some information on preventing falls


Exercise for Falls Prevention – Residential Setting

Strength and balance can be developed via evidence based strength and balance falls prevention programmes such as OTAGO , FaME, Super 6 and Steady. All programmes require a suitably qualified professional to deliver them. Current programmes in development with HSE and Sports Partnership in CHO 1.


Footwear!


Active Problem ; Footwear

• Is the patients Footwear Inappropriate ?

Action Footwear • Request Suitable Alternative footwear


Suitable Footwear??


Evidence appropriate Footwear • Point prevalence of suboptimal footwear features among ambulant older hospital patients: Implications

for fall prevention ,Satyan Chari , Prue mcRae, Matthew Stewart, Joan Webster Australian health review: a publication of the Australian Hospital Association40(4) · October 2015 DOI: 10.1071/AH14168

• Objective. The aim of the present study was to establish the point prevalence of 'suboptimal' features in footwear reported to have been used by older hospital patients when ambulating, and to explore underpinning factors for their choice of footwear. Method. Across-sectional investigation was undertaken on 95 of 149 eligible in-patients across 22 high fall-risk wards in a large hospital in Brisbane, Australia. Results. Over70%of participants experienced an unplanned admission. Although most participants had access to some form of footwear in hospital (92%), nearly all reported ambulating in footwear with 'suboptimal' features (99%). Examples included slippers (27%), backless slippers (16%) or bare feet (27%). For patients who ambulated in bare feet, only one-third reported 'lack of access to footwear' as the primary cause, with others citing foot wounds, pain, oedema and personal choice as the main reason for bare foot ambulation. Conclusions. Admitted patients frequently use footwear with 'suboptimal' features for ambulation in hospital. While some footwear options (for example well-fitting slippers) could be suited for limited in-hospital ambulation, others are clearly hazardous and might cause falls. Since footwear choices are influenced by multiple factors in this population, footwear education strategies alone may be insufficient to address the problem of hazardous footwear in at-risk patients. Footwear requirements may be more effectively addressed within a multidisciplinary team approach encompassing foot health, mobility and safety.

https://www.researchgate.net/journal/0156-5788_Australian_health_review_a_publication_of_the_Australian_Hospital_Association

https://www.researchgate.net/journal/0156-5788_Australian_health_review_a_publication_of_the_Australian_Hospital_Association

http://dx.doi.org/10.1071/AH14168


Evidence Non Slip Socks

• Are non-slip socks really 'non-slip'? An analysis of slip resistance

Satyan Chari, Terrence Haines, Paul Varghese and Alyssia Economidis BMC Geriatrics 9(1):39 · September 2009

DOI: 10.1186/1471-2318-9-39 · Source: PubMed

• This study compared the relative slip resistance of commercially available non-slip socks with other foot conditions, namely bare feet, compression stockings and conventional socks, in order to determine any traction benefit. Barefoot conditions produced the highest slip angles for all participants indicating that this foot condition provided the highest slip resistance. It is evident that bare feet provide better slip resistance than non-slip socks and therefore might represent a safer foot condition. This study did not explore whether traction provided by bare feet was comparable to 'optimal' footwear such as shoes. However, previous studies have associated barefoot mobilisation with increased falls. Therefore, it is suggested that all patients continue to be encouraged to mobilise in appropriate, well-fitting shoes whilst in hospital.

https://www.researchgate.net/journal/1471-2318_BMC_Geriatrics

https://www.researchgate.net/deref/http:/www.ncbi.nlm.nih.gov/pubmed/19706167


Action Footwear

• Footwear should stabilise the ankle and foot and improve postural stability

• Patients on admission to ED given leaflet/information on clothes and footwear to improve mobility and independence!

• Get up Get Dressed Get Moving is it in your hospital or residential setting???


References • http://www.acutemedicine.org.uk/wp-content/uploads/2016/09/2.8-National-Falls-Programme-Lianne-McInally.pdf

• https://tilda.tcd.ie/publications/reports/pdf/w3-key-findings-report/Chapter%206.pdf

• http://www.dchs.nhs.uk/assets/public/online_resources/NHS_Falls_Awareness/docs/Falls%20Managment%20Policy%20for%20use%20in%20%20Community%20Servicesl.doc

• The Prevention and Management of Falls in the Community A FRAMEWORK FOR ACTION FOR SCOTLAND 2014/2016

• Health Quality & Safety Commission. Topic 10: An integrated approach to falls in older people: what is your part? 2014. Available from: www.hqsc. govt.nz/our-programmes/reducing-harm-from-falls/10-Topics/ (Accessed Sep, 2014).

• https://bpac.org.nz/falls/

• //www.health.qld.gov.au/stayonyourfeet

http://www.acutemedicine.org.uk/wp-content/uploads/2016/09/2.8-National-Falls-Programme-Lianne-McInally.pdf














https://tilda.tcd.ie/publications/reports/pdf/w3-key-findings-report/Chapter 6.pdf








http://www.dchs.nhs.uk/assets/public/online_resources/NHS_Falls_Awareness/docs/Falls Managment Policy for use in Community Servicesl.doc



https://bpac.org.nz/falls/

mobility needs and footwear - hse.ie

Documents