Post-fall Assessment & Management in Persons with Dementia Sylvia Davidson Professional Practice Chief – Occupational Therapy ADI – March 9, 2012

Providing the world with innovations in aging 21/02/2019 Objectives Impact of falls Policy development Significance of dementia Pockets of excellence Next steps Providing the world with innovations in aging 2

Providing the world with innovations in aging 21/02/2019 Impact of falls In fiscal year 2009 50% of injury-related hospitalizations for seniors were due to falls > 90% of all hip fractures were due to falls Ontario’s annual costs for falls in seniors have been estimated at $962 million. Toronto Central Local Health Integration Network Integrated Provincial Falls Prevention Framework & Toolkit – Backgrounder Providing the world with innovations in aging 3

Providing the world with innovations in aging 21/02/2019 Policy Development To provide a consistent and systematic organizational approach to falls risk management. Falls risk assessment Individualized fall plan Post-fall assessment & management Timelines Recognized responsibilities All clients have the right to take risks Providing the world with innovations in aging 4

Post-fall assessment Neurological assessment should be completed after a fall (witnessed or unwitnessed) Post-fall, neurological assessment was… Actual number of incidents Percentage of incidents (%) Completed 18 52.9% Not completed* 16 47.1% Total 34 100% * One incident not a suspected fall, thus no neurological assessment done Providing the world with innovations in aging

Providing the world with innovations in aging Post-fall management Elapsed time: time of incident occurrence/discovery of incident to time assessment/intervention initiated (e.g., physician assessment and treatment or resident transferred to acute care) Providing the world with innovations in aging

Providing the world with innovations in aging 21/02/2019 Dementia significance Older adults with cognitive impairment have increased risk of falling Risk of morbidity and mortality post-fall increases with age Post-fall assessment may be compromised by individual’s agitation Falls may be unwitnessed and self-reports of injury or distress may be unreliable Providing the world with innovations in aging 7

Providing the world with innovations in aging 21/02/2019 Dementia significance % 2011-12 Quarter 3 Providing the world with innovations in aging 8

Providing the world with innovations in aging 21/02/2019 Pockets of Excellence Case Example 64 year old male, admitted to Behavioural Neurology unit from long term care home with diagnosis of Alzheimer’s Disease. Falls risk score 5. Contributing factors: difficulty with transfers related to diminished judgement, problems with ambulation related to visuospatial deficits, limited concentration, impulsiveness, pain related to significant osteoarthritis, aggressive & agitated when unable to communicate needs. Providing the world with innovations in aging 9

Providing the world with innovations in aging Pockets of Excellence Goals reduce falls & reduce degree of injury from falls identify triggers to behaviour through A-B-C charting Plan Weekly Safe Mobility Rounds – interprofessional discussion with focus on falls and behaviour bed sensor and chair sensor trial hip protectors & trial use of rollator walker noisy environment identified as trigger to aggressive behaviour and increase in restlessness, therefore reduce unnecessary stimulation/relocate to quiet area as necessary ongoing monitoring of pain Providing the world with innovations in aging

Providing the world with innovations in aging Focus on Post-fall process • Post-fall debriefs • Support for clinical observations made by members of the interprofessional team • Regular refreshers on documentation • Ongoing support for leaders and champions within the team Providing the world with innovations in aging

Providing the world with innovations in aging 21/02/2019 Next steps Next steps to include, but not limited to: WHAT? WHO? WHEN? Audit process to monitor compliance/metrics at unit level   Unit managers Quarterly Development of further communication, education and training - focus on sustainability Unit champions Staff orientation Organizational monitoring and control through Falls Steering Committee Senior Management representation Ongoing Providing the world with innovations in aging 12

Providing the world with innovations in aging 21/02/2019 Acknowledgements A. Bandali & K. Agtarap-Rose; Advanced Practice Nursing J. Rice, Occupational Therapist, and the Baycrest Behavioural Neurology Team Baycrest Professional Practice Providing the world with innovations in aging 13

Providing the world with innovations in aging 21/02/2019 Thank you! Providing the world with innovations in aging 14