An introduction to falls prevention Primary care Jo Davies - Bsc (Hons), RN Falls prevention Clinical Lead BCUHB Wrexham ,

North Wales Demographics Locality Number - over 65 years Percentage Welsh Ambulance call outs (2015-16) Wrexham 31,736 23.6% 2,686 Flintshire 32,530 21% 3,317 Denbighshire 23,850 25% 2,981 Conwy 36,250 27% 3,938 Anglesey 18,700 1,669 Gwynedd 30,380 3,128 Total 173,446 17,719

Under reported problem – understanding falls classifications Explained vs Unexplained Extrinsic vs Intrinsic Injurious vs Non-injurious Plus the behavioural risks Ref : D Skelton

Consequences At least 95% of hip fractures are due to falls, with osteoporosis playing a contributory factor, Lothian NHS, 2011. Osteoporosis is considered a silent killer. According to the National Osteoporosis Society 1:3 women and 1:5 men over the age of 50 will suffer an osteoporotic fracture, rising to 1:2 women after the age of 70.

Referrals to community falls service First phase Primary care WAST Emergency department SPOA Mobile response teams Second Phase Community mental health teams Third sectors Voluntary organisations Re-ablement Third Phase Falls clinic Fire service Domiciliary care Housing associations Opticians

BCUHB community falls service – expanding referral rates Falls prevention work has been duel focused: seeking opportunities to identify and secondly educating and working in partnership to employ evidenced based interventions

Case Study 93 year old gentleman 7 falls in 2 weeks. Diagnosed urinary tract infection, loss of appetite, reduced mobility, increased difficulty to maintain independence. Lives alone, no nuclear family. Multiple medications Side effects Fear of falling Reluctance to accept support Environmental hazards & poor usage of sensory equipment

Intervention opportunities General Medical Practitioner – medical and medicine review Occupational Therapy – multiple home improvements and aids to improve safety Physiotherapy – initial domiciliary input followed on by strength and balance Optician and audiology – single lens glasses and referral to audiology for hearing aid Social services –Discussed options of day care Telecare – Discussed benefits of telecare in independent living. Falls pendant and multiple gem in brackets installed Third sector – Be-friending service Care home – shared communication of resource pack and community falls risk assessment Shared communication with Community resource team in the event of hospital admission – in the event of emergency step up bed required

BCUHB Aims Improving communication opportunities for falls prevention within each area

Impact within Care homes Audit work carried out July (2016) identified number of residential homes utilising BCUHB falls resource pack Audit undertaken August 2016 Pre June 2016 Dec 2016 - Current Residential care homes in Wrexham locality Total number of people aged 65 in care in Wrexham : 1,211 29 Care homes utilising BCUHB falls pack 8 7 Partially completed 26 Care homes not utilising falls pack 21 3 (declined as not mandatory)

Reflective journey Reflect in practice Reflect on practice Educate Understanding individuals’ physical, social, psychological and environmental needs, ability to pre-empt Understanding who is at risk of falls and falls risk factors/ employ early interventions Educate Developing skills to equip competency – theoretical, reflective and interactive sessions Training sessions around each of the subject domains Reflect in practice Falls Champions Tailored plans of care Continuous communication cycle with individual and stakeholders Reflect on practice

Reviews

Post falls guidance

Working to BCUHB Vision Reduce harm & fall rates Effective service pathway Support structure Educate about importance of falls Evidenced based practice Continuous practice development Empowerment Working in partnership

Partnership