Falls Awareness Training How to use these notes pages For each slide there are words in normal or bold ( where there is emphasis) text that can be read out as they are with  indicating press to move to next element or slide. Text in italics is intended as guidance to the presenter and should not be read out. If the presenter prefers, they can talk to the slides with out using the notes and with personal and local statistics and information. Or, once presentation is on their computer write their own notes. While this slide is on introduce presenter and group, and do household information e.g. fire arrangements and toilets etc  Next Slide

Aims & Objectives What makes people fall? What are the implications of falling? Identify potential areas of personal and environmental risks Understand what can be done to prevent falls, and who can help These are the Aims and Objectives of our session We will learn -  What makes people fall and  what are the implications of those falls We will  Identify potential areas of personal and environmental risks and we will learn how to  use a checklist in identifying hazards Understand what can be done to prevent falls and who can help Before we do that lets get a bit of background  Next Slide

How big a problem is falls? Heart attacks Strokes Falls 111,000 per year 110,000 per year 2,700,000 per year How big is the problem with falls? Lets compare with other conditions – for example in England there are   111,000 heart attacks a year,   and 110,000 people a year have a stroke –  How many falls a year do you think there might be –ask the audience -  well there are two million seven hundred thousand! In a typical town with a population of 100,000 420 people are admitted to hospital and 140 will have had a hip fracture (Falls Fragilitiy and Fractures Colin Cryer) If you have any local statistics about your area you can read them out here References; http://www.nhs.uk/Conditions/Heart-attack/Pages/Introduction.aspx http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Longtermconditions/Vascular/Stroke/index.htm  Next Slide

Falls In Older People In England, the number and rate of serious injuries from falling is increasing at around 10% every year. Hip fracture incidence has been projected to increase by 50% by 2020. Falls and fractures in people aged 65 and over account for 4 million bed days Costs associated with fragility fractures estimated at £2 billion a year Approximately 30% of people over 65 years of age living in the community fall each year. Now lets look at falls In older people References are in italics Despite all out effort the number of falls is increasing  The numbers of Hip fractures is also rising  Falls create the largest demand for trauma and orthopaedic bed days Costs are rising – but the main reason for preventing falls is the effect it has on quality of life; R.C.P. audit report 2011 Approximately 30% of people over 65 years of age living in the community fall each year. Interventions for preventing falls in older people living in the community Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe If you want to you can read this out. For a PCT and local authority with a population of 320,000, there will be around 45,000 people aged over 65 in 2009. Of these: 15,500 will fall each year, 6,700 twice or more most will not seek help 2,200 will attend A&E or a minor injury unit (MIU) a similar number will call the ambulance service 1,250 will have a fracture, with 360 of these likely to be hip fractures. From South West Strategic Health Authority If you have other statistics you can use them here See also: www.helptheaged.org.uk  Next Slide

Group Activity – Personal Risk Factors Now we will have a group activity - Do not read out this page. Allow 5 minutes exercise, 5 minutes feedback minimum. Do this exercise either in groups or as one group depending on the size of the group. Give them flip chart so they can write a list and explain you don’t want a list of hazards that people can trip over we are going to do an exercise on – but factors within the older person themselves – an example would be poor vision Get them to mention experiences of people they have known At the end of the session put the flip charts up and them compare with the list below: (Items in bold are covered in more detail on next slide) History of Falls Medication – over 4 a day or particular types Alcohol Blood pressure – drop when standing Vision Hearing Mobility Transfers – getting from bed to chair Balance This list comes from Falls Fragility and Fractures – evidence based risk factors Other risk factors are Incontinence, Dementia, Disabling condition e.g. Parkinson’s Disease, Stroke etc Your group may come up with others – this list could be very long. Falls can be caused by heart problems and these must be dealt with straight away – if person says they blacked out they must see a doctor  Next Slide Why do older people fall? List all the personal risk factors you think could make an older person more likely to fall

Main Personal Risk Factors Balance Medication Blood Pressure Vision We are going to recap now the main personal risk factors  Balance – it is an unfortunate part of the aging process that one’s balance mechanism does not function as well when one gets older. The muscles don’t react as quickly and the messages from the brain can slow down. The ‘righting reactions’ – the bodies automatic response when we nearly fall over – do not work so well  The evidence says that if you are on more than 4 medications a day then you are more at risk of falls – also some tablets that work on the nervous system can cause people to fall  One of the most common cause of falls is when there is a drop in the blood pressure when you stand up – people often say they feel a bit dizzy when they stand up. This is one of the causes that can be treated so its important to get medical advice  It seems obvious but if you can’t see very well then this can cause you to fall. It is also known that bifocals can increase the risk of falls in the older person. – let’s look now at what some one with poor sight might experience.  Next Slide

Poor vision can obviously make you at risk of falls. Here is what you see with normal vision next slide

This is what the world might look like if you have a cararact next slide

And this is how it would be if you had age related macular degeneration next slide.

What are the implications? Physical injuries Loss of independence Psychological Social impact Carer impact Cost to services So when people fall what are the implications?  you could ask the group for their ideas here if you want to.  Obviously the first and most obvious result is that people may hurt themselves – from bruises and cuts to fractured bones,  and this can lead to a loss of independence.  Less obvious but of great importance is the effect falls can have on their confidence and mood. Fear of falling can make people afraid of going out and make them housebound. You could ask if anyone has fallen and get them to talk about how they felt (only if time).  Falls can have an impact on peoples social life and they may need more help from social services and  it can impact heavily on the carers of people who have fallen.  And we talked at the beginning of the cost of looking after people who have fallen  Next Slide

Group Activity – Environmental Risk Factors Why do older people fall? List all the environmental risk factors you think could make an older person more likely to fall Now we will have another group activity - Do not read out this page. Allow 5 minutes exercise, 5 minutes feedback minimum. Give people the same as before – a flipchart page and pen. Feedback from one group and then see what is different on the other groups. There are always lots of answers – usually not wrong. Next slide picks out main risks.  Next Slide

Environmental Risk Factors Trip Hazards Footwear Risky Behaviour Slippery Surfaces So from your work we see there are many environmental factors that can cause falls – the main ones are:  Footwear – Sloppy slippers, slippery soles, foot care  Trip hazards – rugs, wires, steps  Risky behaviour – standing on chairs to change light bulbs, using a torch instead pf putting the light on, poor lighting  Slippery surfaces – wet floors icy pavements  Next Slide

Identifying people at risk Ask about falls Use a Falls Risk Screen Home Hazard – self assessment tool When someone has had a fall it is vital we find out why they fell and try to treat the cause, and so prevent further falls. Older people do not always tell you when they have fallen so it is necessary to ask - if someone has fallen once they are more likely to fall again. We then need to assess the personal risks. This is in two stages – anyone can use a screening tool (for example the Falls Risk Assessment Tool (FRAT) to spot the people who might be at risk – then a full Falls Assessment is conducted by specialists who look carefully at all the risks Different areas have developed different tools- show them your local form here is you have one. Some people like the Falls Risk Assessment Tool for the first step– if you use this have a sample ready to give out. We also need to check the environment. Because older people do not always respond well to being told what to do (Do any of us?) this Home Hazard checklist is good because it is a self assessment. [The Home Hazard Checklist and a version of the FRAT is available on www.tinyurl.com\avonsafefalls].  Next Slide

4. Film Head Over Heels DVD  Next Slide

What can be done? Medical – investigations and medicine review Exercise – strength and balance training Home Hazards – O.T. and Care & Repair Raise Awareness – with everyone Think ‘Why did they fall’ Use this Avonsafe Training Pack Now you know what the main risk factors for falls are – the next questions is what should we do.  The person who is falling may need to see a Doctor. Their G.P. or a specialist doctor in falls, they would do investigations, a medicines review and may refer on to other speciality.  If a person is found to fall because they have poor balance this can be helped by specific balance challenging exercises, usually under the supervision of a Physiotherapist. Other exercises can help – i.e. Tai chi  Reducing the hazards in the home is important and they can be referred to an Occupational Therapist or to Care and Repair ( don’t forget the Home Hazard form I mentioned earlier)  What is important is that everyone who works with older people is aware of the causes of falls and does not take them for granted.  If anyone falls – once we have picked them up and dealt with any injuries we must ask ‘Why?’ This training session is a good way of raising awareness and anyone can use it. It can be found on the Avonsafe Website ? next slide

Recap: Aims & Objectives What makes people fall? What are the implications of falling? Identify potential areas of personal and environmental risks Understand what can be done to prevent falls, and who can help Any Questions? Recap what we have learnt Ask if anyone has any questions – and have open discussion about what they have learnt Remind them to fill in the course evaluation sheet  Next Slide

Thank you for listening – please fill in the evaluation sheet before you go. This training package has been put together by the Avonsafe Older Peoples Group in partnership with Somerset Coast PCT Falls Awareness Training Group and Lifeskills. Thank the group.