Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Quality Improvement and Enhancement Program (QIEP)

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP What is a fall? Fall = Sudden, unanticipated change downward in body position with or without physical injury.

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Falls Statistics - Frequency One in every three people aged 65 years and over fall each year Approximately 50% of nursing home residents fall at least once a year Older adults who fall once are 2-3 times as likely to fall again within a year Older adults are hospitalised for fall-related injuries five times more often than they are for injuries from other causes

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Falls Statistics - Frequency Falls account for 38% of all adverse incidents within Australian hospitals In Queensland, there were 292 deaths and 15,897 hospital separations with a principal diagnosis of falls in 2000 (Health Information Centre, Queensland Health)

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Falls Statistics - Outcomes Falls are the leading cause of injury deaths among people 65 years and older Among people 85 years and older, 20% of fall- related deaths occur in nursing homes 20-30% of those who fall suffer injuries that reduce mobility and independence and increase the risk of premature death At least 95% of hip fractures are caused by falls Only about 2% of hip fractures are spontaneous

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Falls Statistics - Costs The average direct cost for a fall-related injury was $1,400 for a person over the age of 65 in 1994 (United States) Falls and fall-related injuries cost Queensland approximately $750,000 annually By 2020, the cost of fall-related injuries is expected to reach $32.4 billion Assuming 5% inflation and the growing number of hip fractures, the total annual cost of these injuries may reach $240 billion by the year 2040

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Risk Factors for Falls Falls are caused by the interaction of a number of different factors Factors may be a combination of both intrinsic risks (internal - related to the individual) and extrinsic risks (external to the individual)

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Risk Factors - Intrinsic History of falls Nutritional deficiencies Impaired cognition Visual impairments Impaired mobility and gait Polypharmacy Medical conditions: diabetes, stroke etc. Foot problems Muscle weakness and limited endurance Psychological status: fear of falling, denial Respiratory disease, musculoskeletal disorders

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Risk Factors - Extrinsic Environmental hazards (eg. clutter, poor lighting, slippery floors, uneven surfaces) Footwear and clothing Inappropriate walking aids or assistive devices

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Consequences of Falls Physical injury (fracture, skin tear, abrasion, contusion) Restriction of activity/functional deterioration Loss of confidence/fear of falling in future Pain/limitation of activity following a fall Decreased quality of life Social isolation Depression and feelings of helplessness

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Costs to the Health Care System Increased length of stay in hospital Increase in fees associated with hospital and nursing home care Physician and other professional services Rehabilitation Prescription medications Use of medical equipment/home modifications Community based services Insurance administration/risk of litigation

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Falls Prevention Strategies Clinical assessment and review (individual risk) Medical screen Physical conditioning and/or rehabilitation/ exercise programs Medication review Education: Health professional and patient/ resident Sensory evaluation Environmental assessment and modification Assistive device/walking aid review Continence management

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP Injury Prevention Strategies Nutrition management Hip protector pads ­Reduction in relative risk of hip fractures by up to 60%

Falls Prevention in Public Hospitals and State Government Residential Aged Care Facilities Project, QIEP What to Avoid Restraints can actually contribute to fall-related injuries and deaths. Limiting freedom to move and personal autonomy results in deconditioning and muscle atrophy that can increase functional decline Since new federal regulations took effect in 1990, nursing homes have reduced the use of physical restraints. Although some institutions have reported an increase in falls, fall-related injuries have decreased in most nursing homes.