Falls prevention in care homes and at home Dr Raymond F Jankowski

Why ? Falls are a major cause of disability and the leading cause of mortality in people aged % of people aged 65 or over are likely to fall at least once a year – this rises to approx. 50% in those aged 80+ Annually, 10% - 25% of fallers sustain a serious injury, with up to 6-8% culminating in a fracture Falls in majority, even without fracture, result in reduced independent living The rate of falls in institutions is almost 3 times that of those living in the community and result in considerable higher injury rates

Why ? In England, the number of people aged 65+ is expected to rise by a third by 2025 –The number of people of aged 80+ will double –The number of people aged 100+ will increase fourfold The direct cost to commissioners for a hip fracture alone is approximately £12,000 to the NHS plus the cost of social care Health and social care for hip fractures costs £2.3 Billion (comparable with heart disease and stroke)

Falls in Hertfordshire in over 65 year olds Estimated 52,000 falls 22,500 fall two or more times per year 19,000 ambulance 999 calls per year 5,000+ hospital admissions 1,100 hip fractures Estimated annual cost of £40 million …….and rising!

Ambulance 999 calls in Hertfordshire 100,000 for 999 calls for ambulance in Hertfordshire per year FALLS are the NUMBER ONE reason for 999 call outs to ambulance service in Hertfordshire Falls account for 19% in call outs to over 65 year old compared to national average of 10%

Falls in care homes in Hertfordshire Over 2,000 falls per year from care and residential homes 180 X variation in care homes of 999 ambulance calls per bed

In Hertfordshire, falls in one year….. Estimated 52,000 falls in > 65 year olds 19,000 emergency ambulance calls 5005 emergency admissions 1,100 hip fractures deaths

Hospital admissions to over 65s Hertfordshire PCT registered patients

Source: DWP

The lot of a “frequent faller” Frequent faller 10-25% sustain serious injury 6-8% sustain a fracture Fear of falling Loss of independence death Reduced quality of life Majority of cases

Objective 1: Improve outcomes and improve efficiency of care after hip fractures – by following the 6 “Blue Book” standards Hip fracture patients Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care Non-hip fragility fracture patients Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention Individuals at high risk of 1 st fragility fracture or other injurious falls Objective 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards Older people NSF, TA161, CG21, Blue Book & NHFD NSF, TA161, CG21 & Blue Book NSF, TA160 & CG21 NSF, LTC programmes Social care DH Systematic approach to falls and fracture care & prevention: four key objectives

So what ? Evidence shows between 20-30% of falls are preventable

Action plan for falls prevention in a care home Appoint a falls champion Keep an up to date risk register of falls Use of Cryer brief assessment tool to identify those at risk of future falls Initiate staying healthy measures Initiate appropriate staying safe measures Monitor

Cryer brief assessment tool QuestionYes/NoScoreAction Is there a history of a previous fall in the past year?1 Is the patient taking 4 or more medications?1Refer for Medicines Review Is there a history of stroke or Parkinson’s disease?0Refer/inform GP Does the patient have problems with balance?1Postural stability course Does the patient have difficulty rising from a chair of knee height? 1Postural stability course Does the patient complain of blackouts or loss of consciousness? 0Refer/inform GP Does the patient have a fear of falling?1Postural stability course Score 0 = patient information and advice leaflet Score 1-3 = actions as listed plus patient information leaflet Score 4-5 = refer to falls ‘clinic’ for Level 2 assessment

Simple advice: stay healthy Stop smoking Healthy weight Regular physical activity Alcohol in moderation Diet rich in Vit D and Calcium Drink plenty Flu jab every Autumn Keep house warm

Simple advice: stay safe Safe footwear, including slippers De-clutter living space, including extension cables Appropriate walking aids Secure carpets, nonslip surfaces Good lighting Personal alarm worn round neck Check eyesight 2 yearly minimum If on 4 or more medications, need review every six months If medical conditions such as stroke or Parkinson’s disease- need regularly review. If appears to have balance problems, referred for an assessment for postural stability exercises Assess for osteoporosis Safe environmentSafe medically

Conclusion Falls are not a manifestation of normal aging Rising national and local priority At least 20-30% of falls are preventable Staying healthy actions Staying safe actions

Thank you ! Questions please?