1. Katrina Macintosh Occupational Therapist/ Falls Practitioner
MIDLOTHIAN ENHANCED RAPID RESPONSE INTERVENTION TEAM (MERRIT) FALLS SERVICE
Katrina Macintosh
Occupational Therapist/
Falls Practitioner

2. Midlothian RRT Falls Service Aim
We aim to work alongside our colleagues within Health and Social Care to prevent unnecessary Hospital admissions for uninjured clients in Midlothian.
For those who have fallen we aim to provide a speedy service at the time of fall and follow up assessment and interventions to reduce the risks of further falls/fractures.
The service also aims to provide falls education, assessment and intervention with a view to reducing risk of falls in the longer term.

3. Falls
30% of people aged 65+ and 50% of 80+ living in the community fall each year.
Equating to about 73,943 across Lothian.
With the over 65s, falls account for over 18,000 unscheduled admissions and over 390,500 bed days each year.
75% of falls-related deaths occur in the home.
6% of fall result in fractures – 1% hip fractures
75% of falls are not reported. Most falls occur when performing activities in the home.
(Midlothian Falls Strategy, 2016)

4. RRT Falls Service
24/7 service Accessed via contact number or community alarm. RRT on call care support workers respond to a fall as soon as possible - on average carers respond within 30 minutes to a call out within Midlothian.

5. Lifting aids used to assist person from floor
Camel Elk
Manger Elk
Portable Hoist (Oxford advance)
HoverJack

6. Falls Follow Up RRT carers carry out head to toe check.
RRT carers will document any details of fall, injuries, environment, any concerns etc.
Next day follow up carried out for all fall call outs – phone call to person, family or carers.
Multifactorial Assessment visit in persons home.

7. RRT Falls Service
Referrals can also be made for a falls assessment from clients directly or other healthcare professionals. Other Professionals that refer into the Falls Service include:- GP / NHS 24 Ambulance Service Fire service Police Social Care Services Dementia Team Hospital Staff

8. Falls Risk Factors

9. Reduced Mobility Regular exercise, keep physically active and mobile
Physiotherapy may be required to improve strength, balance, endurance, coordination, gait training and physical function
Balance and muscle strengthening exercises can reduce risk factors for falling.
Clients should always use prescribed walking aid.
Walking aids regularly maintained.
Wheelchairs regularly serviced/ repaired

10. Walking aids

11. Footwear/Footcare - Risks
Foot pain can cause person to walk more slowly and may walk badly. They are less able to balance and coordinate stability.
Swelling in feet and ankles can inhibit footwear fitting well; often resulting in person mobilising barefoot.

12. Footwear/Footcare - Prevention
Feet should be washed daily dried thoroughly, and toenails should be trimmed.
Well fitting footwear can improve stability, balance and overall mobility
Soft soled shoes or shoe-style slipper
Slippers should not be worn for long periods and avoid use on stairs, particularly if loose fitting.

13. Vision – Risks Reduces as we get older.
60 yr old requires 3 times more light than 20 yr old.
Macular degeneration, cataracts and diabetes result in problems.
Visual-Spatial Problems – over reaching for items
Visual overload – flooring changes at doorways can cause freezing

14. Vision - Prevention Regular eye tests - Clean glasses regularly
Separate glasses for reading and distance are safer than bi-focals or vari-focals.
Wear the right glasses for the right job
Step closer to items before reaching
Rooms, stairs and walkways well lit and clutter free
Highlight edges of steps and stairs where accidents could happen

15. Medication - Risks More than 4 medications can be a risk factor
Side effects should be reported to GP
Some drugs may cause drowsiness e.g. sleeping tablets, tranquilizers, antihistamines, anti-emetics, anti-epileptic. Hypotensive drugs and diuretics may cause blood pressure to lower and cause dizziness
Poor administration of medications; wrong days/times; taking wrong dosage.

16. Medication - Prevention
Ask GP/ Pharmacist to review. MERRIT pharmacist can review medications and recommend any alterations to help reduce falls risks. Never mix alcohol with medication. Use a dosette box to prompt correct times and days for each medicine.

17. General Health Important to eat well
Foods rich in calcium and Vit D important for bone strength.
Calcium - Milk, cheese and yogurt
Vitamin D - Sunlight, oily fish, eggs,fat spreads and cereal.
Reduced alcohol consumption - refrain from mixing with medication.

18. Environment - Risks Loose carpets, rugs, uneven thresholds.
Poor lighting
Clutter, items on floor, blocked walkways
Trailing cables
Open spaces/stairs without rails
Unsuitable furniture – wrong height, worn
Items out of reach
Outdoors - Beware of ice, leaves, uneven pavements

19. Environment - Prevention
Ensure good lighting – avoid walking to bathroom
overnight in the dark
Avoid loose carpets & slippery surfaces; remove rugs
Lift clutter and trailing cables
Ensure suitable walkways for safe mobility with or without an aid
Grab rails on steps / stairs may be required
Good height chairs/bed
Frequently used items within easy reach e.g. telephone, cupboards etc.

20. Aids & equipment

21. Aids & equipment

22. Telecare Support CAS alarm Falls detector Bed occupancy monitor
Pressure mats
Wander alarms

23. MERRIT Contact Number
MERRIT Falls Service