1. Reducing Falls & Fractures

2. What is Osteoporosis ? Normal Bone Osteoporotic Bone Osteoporosis means fragile bones

3. Fracture statistics 25% of people admitted to hospital with a broken hip live in care homes 30% will die as a result of the hip fracture Many have had a more minor broken bone before they break their hip Most of these broken bones are due to osteoporosis

4. What do we need for strong bones ? Calcium Vitamin D3 Weight-bearing exercise Avoid smoking, too much alcohol, too much caffeine Avoid too many fizzy drinks particularly Coca Cola

5. What is important about Vitamin D3 ? Enables the body to use calcium Affects mood Affects muscle strength Reduces likelihood of infections Those who are housebound or live in residential settings are often low in Vitamin D

6. Why are the elderly more at risk of breaking bones ? Poor appetite so don’t eat enough calcium Go outside less Make less vitamin D Less mobile and active More likely to fall

7. What can we do? Give calcium/vitamin D3 supplements after lunch and evening meal. (eg Calcichew D3 forte, Adcal D3 caplets, Adcal D3 Dissolve) Ask the GP to change the type of calcium/vitamin D prescribed if the resident doesn’t like it. Consider all new residents and ask the GP to prescribe calcium/vitamin D3 for them

8. What if they won’t take it? Try different types first. If patient cannot tolerate any, then ask GP to prescribe Fultium D3 which is vitamin D3 without the calcium. Very rarely has any side effects. Try to make sure the patient has good amount of dietary calcium.

9. How to give osteoporosis medication Once weekly tablet- Alendronic acid or Risedronate. (bisphosphonates) Same day each week. Take as soon as the resident gets up with large glass water. Remain sitting upright for at least half an hour. Nothing else to eat or drink during the half hour. No Calcium/vitamin D supplements to be taken until at least 4 hours later.

10. Contacts The Fracture Liaison Service can be contacted for any advice regarding the calcium/vitamin D3 supplements and bone protection medication and are happy to help. Please call 01803 655603

11. Falls Prevention If a person doesn’t fall they won’t break a bone!! Reduce the risk of falls

12. First 4 hours - identify risk Is the resident: Walking unsteadily/ unsafe to walk alone? Confused/disorientated? Having falls before or since arrival? Taking tablets to calm them down or help them sleep? Being incontinent/needing the toilet frequently?

13. Orientate Orientate to home environment –Toilets and wash areas - location, use of lights, alarm cord –Call bell – check their ability to use it and alternatives if not able to, demonstrate and explain its use

14. Observe Observe –Can resident be placed where they can be seen regularly/easily? –Confusion; is this acute or chronic? Ask family/friends to establish this and discuss with GP. Comfort Rounding –Ensure all residents are checked at least 2 hourly for personal needs, drinks, toileting & position change/standing (to prevent pressure sores)

15. DAME to assess falls risk Drugs Ageing Medical conditions Environment

16. Drugs Side effects of Drugs Poly-pharmacy (more than 4 medications) Culprit groups: sedatives, water tablets, blood pressure tablets, sleeping tablets, antidepressants, strong pain killers. Alcohol/recreational drugs Check resident has at least yearly medication review, particularly after a fall.

17. Ageing Impaired vision Hearing problems Reduced strength, balance, gait, bone density Cognitive impairment, dependence Bereavement/depression Fear of falling/reduced confidence

18. Medical conditions Any medical condition in combination with ageing can increase the risk of falls Strokes and Parkinson’s disease increase the risk of falls dramatically A sudden drop in blood pressure when a resident stands up is a common cause of falls. Confirm by taking lying/standing blood pressure

19. Environment Ill-fitting footwear Bed rails and height of beds/chairs Trip hazards Risky behaviourSlippery floors Poor lighting

20. Ask all residents about falls Involve GP to exclude any acute illness/ heart or neurological causes Physiotherapy Treatment If any medical cause identified Medication Review by Pharmacy/GP Occupational Therapy What can we do to reduce falls? Identify the risks & complete falls care plan Put in place appropriate interventions to minimise risks of falls Re-assess risks and interventions regularly. Consider onward referral if necessary Ensure all staff are aware of falls risk

21. Resources -Telecare sensors Most homes have these Where are they stored? Who takes responsibility for them? Are they in working order? Do staff know how to use them and who they are appropriate for? Staff can get advice on these from the Trust’s Telehealth care team on 0300 456 4861

22. Resources 2 There are pages on falls, fractures and bone health on the Trust’s website: www.tsdhc.nhs.uk A national resource is Age UK on www.ageuk.org.uk www.ageuk.org.uk OT and Physiotherapy assessments are available by contacting your local team

23. Resources 3 Care home falls prevention page now on the public website Links to free downloadable resource Living Well through Activity toolkit 5 specific modules for: Residents and families Staff Owners/managers Commissioners Occupational Therapists