1. Falls Prevention in Care Homes
Inform delegates of the topic area – Falls prevention.

2. Aim To raise awareness of the causes and
prevention of falls and fractures in older people
living in residential or nursing homes.
Inform delegates of the aim - The principles of assessing and managing falls in Care Homes.

3. Outcomes By the end of the session delegates will be able to:
Identify risk factors for falls
Identify risk factors for Osteoporosis
Understand that some risk factors can be modified or reduced and some are not modifiable at all.
Inform delegates of the outcomes for the topic area.

4. Definition A fall is an unexpected event resulting in the
Person coming to rest on the floor or other
lower level.
It includes:
Falling out of bed
Falling off a chair or toilet
Falling while walking
Falling downstairs.
Aim – To define falls.
Suggested activity:
Read slide
Suggested time 10 minutes
Remember:
Statistics
The risk of falling rises with age:
1 in 3 people between the ages of fall each year
1 in 2 people over the age of 80 fall each year
20% of falls in older people living in their own homes result in injuries requiring medical attention
5-6% of these injuries are fractures
Older people living in Care Homes are 3 times more likely to fall than older people living in the community because they are frailer.
25% of falls in Care Homes result in serious injury and
40% of hospital admissions from Care Homes follow a fall
The risk of a hip fracture for a resident with dementia is ten times higher than for an older person living in the community
The effects of a fall on staff:
Emergency action after a fall diverts staff from planned care
Care to relieve injuries and anxiety from a fall increases workloads
Complaints about falls create a negative publicity
Litigation may suggest a breach of the duty of care
Falls are the highest cause of death for older people.

5. Risk factor Something associated with a condition or
an event that makes it more likely to
happen.
Aim – To understand risk factors.
Suggested activity:
Read slide and ask delegates to discuss other risk factors that you can think of e.g. high blood pressure being a risk factor for Stroke.
Suggested time 5 minutes.

6. Falls
Falls in older people are due to the interaction of their personal risk factors with their environment.
Falls in older people are multi-factorial – not caused by one factor.
Aim – Understanding falls.
Suggested activity:
Read slide and ask delegates to write down all the things that might make an older person more likely to fall.
Suggested time 10 minutes.

7. Risk factors for falling
Personal
Environmental
Behavioural
Of these, some are
Modifiable or reversible
Non-modifiable
The more risk factors a service user has, the
greater the risk of falling.
Aim – Understanding risk factors in falling.
Suggested activity:
Get delegates into 3 groups and ask them to list on flip chart the risks under each heading highlighted on the slide.
Personal:
Anything associated with the person e.g. their medical conditions – both long term conditions (Stroke, Heart disease, Parkinson’s Disease, Diabetes, Arthritis & Dementia) and short term (infections), muscle strength, confidence, poor vision.
Taking more than 4 prescribed medicines a day is a risk factor for falling. In addition, some drugs are more likely to cause a fall than others eg sedatives making a person drowsy and diuretics dropping the blood pressure.
Environmental:
Wet floors, poor lighting, trailing clothes, different/incorrect heights of furniture, wheels on bed/chairs, clutter!
Behavioural:
When a person chooses risk behaviour that is likely to result in a fall, eg going out in the snow and ice, climbing on furniture, drinking excessive alcohol
Suggested time 10 minutes.

8. Reversible/modifiable Non-reversible Poor footwear
Risk factors
Reversible/modifiable
Non-reversible
Poor footwear
Environmental hazards
Taking lots of medicines
Postural Hypotension (Blood pressure dropping on standing)
Muscle weakness
Poor balance
Unsteady walking
Confusion due to urine infection
Medical conditions e.g. Stroke
Vision e.g. blindness
Loss of feeling in feet and legs due to Diabetes
Confusion due to Dementia
Aim – To understand risk factors.
Suggested activity:
Look at the 3 lists of risk factors made on flip chart and ask delegates to now consider which ones could be changed, removed or modified to reduce the risk of falling for that person. What else could you do in the Home to reduce the risk of falls?
Suggested time 20 minutes
Remember
Use the factsheets to support learning
Medication
Balance & Posture
Walking & walking aids
Feet and footwear
Vision & hearing.

9. Bone Health 95% of hip fractures are caused by a fall
A person with osteoporosis is at very high risk of breaking a bone if they fall
Osteoporosis affects 1 in 2 women and 1 in 5 men over the age of 50
Vertebral (spinal ) fractures occur without falling, are often unrecognised and very painful
Bone density reduces with age
Aim – Understanding bone health.
This slide is animated. On your first click it will begin the animation and run automatically.
Suggested activity:
Read slide and ask delegates how many residents have had a fracture in the past
Suggested time 5 minutes.

10. What Osteoporosis looks like
normal
osteoprotic
Aim – Understanding Osteoporosis.
Suggested activity:
Read slide
Suggested time 5 minutes
Remember:
Osteoporosis is a silent disease, you don’t know you have it until you break a bone after a minor trip or fall.
The risk of osteoporosis increases with age.
Find out more information from The National Osteoporosis Society is the only charity that raises awareness of this disease, supports people suffering with it, and raises funds to pay for research into treatment for it.
Their website has lots of information
The booklet, ‘An introduction to Osteoporosis’ can be downloaded from the website or ordered via the telephone free of charge.

11. Preventing hip fractures
Assess and reduce fall risk factors for every resident as much as possible
Check all residents’ weight and think about their food intake
Encourage weight-bearing exercise, good posture and back care
Discourage smoking and excess alcohol intake
Encourage residents to sit outdoors in the summer for 20 minutes
Check that all residents are having Calcium & Vitamin D supplementation to help their bones and their balance
Hip protectors can reduce the risk of a hip fracture if worn and correctly fitted.
Aim – To understand how to prevent hip fractures
Suggested activity:
Read slide and ask delegates to consider what could be done to reduce the risk of fractures
Suggested time 15 minutes
Remember
If you can reduce the falls, you will reduce the risk of fracture for your residents.
Residents who are thin are more likely to fracture if they fall, its important to check their weight regularly and inform the GP of weight loss. You may wish to ask for a referral to a Dietician.
Bones need weight bearing exercise, residents who sit or lie down for much of their day are more at risk of Osteoporosis.
Encourage good posture and think about good back care – for staff as well as residents.
Sitting out in the garden (not in full sun) for 20 minutes a day between May & September will help to make Vitamin D which we need for our balance as well as our bones.
There is evidence that older people in Care Homes are deficient in Vitamin D; a supplement of Calcium & Vitamin D is recommended for all mobile residents.
Hip protectors can reduce the risk of a hip fracture but must be correctly measured and fitted for an individual resident. See the Hip Protector information factsheet.

12. How can we reduce falls?
Evidence suggests that the number of falls and
injuries can be reduced when:
an older person receives an individual assessment of their risk factors
their reversible risk factors are identified and reduced
their care plan shows action taken to reduce fall and fracture risk
all staff are aware of residents likely to fall
everyone works together – falls need team work!
Aim – To understand how to prevent hip fractures
Suggested activity:
Read slide and ask delegates to identify a service user who has had falls, look at their risk factors, care plan and check if there is anything more that can be done to reduce the risk of a fall.
Suggested time 20 minutes
Remember
Reducing falls in a Care Home is ‘everybody’s business!’
All Care Home residents are at high risk of falling
It is not enough to complete a falls risk assessment and do nothing else
Look out for reversible risk factors e.g. a resident who is unusually confused due to a urine infection
Report it! Act on it! You could ask for a GP review.
Ensure all staff are aware, encourage fluids.
In your Home is there a policy that ensures residents have:
Falls risk assessment on admission, after 3 months and after a fall
Nutritional assessment
Medication review
Continence assessment
Chiropody/footwear
Environmental risk assessment – bedroom, bathroom, communal areas
Walking aid checks.

13. Comfort checks
A method of providing care to a resident on a regular basis
A comfort check would include:
Asking how the person is, if they have any pain
Asking if they would like to go to the toilet or for a walk
Offering a drink
Checking they have good footwear on
Checking the area around them for trip/fall hazards
Ensuring that their walking aid/glasses/call bell are close at hand
Telling the resident that you will be back again to see how they are in an hour.
Aim – To understand how comfort checks can support the prevention of falls
Suggested activity:
Read slide
Suggested time 5 minutes
Remember
Falls can be reduced by regularly checking on residents. Many residents will fall while trying to go to the toilet unaided.

14. Posture and Seating Good posture is important for residents
Poor posture can cause:
Pressure ulcers
Pain in muscles and joints
Risk of falling out of the chair
Difficulty eating, talking, breathing
Poor balance and higher risk of falls when standing
Aim – To understand how comfort checks can support the prevention of falls
Suggested activity:
Read slide
Suggested time 5 minutes
Remember
Sitting for too long in a poor position can cause skin to breakdown, it is important to encourage residents to move every minutes.
Sitting with rounded shoulders and a flexed (curved) spine will make it difficult to straighten up to drink properly. Breathing will be more difficult as the lungs have little room for expansion, and indigestion is more likely as the stomach is compressed into a smaller space.

15. Top tips Change position often – stand up every 2 hours
Rest on the bed for an hour after lunch, allows joints and muscles to stretch and takes weight off the bottom
When sitting, ensure feet are on the ground or footrest
Hip, knee and ankle should be at 90°
Encourage residents to sit symmetrically, not leaning to one side
If the chair is too low, raise the height through the legs, rather than adding extra cushions
If a resident can’t move well in a chair, help them to stand up and sit down again
Encourage activity and mobility
Aim – Top tips to support the prevention of falls
Suggested activity:
Read slide and ask delegates what they can do to improve service users comfort and posture
Suggested time 10 minutes.

16. Top tips for maintaining mobility
Regular (daily if possible) exercise
Encourage residents to walk whenever possible, check walking aids are clean and in good condition and the right size
Ensure you use the correct techniques for assisting residents to stand up and walking
Ensure (as far as possible) that all residents have good, safe footwear, light shoes are better than loose slippers.
Aim – Top tips to support the prevention of falls
Suggested activity:
Read slide and ask delegates what they can do to maintain mobility
Suggested time 10 minutes
Remember
Do you run exercise sessions? Do you have an activity coordinator who leads activities? If not, could you start an exercise session?
Hampshire County Council leads training sessions on exercise – Better Balance for Life. Contact Sophie Jevons on Walking aids:
These need to be checked and cleaned regularly for safety and should be labelled with the resident’s name.
How to assist a resident to stand up from a chair:
encourage the resident to wriggle forwards to the front of the chair,
both hands on the arms of the chair
lean forwards
push with hands
straighten knees
place hands on the frame
staff hand on residents back to assist with forward movement.
Ensure staff do not put their arms under the residents’ shoulder – shoulders can be dislocated in this way.
Footwear
Discourage loose slippers and slingback, open toe sandals. Thin soles, good support and flat or low heels are more helpful for balance and walking.
Good footwear can be provided from various catalogues eg Cosytoes and DBshoes.

17. Bedrail use
Falling out of bed can cause a head injury or fractured hip
Bedrails are not to be used to prevent residents getting out of bed i.e. as a restraint
Do not use for residents who are confused and mobile enough to climb over or round them
There is a risk of limbs becoming trapped in bedrails, so bumpers/covers should be used
Aim – Understand the use of bedrails to support the prevention of falls
Suggested activity:
Read slide and ask delegates discuss decisions using the flowchart handout
Suggested time 10 minutes
Remember
If available, an ultra low bed can be used to reduce the risk of injury from a fall out of bed
Sensors and alarms could be used to monitor residents at risk of falls.

18. Action following a fall: 1
Most falls in Care Homes are un-witnessed
Assume a head injury may have been sustained unless proven otherwise
Refer to post fall protocol
Consider whether the resident needs to be moved – ‘don’t add insult to injury’
Head injury observations for un-witnessed falls as well as when there is clear evidence of a head injury
Aim – Understand the actions required
Suggested activity:
Read slide and ask delegates to discuss the procedure for managing a service user who has fallen.
Consider - Is it written clearly and displayed where all staff can read it?
If appropriate, ensure staff are competent in taking head injury observations.
Suggested time 20 minutes
Remember
Most falls in Care Homes are un-witnessed so it is important to assess carefully when finding a resident on the floor.
The person may have hit their head.
The person may have a hip or spinal fracture which will become more serious if they are moved or hoisted.

19. Action following a fall: 2
Complete accident/incident book
Inform the GP
Inform the relatives
Complete the resident’s falls register
Update the falls care plan
Ensure all staff are aware of the fall
Aim – Understand the actions required
Suggested activity:
Read slide and ask delegates to if they use an individual falls register for each resident?
Discuss what information is needed when writing a report after a fall using the Reporting Falls prompt sheet.
Include as much information as possible – just writing “found on floor” is not helpful when trying to prevent another fall for that resident
Suggested time 20 minutes.

20. Days since last fall ___ days1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
Days since last fall 27 28
___ days 29 30 31
Aim – to understand the safety cross – visual measurement tool
Suggested activity:
Using the slide explain the safety cross principles
Green = 0 falls Red = falls with number of incidents
The Safety Cross is a good way of ensuring all staff are aware of which residents are falling and how often. The goal is to have each month coloured in
green and the number in the bottom left hand corner of the page showing an increasing length of time since the last fall.
Other ways of recording falls
Get a floor plan of the Home and stick a coloured dot on the place where there is a resident fall. This shows up ‘hot spots’ which might be connected with flooring or lighting.
Use a Clock face to identify the times of day that falls are happening. You could review staffing levels or activity at those times.
Suggested time 10 minutes.

21. To prevent falls you need to
Carry out regular audit by managers/senior staff of fall numbers, times, locations, injuries
Feedback to all staff about fall rates
Have good handover and communication between staff
Ensure there are regular falls training updates and induction for new staff
Involve residents and families in falls prevention measures and education
Aim – to find falls champions
Suggested activity:
Read slide and ask delegates if they are willing to be ‘falls champions’. They can help to raise awareness in the Home.
Encourage them to accompany you to the PaCT conferences for updates.
Ideas you may like to try:
Join in with National Falls Awareness Week, run by Age UK for 1 week in June each year. Details can be found on the website:
Put some posters up in the Home, invite families to join in activities to raise awareness of falls e.g. exercise session,
Use other dates e.g. National Osteoporosis month (June) to organise events to raise awareness.
Suggested time 10 minutes.