Transcript Falls prevention

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 75+
• 30% 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
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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
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100,000 for 999 calls for ambulance in
Hertfordshire per year
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FALLS are the NUMBER ONE reason for 999
call outs to ambulance service in Hertfordshire
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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…..
45-50 deaths
1,100 hip fractures
5005 emergency admissions
19,000 emergency ambulance calls
Estimated 52,000 falls in > 65 year olds
Hospital admissions to over 65s
Hertfordshire PCT registered patients
Number of Herts PCT Falls admissions in over 65s, 2007/8 onwards
and predicted for 2010/111
7000
6000
y = 475.5x + 3670
5000
Actual
4000
Prediction
3000
2000
1000
0
2007/8
2008/9
2009/10
2010/11
Source: DWP
The lot of a “frequent faller”
10-25% sustain
serious injury
6-8%
sustain a
fracture
death
Frequent
faller
Reduced
quality
of life
Fear
of falling
Majority
of cases
Loss of
independence
DH Systematic approach to falls and fracture
care & prevention: four key objectives
NSF, TA161, CG21,
Blue Book & NHFD
NSF, TA161, CG21
& Blue Book
NSF, TA160
& CG21
NSF, LTC
programmes
Social care
Hip
fracture
patients
Non-hip fragility
fracture patients
Individuals at high risk
of 1st fragility fracture
or other injurious falls
Objective 1: Improve outcomes and
improve efficiency of care after hip
fractures – by following the 6 “Blue
Book” standards
Objective 2: Respond to the first
fracture, prevent the second – through
Fracture Liaison Services in
acute and primary care
Objective 3: Early intervention to restore
independence – through falls care
pathway linking acute and urgent
care services to secondary falls
prevention
Objective 4: Prevent frailty, preserve
bone health, reduce accidents –
Older people
through preserving physical
activity, healthy lifestyles and
reducing environmental hazards
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
Question
Yes/No
Score
Action
Is there a history of a previous fall in the past year?
1
Is the patient taking 4 or more medications?
1
Refer for
Medicines
Review
Is there a history of stroke or Parkinson’s disease?
0
Refer/inform GP
Does the patient have problems with balance?
1
Postural stability
course
Does the patient have difficulty rising from a chair of
knee height?
1
Postural stability
course
Does the patient complain of blackouts or loss of
consciousness?
0
Refer/inform GP
Does the patient have a fear of falling?
1
Postural 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
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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 environment
• 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
Safe medically
• 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 diseaseneed regularly review.
• If appears to have balance
problems, referred for an
assessment for postural
stability exercises
• Assess for osteoporosis
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?