1. FALLS AWARENESS TRAINING INFORMATION PACK
STOP FALLS NETWORK
Falls Prevention for Older People
The City and Hackney Carers Centre
96 – 102 Springfield House
5 Tyssen Street
E8 2LZ
Tel/Fax or

2. Aims Objectives To raise awareness of falls risks for older people.
To raise awareness of how these risks can be minimised.
Objectives
To have an understanding of the consequences of falls for older people.
To identify risk factors that contribute to falls.
To have an understanding of ways to help reduce the risk of falling amongst older people.
To have an awareness of the local services linked to the Falls and Bone Health Care Pathway and of how to signpost older people to these services.

3. Why Falls Prevention? The Facts
Falls are not an inevitable part of ageing. In many cases, taking the right steps at the right time can prevent falls and enable an older person to continue a physically active life
The Facts
1 in 3 people over the age of 65 have a fall each year
1 in 2 people over the age of 80 fall each year
Injury caused by falls is the leading cause of accidental death for people over 75
50% of older people cannot live independently after a fracture
Shockingly 20% of older people who have a hip fracture die within 6 months.
Accidental falls and fractures by older people cost the NHS £2 billion a year.
(Quote and figures taken from “Managing falls and fractures in care homes for older people” Published by NHS Scotland and Social Care and Social Work improvement Scotland)

4. Considering falls in care homes The Facts
Residents in care homes are 3 times more likely to fall than in the community.
25% of older people who fall in care homes suffer serious injury
40% of hospital admissions from care homes are due to falls
40% of moves to care homes are following a fall.
(Figures for falls in Care Homes taken from Age Uk 2006: ‘Preventing Falls: Managing the Risk and Effect of Falls Among Older People in Care Homes’ )

5. THE CONSEQUENCES OF FALLS AND IMPLICATIONS FOR CARERS
Disruption of care and routine – emergency action diverts from planned care.
Increases the workload – special care following injury; extra support needed due to lack of confidence and anxiety about falling again.
Impact on relationships – between carers; clients; and relatives.

6. What are the risk factors?
History of falls: 1 or more falls in past year.
Medications: 4 or more prescription medications daily. Types of medication.
Dizziness: blackouts must be investigated medically. Postural hypotension.
Poor mobility and balance: muscle weakness and/or poor gait leading to unsteadiness.
Slowed reaction time
Visual problems: use of bifocals increase the risk.
Fear of falling: lack of confidence leading to reduction in mobilisation and function.
Certain medical Conditions: Parkinson’s; Stroke; Osteo-arthritis, diabetes and unmanaged pain.
Foot problems: Numbness in ankles and feet, inappropriate footwear.
Cognitive problems such as memory loss, lack of awareness of safety and risk.
Hearing problems
Continence problems

7. Environmental Hazards
Poor Lighting
Lighting must be adequate particularly on stairs, corridors and regularly used passageways e.g. from bedroom to toilet.
Bedside lighting must be adequate and within easy reach particularly at night-time.
Never use a torch as a form of lighting particularly while walking. This can affect an older person’s balance.
Use long -life light bulbs to cut down on the need to change bulbs regularly.
Never stand on chairs or stools to change light bulbs
Clutter
Clear clutter from floors, stairs, around the bed and around regular passageways.
Mats, Rugs, Carpets.
Should be secure with non-slip backing.
Check if the rugs or mats are really necessary.
Repair worn carpets.
Check thresholds are safe

8. Trailing Wires And Cable Secure any trip hazards with tape Adaptations
Use grab rails where necessary around the toilet, on stairs, in the bathroom, corridors and bedroom.
Make sure the rails are appropriate and in good repair.
Is an OT assessment necessary?
Wet Surfaces
Mop up spillages of water or food immediately e.g . in the bathroom, kitchen and dining area.
Use non-slip bathmats
Clothing
Trailing belts are a trip hazard.
Loose clothing can catch on furniture
Footwear
Wear full backed slippers; non-slip soles with a good grip.
No sling-backs or flip-flops.
Trainers can lessen the ability to sense the ground under foot.
Cold Environment
Causes stiff muscles affecting mobility. .

9. Keep Things Within Easy Reach
Falls can be caused by over -stretching and over-reaching
Walking Aids
Are walking aids appropriate and the right size? The person may have shrunk especially if s/he has osteoporosis.
Are they being used correctly?
Are they in a state of good repair?
Is a Physiotherapy assessment necessary?
Alarm systems
Are they the appropriate ones?
Are they working?
Are they within easy reach
External environment
Uneven paving stones.
Need for rails on external stairways

10. Falls risks associated with care delivery
There may be a greater risk of falls at certain times of day;
mornings
evenings
mealtimes
change over of staff
Incorrect use of moving and handling techniques.
Lack of time; carers and/or the older person rushing.
Unclear instructions;
between carers working together
between the carer and the older person.
Equipment out of reach.
Obstacles and trip hazards

11. Medicines for older people
The NHS drugs bill for people over 65 is £370 per person per day.
Older people in care homes are given up to 4 times more prescriptions than at home.
What do you think happens to the body as you get older?
With age our bodies reduce in size and function
Organs and systems become less efficient
Liver is not as efficient at breaking down medicines.
Brain is more sensitive to drugs.
We are 3 times more likely to suffer an unwanted effect of medicine at age 60 years than at age 39 years.

12. What drugs can increase the risk of falls?
Anti depressants
Drugs for anxiety can increase body sway and reduce reaction time.
Drugs to aid sleeping can cause confusion.
Drugs for behavioural problems in dementia
Antihistamines
Painkillers
Drugs for nausea and vomiting
Drugs for high blood pressure
Alcohol

13. Reducing Falls Multi - interventions
An older person who has had a fall should have a Falls Risk Assessment followed by appropriate interventions.
Training and awareness
Falls Awareness training for staff, clients and relatives.
The inclusion of falls prevention as part of the holistic care of residents.
Falls records and audits
The practice of recording and examining the circumstances of each fall. This can help to identify new risks and prompt interventions. It can also increase falls awareness for both clients and staff.
Medical assessment
Any fall should be reported to the GP
A medical assessment may be needed
All episodes of dizziness and blackout must be investigated
Medication review
GP or NHS pharmacist.
At least every 6 months

14. Physiotherapy/ Occupational Therapy assessment
For mobility, balance and walking aids
Strength and balance exercises in hospital or at home
For home safety check
Stop Falls Network
For strength and balance
For bone health
Home based exercises
Home safety check
Optician for annual eye check
Chiropodist
Continence advice

15. What should I do if I have a fall? Advice to an older client
Lying on the floor unable to summon help is one of the most frightening and dangerous problems an older person can face.
It is best to work out in advance what you would do if you had a fall. Don’t ignore the possibility.
Ask a friend/relative/neighbour to help you plan what you would do if you had a fall.
Get a community alarm button (available from Telecare based at Hackney Social Services); wear it at all times and use it when necessary. Check it regularly to make sure it is working.
Ask a friend/relative/neighbour to ring you at regular times each day with a special code e.g. 5 rings before you answer. They can summon help if you do not respond.
Ask a friend/relative/neighbour to call at your home at regular times each day. They can summon help if you don’t answer the door.
Ask neighbours to notice your daily routines e.g. taking the milk in, so they can summon help if they notice any unusual changes.
Carry a whistle and/or mobile phone with you as well as your community alarm so that you can draw attention to yourself if you have a fall.
Before you have a fall, learn what you can do to help yourself get up after a fall; and what to do if you can’t get up. (See diagrams attached)
REPORT ANY FALL YOU HAVE TO YOUR G.P.

16. I have had a fall… I can get up I can’t get up Advice continued…
Move onto your hands and knees and ease yourself up onto your elbows. Hold onto a firm surface to support you. Facing the chair ease yourself to a standing position. Turn yourself gently and sit on a firm surface. Tell your GP or health professional about your fall.
I can’t get up
Can I attract attention shout and bang something, press your pendant alarm use the telephone if you can.
Can I get comfortable? Find a near by pillow, cushion, rolled up item of clothing to put under your head.
Can I keep warm? Cover yourself with clothing, tablecloth or rug.
Can I keep moving? Move position to avoid getting pressure sores. Move joints to avoid stiffness and help circulation. Roll away from a damp area if you bladder lets go.
Tell your health professional about your fall.

17. OSTEOPOROSIS The Cost to Society;
Osteoporosis or a thinning of the bones is a very common condition in older people. It occurs when there is a gradual loss of density of the bones; the struts that make up the mesh like structure within bones become thin. The loss of bone density means a person with osteoporosis is more likely to break a bone if they fall. For this reason you need to consider falls prevention and the diagnosis and management of osteoporosis together.
Osteoporosis affects 1 in 2 women and 1 in 5 men over the age of 50.
Osteoporosis is usually undetected until there is a fracture, usually from minor causes.
Common fractures from osteoporosis are of the wrist, hip and spine.
Osteoporosis costs the government and NHS around 1.8 billion a year
Falls and OP are related to aging and society is aging > incidence will rise > cost will rise
Evidence shows; Falls can be reduced, OP effectively treated, Resulting in decreased fractures.
(Quote taken from “Managing falls and fractures in care homes for older people” Published by NHS Scotland and Social Care and Social Work improvement Scotland)

18. OSTEOPOROSIS RISK FACTORS;
Being elderly
Early menopause, before age 45
Family history, particularly maternal, of osteoporosis
Some medical conditions such as Rheumatoid arthritis and diabetes.
Medications such as long term steroids, thyroid hormones, epilepsy treatments and breast cancer treatments.
Diet low in Calcium and Vitamin D
Lack of adequate exposure to sunlight the main source of vitamin D
Weight loss

19. Lack of physical exercise.
Heavy alcohol consumption
Heavy smoking
TREATMENT AND DIAGNOSIS
Osteoporosis is diagnosed by a DEXA bone density scan ( Dual Energy X ray Absorptiometry Scan
Drug treatments that slow down bone loss and or rebuild bone. It has been shown that some medications can reduce the risk of having a fracture considerably.
Calcium and Vitamin D Supplements

20. Lifestyle changes Exercise
at least 150 minutes a week (30 mins 5 days a week)
weight-bearing e.g. brisk walking; dancing
Use exercise bands for resistance exercise.
Diet high in Calcium
at least 700mg of calcium per day (the equivalent of 1 pint of semi- skimmed milk)
other sources of calcium: baked beans, kidney beans, lentils, cereals, sardines, pilchards, tofu, spinach, broccoli, nuts, dried fruits
Adequate exposure to sunlight
15-20 minutes exposure to face and arms every day during the summer
STOP SMOKING
REDUCE ALCOHOL INTAKE

21. Dementia and falls risks
Individuals with a level of cognitive impairment with or without the diagnosis of dementia are an increasing large group of people.
Due to the loss of a person’s cognitive abilities, there can be an increased risk of falls. People with dementia experience changes to their physical, mental and emotional functioning that effects how they cope with day to day activities, relate to others and how they communicate. Confusion, disorientation, memory loss, restlessness , agitation, behavior that challenges and lack of judgment and insight can contribute to their falls risk.
Some individuals may require re orientation regularly to their surroundings and may require visual ques to reduce their risk of falling, for example pictures on doors to identify toilets and bathrooms. The physical environment generally can have a huge impact such as lightening, floor coverings and safe outside spaces.
(Quote taken from “Managing falls and fractures in care homes for older people” Published by NHS Scotland and Social Care and Social Work improvement Scotland)

22. Falls Prevention and the Bone Health Pathway
Where to get help in Hackney?
General practitioner
Always report any fall to your GP.
Your GP should review your medication at least every 6 months.
Your GP can refer you to all other services.
If you think you may be at risk of having osteoporosis you can ask your GP to refer you for a DEXA Scan.
Falls Clinic at the Bryning Unit at Homerton Hospital:
Provides a thorough medical assessment for unexplained falls; also Physiotherapy and Occupational Therapy assessments and referral onto community falls prevention services.
People need to be referred by their GP.
Community Physiotherapy Services:
Based at the Adult Community Rehabilitation Team at St. Leonard’s. Provide assessments for mobility and balance problems.
Can be referred by GP, other Health Professionals and Stop Falls Network.
Hackney Social Services Access Team:
For an Occupational Therapy assessment for home adaptations and aids. Contact; 205 Morning Lane E9 Tel:

23. Telecare Community Alarm Service:
Provide community alarms. Referrals are made through Hackney Social Services Access Team contact number above.
Stop Falls Network
Community falls prevention service: 96 – 102 Springfield House, 5 Tyssen Street: E8 2LZ
Tel:
Provide:
Information and advice
Falls risk assessments
Specialist exercise groups for people with risk of falling Specialist exercise groups for people who have a diagnosis of osteoporosis
Free home safety checks and small aids fitting
Free Osteopathy at Hoxton Health Group for first time fallers
Free home exercise courses for homebound people.
NHS Pharmacy
Some high street pharmacists are now NHS pharmacists and can offer personal appointments for a medication review.
Optician
Information about home visits from Opticians is available from Stop Falls Network.
Chiropody
People can be referred by their GP or refer themselves for Chiropody to the Dept. of Foot Health at St Leonard’s Tel:

24. Stop Falls Network Falls Prevention in the Community
Our Office is based at:
City and Hackney Carers Centre
96 – 102 Springfield House
5 Tyssen Street
E8 2LZ
Telephone:
Fax:
Website:

25. What We Do! Long-term PSI exercise courses
Home based exercise programme OTAGO for home bound clients
Specialist classes for Osteoporosis sufferers
Osteopathic treatment for first time fallers
Home Safety Scheme with small aids fitting, small repairs and alterations
Awareness training for front line workers, volunteers and older people

26. Who we are
A team of 3 Postural Stability Exercise Instructors (PSI), 1 home safety worker, 1 outreach and admin worker, and project coordinator
Referrals from:
Balance groups at St. Leonard’s and Homerton Bryning
First Response and Community / District Nurses / GPs
Hackney Social Services
Floating Support officers
Family and self referrals
How to refer:
Download referral form from website:
- call for referral form -
for referral form
- fax referral form and medical records to

27. The ‘Staying Steady’ Programme
Variety of Community Falls Prevention classes at
11 venues around Hackney
All classes are run by qualified Postural Stability
Instructors (PSI evidence based)
Course length of 24 sessions with progress
monitoring and free course books and therabands
for home exercising
All participants have medical clearance through
their GPs

28. Housebound patients Home Hazards
OTAGO programme to enable people to live independently for longer
6 training visits per patient spread over 4 month to learn the programme
Exercise manual, diary and leg weights provided
Telephone support up to 6 month
For patients that have low risk, mild/early signs of balance problems, worried about falling, have low bone density…
GPs and Nurses can directly refer to Stop Falls Network
Home Hazards
Falls and accident risk assessment of home environment
Home Safety Check includes minor repairs, small aids fitting and alterations free of charge
Lifestyle advice, information, referrals to other services as appropriate

29. Key Messages to take away with you today.
You should prevent falls while preserving as much of the an older person’s independence as possible. Continuing to encourage safe physical activity and maximizing quality of life.
Falls can be a serious problem, resulting in suffering, disability loss of independence and decline in quality of life.
Do no accept falls as an inevitable part of getting older; many falls are preventable
A fall is nearly always due to one or more risk factors. Recognizing then removing or altering an individuals risk factors can prevent a fall.
If a person has osteoporosis they are more likely to break a bone if they fall. Medication for Osteoporosis can help strengthen the bones and reduce the risk of having a fracture.
(Quote taken from “Managing falls and fractures in care homes for older people” Published by NHS Scotland and Social Care and Social Work improvement Scotland)