Falls Assessment Patient Safety

Falls ‘An event whereby an individual comes to rest on the ground or another lower level with or without loss of consciousness’ National Institute for Clinical Excellence (NICE guidance 2004)

Del Boy Falls Through The Bar - High Quality.wmv

Falls- what ’ s the problem? Major cause of disability Leading cause of mortality from injury in people aged 75+ in the UK Over 700,000 A&E attendances for falls related injuries in 2000, with over 220,000 admission EMAS we are currently responding to approximately 6000 fallers 65+ per month

Estimated and projected population aged 85 and over, United Kingdom, 2008 and 2033 (millions)

National Response Accident prevention is one of the four priorities for the NHS as set out in the White Paper Saving Lives: Our Healthier Nation (1999) The National Service Framework for Older People (2004) Standard Six, focuses on falls which result in serious injury*

National Response cont: Local falls teams set up National and local falls prevention projects Ambulance trusts’ taking a more active role

*NSF for Older People Standard six (2004) requires healthcare organisations to work towards implementing a falls prevention and management strategy to reduce the incidence of falls within the elderly population

EMAS Response Currently involved in the Safer 2 falls research project in Nottingham Published recent research project Improved staff awareness Greater involvement at local level with other agencies involved in falls prevention (Currently varies from division to division)

Why do People fall? Numerous factors, which can be placed under two distinct headings: Intrinsic Extrinsic

Intrinsic Ageing process (risk › over 65yrs) Poor mobility (Gait and Balance) Cognitive impairment / confusion/ agitation Continence problems History of falls (Strongest Risk Factor) National Collaborating Centre for Nursing and Supportive Care, 2004

Intrinsic Medical conditions (Osteoporosis) Sensory deficits (vision, hearing, sensation) Poor nutritional status Emotional distress / depression

Extrinsic Medication known to affect balance/cognition Polypharmacy Lack of exercise Poor Foot health/Footwear

Extrinsic Environmental hazards Poor lighting Inability to provide appropriate nutrition due to physical factors

The Falls Cycle Fear of falling Increased risk of falling Fall Decreased activity results in weakness Undoubtedly the consequence of a fall can lead to a downward spiral in ability to undertake activities of daily living (ADL)

Risk Factors Risk increases with advancing age: –Extrinsic factors can be dealt with therefore reducing the risk of recurrence –If a fall is caused by Intrinsic factors, such as those affecting posture and balance, it is more likely to recur

‘A cluttered home is a comfortable home!’

Student Activity In Groups, on the flip chart, identify three environmental hazards in each of the given scenarios

Identify 3 environmental hazards in this picture

Identify 3 more in this picture

3 more in this picture!

Non-Injury Falls Many falls do not result in injuries, yet a large percentage of non- injured fallers (47%) cannot get up without assistance For the elderly who fall and are unable to get up on their own, the period of time spent immobile often affects their health outcome.

Management of falls patients Primary Survey –A, B, C and D Secondary Survey –Full Head-to-Toe Gait and Balance Test Postural Hypotension Assessment

Normal changes of Gait Slower gait Decreased stride length and arm swing Forward flexion at head and torso Increased flexion at shoulders and knees Increased lateral sway

Gait and Balance Timed up & go test –ask person to get up from chair –walk 3 metres –turn around, return to chair and sit down The turn 180° test –ask person to stand up –step around until facing opposite direction

Disposition Take to Hospital? Leave at Home? or With Patient’s Consent

Take to hospital/A&E following a fall Factors Including: Over 65 and Unconscious Suspicion of Bony Injury Underlying Medical Condition

Leave at home Falls Risk Assessment Tool (FRAT) Prevention Advice Safety Netting SBAR **

Student Activity - Scenario Given the scenario and using the version of FRAT, handed out earlier, decide on the appropriate disposition for John Smith (With his consent)

Insite The learning zone Essential education

The desired clinical impact, following falls intervention Elderly people with a history of falls will benefit by improved well being and confidence Medication reviews will improve patient care in therapeutic areas as well as reduce falls risk Better quality of life Other interventions will also improve health in such areas as respiratory and cardiac disease

Health & Community Services Impact A successful falls service will reduce the pressure on acute hospital trusts - In A&E departments - Emergency surgery - OPD clinics Ambulance services GP emergency services Decrease pressure in provision of social care

Any Questions?

References National Institute for Clinical Excellence (NICE guidance 2004) National Service Framework for Older people- Standard Six (2004) National Collaborating Centre for Nursing and Supportive Care, practice/monograph/972/diagnosis/tests.html Special thanks to Paul Bramwell, Divisional Clinical Champion