1. Domestics Toilets Smoking Fire exits Mobile phones
Practicalities - hearing/seeing/comfort
Confidentiality
Hand-outs / Resources
Health declaration
Who are your facilitators today?
Questions?

2. Welcome Introductions Who you are? Where you’re from?
What do you hope to learn?
Working together
Partner up
Leaf post it what do you hope to learn on flip pink or other working together agreement
Scale baseline metric
Handout and talk further..... DOMESTICS AND TIMING FOR DAY
Quiz sets scene of subject and a light consideration with discussion acts as an ice breaker working with each other too.
(Base line here measures with quiz? how to do this
Questions? See some base line pointers later along side quiz possibly? Don’t want to take away from the quiz maybe introduce distance travelled with evaluations of knowledge, skills, behaviours, experience at start ensure have time to reflect on learning throughout day with Action Plans verbal info ? prep later.)
Re-done handout – let’s focus
Need answers from Anita/Amanda & discussion re
DOMESTICS
See base line slide to develop an evaluation tool and action plan -

3. Event Programme Breaks Why Focus on Falls - Quiz
What is the data telling us?
What is the human cost?
Falls Definition
Standard 6 and CQC requirements
Why integrate Health and Social Care?
Why do older People Fall?
Causes of Falls
Consequences of Falls and impact
Risk Factors – Assessing risk Mr Rose & Mr Sloppy Slippers
Lunch 12.30pm/1.15pm
Living the Experience – Ageing Well?
Falls Prevention – guidance, solutions
Case study – vignette
Call for Action
Walsall Falls Project – Next Steps
Finish – 4.15pm
Agenda to do9.30am -4.30pm breaks & purchase lunch
Interactive & Participatory
Development of Innovative Falls Prevention Programme for Walsall scaled up Black Country
Integrated Health & Social Care Project
Consequences and Impact of Falls
Resources

4. Walsall Falls Project Aims
There are several falls prevention initiatives already active within the NHS. Walsall Falls Project is not a competing initiative; it is a major step forward in bringing together existing and new falls prevention resources. We hope that these resources are helpful in supporting local initiatives to reduce harm to older people from falls.
Clear aims text – animation for project purpose and outcomes with image – pilot project
(Image to work up as part of logo and website development)

5. Quiz
Why focus on Falls?
Every day in the UK, almost 10,000 people aged over 65 will fall down. The personal costs are staggering, with falls resulting in injury, broken bones, fear of falling and social isolation.
People fall because of a complex mix of factors. To reduce falling, it is important to identify these factors, and recognise those that could signify serious, but treatable, underlying medical problems
Handout and talk further..... DOMESTICS AND TIMING FOR DAY
Quiz sets scene of subject and a light consideration with discussion acts as an ice breaker working with each other too.
(Base line here measures with quiz? how to do this
Questions? See some base line pointers later along side quiz possibly? Don’t want to take away from the quiz maybe introduce distance travelled with evaluations of knowledge, skills, behaviours, experience at start ensure have time to reflect on learning throughout day with Action Plans verbal info ? prep later.)
Re-done handout – let’s focus
Need answers from Anita/Amanda & discussion re
DOMESTICS
See base line slide to develop an evaluation tool and action plan -

6. Identify actions to prevent risk of falls in care environment/settings
What can we do?
This training will provide support, resources and guidance to those most at risk of falling, carers, family members, health & Social care providers
Aims
Highlight the problem of falls in older people and why preventing falls is important?
Increase awareness of the causes of falls, their impact, the consequences of falls and who is most at risk?
Explore what the hazards are and how these can be prevented?
Had a chance with quiz to set scene for today.
How aims of course and the project aims and outcomes – Anita let’s explore SMARTER AIMS AND OBJECTIVES IN RELATION TO MEASURES DISTANCE TRAVELLED Brief Project background explanation? Will be on Chance Card
What do we mean place issue in perspective?
Identify actions to prevent risk of falls in care environment/settings

7. Why are Falls such a major concern?
Falls and Fall-related injuries are a common and serious problem for older people. Deaths
as a result of a fall.
Walsall expected to have a significant rise in number of older people over next 10years
The annual cost of falls of people over 60 in England is £2 billion a year, more than £5.6 million a day
Walsall expected 85 and older increasing from 5, to 8,109 , 2021
Around 30% of adults who are over 65 and living at home will experience at least one fall a year.
Those aged 65 and above predicted to increase by 12.9% 46,095 (2011) to 52,062 (2021) in Walsall. Source Walsall Public Health & strategic review.
20% of older adults will require medical attention for a fall and 5% will experience a serious injury, such as a broken bone
National data
The number of people aged 65 and over predicted to have a fall in England is expected to increase by almost 9% by 2016 i.e. from 2,406,214 in 2012 to 2,639,671 (POPPI, 2012).
Ask first Why are falls such a major concern? ADD
A rise in the incidence of falls will bring an increase in the number of falls related hospital admissions.
The number of people aged 65 and over predicted to be admitted to hospital as a result of falls in England is expected to increase by almost 8% by 2016, from 188,622 in 2012 to 204,913 (POPPI, 2012). Check POPPI for Walsall Data and Nicola/Adam/Paulette public health strategic Review
In those two’s or around the table a quick exchange?
the planning needs of a growing number of older
people must be incorporated within key strategic priorities what do you think? Human cost v cost to Social Care & Health
National data dated for 2009 follow up ie see other data sources slide
Our stats and Public Health Strategic Review
But costs for services one issue other cost human!

8. Costs – Human
13,500 to 14,500 older people are going to fall each year
Recurrent falls are associated with increased:
psychological consequences, lack of confidence, reduced quality of life and increased fear of falling
75% of falls are not reported
Increased support and care from Family Carers
Falls destroy confidence, increased isolation and reduce independence, with 9% of older people becoming afraid to leave their homes
Restrictions in activities of daily living
Increased
stay in hospitalisation
For the person
Mortality
10% of hip-fracture patients will die within one month of their fracture, 30% will die within a year and there are
13,800 hip-fracture-related deaths a year in the UK (sorce Age uk)
Increased rates of people requiring Nursing/ Residential & Home Care
In UK 1 in 2 women and 1 in 5 men will suffer a fracture at some point after the age of 50, mainly because of poor bone health
For women, the risk of sustaining a hip fracture is greater than the risk of developing breast cancer
So the cost to the NHS? Council through Social Care ? What about the human cost?
Discuss anything else? Your experience Want feedback recorded here rich information about people and their lives good, bad and ugly.

9. Why is thee a need for a definition?
Definitions
The definition shown here is the most helpful way to describe a fall. It is intentionally a very broad definition which includes all types of incident, such as slips, trips, falls and faints:
Source: North West Ambulance Service NHS Trust
Why is thee a need for a definition?

10. Some people may intend to fall
Definition
The World Health Organisation defines a fall as:
'A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.‘
The definition shown here is the most helpful way to describe a fall. It is intentionally a very broad definition which includes all types of incident, such as slips, trips, falls and faints:Using a standard definition of 'a fall' makes reporting of falls more likely and more consistent. One commonly used definition is:
'An event, which results in a person coming to rest inadvertently on the ground or other lower level' - World Health Organisation (external link)
Other definitions of a fall include: TINETTI MARY
Some people may intend to fall

11. Why do we need Falls Awareness Training?
“To reduce the numbers of falls which result in serious injury and ensure effective treatment and rehabilitation of those have fallen”
Standard 6
Needs an explanation about the Standard (how old is this and still used – ask other professionals how in this area and others working with these/talk to our commissioners and hospital before delivery)
Is this a question to group? This is one driver and you will hear a great case to focus, raise awareness and really take a significant look at how to prevent further falls by identifying those risks!
Standard 6 Falls
The NHS, working in partnership with councils, takes action to prevent
falls and reduce resultant fractures or other injuries in their populations
of older people.
Older people who have fallen receive effective treatment and
rehabilitation and, with their carers, receive advice on prevention,
through a specialised falls service.
Just like the rest of us, older people want to enjoy good health and remain independent for
as long as possible.
This National Service Framework sets out a programme of action and reform to address
these problems and deliver higher quality services for older people.
Modern standards and service models National Framework for older people

13. Scoping best Practice in Older Adult and Integrated Care (April 2014)
Top four barriers were identified as:
Lack of clarity of roles
Poor communication
Lack of clarity of procedures
Imbalance of power between individuals and agencies
Enablers of successful integration included:
Consistent rules and policies at organisational level
Collaboration between disciplines
Co- ordination of services
Shared values
Integrated care means different things to different people. The Kings Fund has used the integrated care definition; “care which is intended to improve the quality of care for individual patients, service users and carers by ensuring that services are well co-ordinated around their needs”
source: integrated care for patients and populations: improving outcomes by working together, Kings Fund, Nuffield Trust, January 2012.
We are the Local Education And Training Board for the West Midlands
Developing people for health and health care
Walsall Falls Project funders

14. Innovation

15. Break Time Out

16. An Integrated Workforce approach to Falls Prevention Develop skills, knowledge, behaviours in relation to the holistic needs, including the services that can contribute to promoting the total wellbeing of older people
This is what this project is about. Developing the learning with awareness, this Project aims to bring about a standard of care through heightened awareness about the risks, understanding how to prevent them and the serious injuries sustained, who is most at risk, how and what to do to support individuals and their families and carers. There’s an existing programme of learning and interventions within the hospital – And there is a programme which is about to run for the Independent Sector, working in partnership with NHS trainers the project is going to test out what it means to take an integrated approach to learning across our Social Care, Community and health/clinical workforce. So that everyone has a standard of awareness around Falls Prevention and support services. It’s all our business.

17. Settings Achievements
Clarity of the actual settings Who are our stakeholders

18. Walsall Falls Project - settings
Home / Housing
Nursing
Residential care
Domiciliary care
Voluntary Sector
Extra Care
Hospital
Community
Achievements
Clarity of the actual settings Who are our stakeholders
Walsall Falls Project - settings

19. The Care Needs of Older People
Too often care is uncoordinated, leaving too many people needlessly entering the revolving door of their local A&E again and again, because somewhere in the system their care has broken down
Gave some insight at last steering group with a patient whose foot care on the ward was provided, there seemed to be some further exploration of how this person would maintain foot care in the community outside those who would automatically receive podiatry care where they may be diabetic for example.
Example of Community – residential care where resident was walking with slippers too big, toes poking out of the front, (he actually made another whole to match the one already there), gripping the slippers with his toes, Open day market stall – purchased a new pair and had cause to visit recently still wearing them, he may have been a little frugal with purchases shall we say.
Foot care is highlighted within the training content and will certainly be part of the public awareness campaign – sloppy slippers springs to mind from past publicity – (work in collaboration with voluntary sector maybe – Age uk – historically produce fantastic materials ie ‘best food forward’ and others be steady be safe!!

20. Many falls are preventable, right care, services, awareness of underlying symptoms, taking preventive measures , understanding the risk

21. Background information – Facts about Falls
Falls and instability account for 40% of nursing home admissions
30% of people aged 65+ fall each year many falling more than once
About 40% of these will be injured
5% will break a bone
Breaks (such as a fractured hip) can result in death, loss of mobility and reduced quality of life
Discuss their experiences of frequency of falls & consequences

22. Why do people fall? Pictionary
TOP TO TOE
Why do people fall? Pictionary
Groups
2 GROUPS WHY
One activity each? Discussion about the effects of ageing? Falls not inevitable not

24. Falls are not an inevitable consequence of growing old
Must remember
Falls are not an inevitable
consequence of growing old

25. Muscle Weakness
Particularly in the legs. Older people with weak muscles are more likely to fall than those who maintain their muscle strength and flexibility
Balance and gait
How you walk – are other key areas. Older adults who have poor balance or difficulty walking are more likely than others to fall. These problems may be linked to a lack of exercise or to a neurological cause, arthritis, or other medical conditions and their treatments.
Blood pressure & Other long-term chronic conditions
Lying or sitting to standing position can increase your chances of falling.
Called postural hypotension. Could be from dehydration, certain medications, diabetes, neurological conditions such as Parkinson’s disease or an infection.
Some people with postural hypotension feel dizzy when their blood pressure drops. Other people don’t feel dizzy, even if their blood pressure drops a lot when they get up.

26. Footwear
Slippers, high-heeled shoes, and shoes with smooth leather soles are examples of painful feet and wearing unsafe footwear can increase your chance of falling
Sensory problems
If your senses don’t work well, you might be less aware of your environment. Having numbness in your feet may mean you don’t sense where you are stepping.
Slower reflexes when older = increases loss of
Vision
Not seeing well. May take a while for your eyes to adjust to see clearly when you move between darkness and light
Other vision conditions contributing to falls include poor depth, perception, cataracts and glaucoma. Wearing multi-focal glasses while walking or having poor lighting around your home also lead to falls
Confusion
Confusion, even for a short while, can sometimes lead to falls. Unfamiliar environment – Orientation - contrast

27. Medication
Some medications can increase a person’s risk of falling because they cause side effects like dizziness or confusion. The more medications more likely to fall . People who take four or more prescription drugs have a greater risk of falling. Includes over the counter drugs.
Diet
Poor diet, inadequate intake of vitamins and minerals.
Lifestyle factors
Drugs, alcohol
Environment
No single factor
History of Falls
3 or more in the last 12 months

28. Consequences of falls
IMPACT on person, family care workers
IMPACT

29. All these factors can significantly reduce the quality of life
Consequences of falls
Psychological/ emotional
Physical
Social/Functional
All these factors can significantly reduce the quality of life

30. Words, thoughts, feelings of the person
Think about the person immediately after a fall, following the fall and later
Let’s think about this further words, thoughts, feelings of the person who has fallen psychological and physical immediate, and later long term.
Words, thoughts, feelings of the person

31. Social/ Functional Mental/ Physical Psychological
Consequences of falls
Physical
Mental/
Psychological
Social/
Functional
Psychological
Loss of confidence
Fear of falling in the future
Anxiety and depression
Physical
Physical injury
Restriction of activity
Pain, leading to limitation of activity after a fall
Functional
Functional deterioration
Increase in dependency and disability

32. Mentally/Psychological
Socially/functional
Physically

33. The Person Consequences of falls Psychological/mentally/emotionally
Physical
Fractures Pressure Ulcers
Pneumonia Limited mobility Muscle wastage In pain
Use of walking aid Dehydration
Cold A burden intimidated
Exposed Embarrassed Ashamed Unable Useless In pain helpless
Move to Care Home
Lack of Social Contact Withdrawn services
The Person
A3 Handout to write in Groups discussion prompt Discussion about the effects of ageing
Psychological
Loss of confidence
Fear of falling in the future
Anxiety and depression
Physical
Physical injury
Restriction of activity
Pain, leading to limitation of activity after a fall
Functional
Functional deterioration
Increase in dependency and disability
Socially/ Functional

34. Loss of confidence Loss of independence
Fear
Distress
Guilt
Blame, anxiety, embarrassment
Loss of independence Loss of social contacts Move to residential care Financial cost of help/care Decreased quality of life Changes to daily routine Dd
Discomfort and pain
Serious injury
Inability to look after oneself
Long term disability
Mentally/Psychological
Socially/functional
Physically

37. Risk factors for falls can be broadly classified into two categories The person The environment
Often there is an underlying cause or risk factor involved in a fall. As the number of risk factors rise, so does the risk of falling.
Risk categories for older people include
Falls history
Age
Living alone
Medication
Long-term health conditions
Bone health
Balance and gait
Poor vision
Foot health
Poor nutrition
Consumption of alcohol

38. The environment The person Mr Rose Mr Sloppy Slippers
Often there is an underlying cause or risk factor involved in a fall. As the number of risk factors rise, so does the risk of falling.
Risk categories for older people include
Falls history
Age
Living alone
Medication
Long-term health conditions
Bone health
Balance and gait
Poor vision
Foot health
Poor nutrition
Consumption of alcoholPerson - discuss what and how?
And environment what and how?
Write up and feedback
See following table
What might you be able to do? Advice and support? Look at preventable measures......
Mr Rose
Mr Sloppy Slippers

41. Consequences of falls relatives
Anger, Financial Give up work Stress Guilt Complaint / litigation Anxiety
Hospital Patients/staff/family Anger Guilt
Consequences of falls care home/all care staff
Anxiety Guilt increased dependency of resident, Person with hands on care (can compromise care of other residents other customers) Complaints Inquests Serious injury Fatalities
Effects on organisation
Statistics
Complaints /litigation
Local reputation
Newspaper stories

42. FOOD QUIZ

43. LUNCH

44. CALL
Welcome Back
CALL

45. Event Programme Why Focus on Falls - Quiz
What is the data telling us? What is the human cost?
Falls Definition
Standard 6 and CQC requirements
Why integrate Health and Social Care?
Why do older People Fall?
Causes of Falls
Consequences of Falls and impact
Risk Factors – Assessing risk Mr Rose & Mr Sloppy Slippers
Living the Experience – Ageing Well?
Falls Prevention – guidance, solutions
Case study – vignette
Call for Action
Walsall Falls Project – Next Steps
Agenda to do9.30am -4.30pm breaks & purchase lunch
Interactive & Participatory
Development of Innovative Falls Prevention Programme for Walsall scaled up Black Country
Integrated Health & Social Care Project
Consequences and Impact of Falls
Resources

46. Ageing Well? –How well?

47. Geriatric Syndrome Age-related impairments are:
The age simulation suit GERT offers the opportunity to experience the impairments of older persons even for younger people.
Age-related impairments are:
Opacity of the eye lens
Narrowing of the visual field
High-frequency hearing loss
Head mobility restrictions
Joint stiffness
Loss of strength
Reduced grip ability
Reduced coordination skills
Geriatric Syndrome

48. What do you see?

49. What do you see? Pavement optical illusion injures 20 people
A new pavement installed in a Welsh town which creates an optical illusion that hides a kerb has caused at least 20 people to trip so badly that they needed to be taken to hospital.

50. Pavement optical illusion injures 20 people
A £10.5m town centre make-over has been blamed for more than 20 people being taken to hospital for falls after new paving stones "hid" a pavement kerb in Pontypridd, south Wales.
A new pavement installed in a Welsh town which creates an optical illusion that hides a kerb has caused at least 20 people to trip so badly that they needed to be taken to hospital.

51. She said: "I was going to the bus stop and all I remember is falling over the kerb - I didn't see it. "I was taken to hospital and had X-rays and I had a lot of bruising and cuts to my face and neck.
More than 20 shoppers have been taken to hospital after tripping over “crazy paving” in a town centre – because it creates an optical illusion hiding a curb. The new paving stones have been blamed for a spate of falls by people who can’t see the kerb because of the mixed-up pattern. The treacherous stones, part of a £10.5m town centre makeover, create a hidden trip trap – which many are unable to spot the edge of the kerb.
Grandmother Morfydd Jenkins, 75yrs was left badly bruised when she went over the trip hazard while rushing to get a bus. She said “ I was going to the bus stop and all I remember is falling over the kerb – I didn’t see it.
More than 20 shoppers have been taken to hospital after tripping over "crazy paving" in a town centre - because it creates an optical illusion hiding a kerb.
The new paving stones have been blamed for a spate of falls by people who can't see the kerb because of the mixed-up pattern.
The treacherous stones, part of a £10.5m town centre makeover, create a hidden trip trap - with many unable to spot the edge of the kerb.
Grandmother Morfydd Jenkins, 75, was left badly bruised when she went over on the trip hazard while rushing to get a bus.
She said: "I was going to the bus stop and all I remember is falling over the kerb - I didn't see it.
Morfydd Jenkins suffered severe bruising and cuts when she fell (Picture: Wales News Service“
I'm feeling alright now but I'm much more cautious about going out on my own."

53. How many figures can you see?

55. What do you see?

57. Tips...

58. Dementia and Falls –
The specific difficulties a person experiences will depend on the type
of dementia they have. This is because each type of dementia can
damage the visual system in a different way.
Difficulties may include:
• Decreased sensitivity to differences in contrast (including colour
contrast such as black and white, and contrast between objects and
background).
• Reduced ability to detect movement.
Changes to the visual field (how much you can see around the edge
of your vision, while looking straight ahead).

59. Dementia and Falls - People with dementia may experience problems with their sight which cause them to misinterpret the world around them and hallucinate.
Specific types of dementia can also damage the visual system and cause visuoperceptual difficulties. These include Alzheimer’s disease, Parkinson’s disease dementia, dementia with Lewy bodies and vascular dementia.
Chronic conditions and developing ill health: A stroke can also cause someone to have problems with their vision. They may experience central vision loss, visual field loss, eye movement problems and visual perception and processing issues
Sometime medications can cause or contribute to visual difficulties. They include some drugs from the following categories, cardiovascular, non-steroidal anti- inflammatory, antibiotics, drugs for Parkinson’s – even eye medications

60. A person
who falls once is at high risk of falling again and early intervention can prevent further serious injury
Studies show that assessing and modifying person specific risk factors can reduce falls by up to 60%

62. Identify actions to prevent risk of falls in care environment/settings
Falls Prevention

63. Resources

65. Case vignette RON – What Factors place Ron at risk of falling?
What measures need to be put into place before Ron is discharged from hospital?
What measures need to be put into place after Ron has been discharged?
How would you continue to monitor Ron’s progress and reduce his risk of falling in the future?

66. Summary Falls Prevention q Why Focus on Falls ?
Why do older People Fall?
Case study – Vignette Ron
Data/Human cost
Causes of Falls
Integrate Health Social Care
Falls Definition
Consequences of Falls and impact
Standard 6
Risk Factors
Call for Action
CQC requirements
Walsall Falls Project Integrated Health & Social Care Learning & Development Programme Essential guide to Falls Awareness And Prevention
Ageing Well Living the Experience
Agenda to do9.30am -4.30pm breaks & purchase lunch
Interactive & Participatory
Development of Innovative Falls Prevention Programme for Walsall scaled up Black Country
Integrated Health & Social Care Project
Consequences and Impact of Falls
Resources
Next Steps

67. And finally…….. CALL FOR ACTION
One thing:
You’ve learned today
You’ll do differently
Call For Action
What resources do you need? When will you put this into action – record the results follow up from event 2 months

68. Scoping best Practice in Older Adult and Integrated Care (April 2014)
Integrated Care is important for people with
long-terms conditions
Needs are often not just ‘medical’ or ‘social’
Developing integrated care is central to initiatives
to meet the demands of a growing number of
people with chronic conditions and an aging population
We are the Local Education And Training Board for the West Midlands
Developing people for health and health care
Walsall Falls Project funders

69. Evaluation & Thank you Project – Events Public Awareness campaign
Elaine Delaney
Vivek Krishan
WELL DONE EVERYONE!!
Provide copies of powerpoint
Janet Lilley
Lynne Jones
We welcome your feedback 