1. Safe and Wellbeing Visits Falls Initiative
Short information session
About the
Falls Questionnaire

2. Why Falls prevention matters
Falls are the leading cause of death resulting from injury in older people in he UK.
50% of older people who fracture a hip, do NOT regain their independence following the fracture, and many end up in care homes as a result of this.

3. Falls in the UK Annual European Home and Leisure
11 million people aged > 65 yrs
28,000 women aged > 90 yrs
Fractures costs £1.8 billion pa
1 Hip Fracture every 10 minutes
1 Wrist Fracture every 9 minutes
1 Spine Fracture every 3 minutes
500 admitted to Hospital every day
33 never go home
Annual European Home and Leisure
Accident Surveillance Survey (EHLASS)
Report UK 2000
DoH Prevention Package 2009

4. How common are Falls?
In the over 75s, falls are the leading cause of death resulting from injury
75-80% of falls are not reported
One third of over 65s will fall each year, this rises to half of people aged 80 and over.
Over 10% of all call-outs for the UK Ambulance Service are for people aged 65+ who have ‘fallen’.
Nearly half are NOT taken to hospital and are left at home.
Expensive and wasteful of NHS resources
Research suggests that most falls go unreported, older people worry about the ‘stigma’ of having a fall. They are often reluctant to seek help. If we can ‘catch’ them before they have a severe injury or break a bone, we can often prevent more falls from happening.
Skelton & Todd, WHO 2004,
Gillespie 2005, Close 2008

5. Location of falls & related injuries
The location of falls is related to age, sex and fraility.
In women the number of falls outside decreases with age / with a corresponding increase occurring inside the home on a level surface.
Fewer men than women fall inside the home44% vs 65%. More men fall in the garden 25% vs 11%
Frailer people with limited mobility suffer most falls inside the home.
Falls occur in situations where people are doing their usual daily activities and most falls occur during the day only 20% occur between 9pm and 7am.
Lord et al 2011.
Falls in Older People

6. Fear of falling can occur after the FIRST fall an older person experiences.
We have seen older people go from being independent to totally DEPENDENT on friends and family within weeks of having a fall.
Combatting this fear is one of our biggest challenges in the Falls Services.
It can take months to help an older person recover their previous abilities.

7. Appropriate to Refer?
Inappropriate
Under 65 years
No recent falls
Wheelchair user/ paraplegic
Currently receiving physiotherapy or Occupational Therapy
Advanced dementia
Falls caused by known / current medical issue. EG Stroke, Parkinson's Disease. (These people should be under care of specialist services who can help with their balance problems)
Appropriate
Over 65 years
Recent falls (within last 6 months)
Unsure why falling
Injury caused by falls
Worried about falls
Stopped doing things due to fear of falling.
Hasn’t discussed falls with anyone
Please do not promise an older person that they will automatically be offered a falls assessment.
We have to triage the referrals in order to ensure that the people we can help and who need our services are prioritised.
All fallers who fulfil the criteria of having had a recent fall who’s cause is unknown and are not currently receiving similar services will be given the opportunity to request an assessment, or will be advised to speak to their GP about the falls.
People who are falling due to neurological conditions (Parkinsons disease, Stroke, MS, Motor neurone disease etc) will be under the care of specialists who will be able to address their balance issues. These patients are unfortunately usually unsuitable for input from the Community Falls teams.
If you do refer these patients we will triage them, we may ring them for more information and advise them to seek the help of their specialist service providers or GP.

8. Referrals emailed to Falls Service Easington
Triaged by Clinical Lead
Sent Falls prevention Information pack with invitation to contact Falls Service
Contacted by phone for more information
Sent Falls Prevention information pack
This diagram shows the process of how we deal with the referrals received from FRS.
Visited at home by Falls health professional Or
Invited to attend a clinic for assessment (Easington only)

9. Falls Services in Durham & Darlington
Outcomes
May involve referral to consultant for complex medical / cardiac problems.
Referral back to GP for medication changes
Equipment fitted in home to help prevent falls
Social services becoming involved where more home care is needed.
What happens next?
Falls Assessment is a complex process
Patients are assessed for medical and environmental causes of falls
Initial Falls assessment takes at least 1 hour with multiple follow ups by health professionals and other agencies.
A Falls assessment is an extensive assessment which will take initially at least 1 hour in the patients home or in clinic, with follow ups arranged as necessary.
It often involves co-working with other external agencies and other departments within the NHS; for example:
Social services
Housing associations
Durham County Council / Handyman services
Home care providers
Referral to specialist services in NHS
Older persons consultant
Syncope clinic
Secondary Falls clinic (based in hospitals)
Specialist Podiatry clinics
Community physiotherapists / Occupational therapists / Podiatrists
GP involvement (we often ask GPs to review / change current medications)
This is why we triage the referrals you send us. Its not appropriate or feasible to provide an in depth falls assessment to every older person who falls.
A falls referral triggers an expensive and time consuming process which is best targeted at people who are at immediate risk of injury or fractures. Especially where the cause of falls is unknown.

10. Thank You!
With your help we will be able to access people who don’t normally ask for help or who don’t have current involvement with local health services.
A Falls referral will not automatically result in the person being offered a full assessment, but it will flag them up as being ‘at risk’.
The referral you send us will be scanned onto their medical record and we will document what action we take after this.
The people you refer to us (if they are over 65 and have had a fall) will be sent a pack of falls prevention information and advised that if they continue to falls they should speak to their GP about a referral to Falls services.
If they have had more than one fall they may also be sent a self-referral form which the person can then use to access Falls Services if they wish. (This saves time and provides a more direct route into the service).
No one is going to knock on their door out of the blue, or send them an appointment without first contacting them and asking permission.
Hopefully knowing this will enable you reassure people who may be hesitant about allowing you to refer them to us.
Finally we’d like to thank you for doing this work. It will enable people who wouldn’t normally ask for help to access the services they need. Thank you.