1. Post-fall Assessment & Management in Persons with Dementia
Sylvia Davidson Professional Practice Chief – Occupational Therapy
ADI – March 9, 2012

2. Providing the world with innovations in aging
21/02/2019
Objectives
Impact of falls
Policy development
Significance of dementia
Pockets of excellence
Next steps
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3. Providing the world with innovations in aging
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Impact of falls
In fiscal year 2009
50% of injury-related hospitalizations for seniors were due to falls
> 90% of all hip fractures were due to falls
Ontario’s annual costs for falls in seniors have been estimated at $962 million.
Toronto Central Local Health Integration Network
Integrated Provincial Falls Prevention Framework & Toolkit – Backgrounder
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4. Providing the world with innovations in aging
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Policy Development
To provide a consistent and systematic organizational approach to falls risk management.
Falls risk assessment
Individualized fall plan
Post-fall assessment & management
Timelines
Recognized responsibilities
All clients have the right to take risks
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5. Post-fall assessment
Neurological assessment should be completed after a fall (witnessed or unwitnessed)
Post-fall, neurological assessment was…
Actual number of incidents
Percentage of incidents (%)
Completed 18
52.9%
Not completed* 16
47.1%
Total 34
100%
* One incident not a suspected fall, thus no neurological assessment done
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Post-fall management
Elapsed time: time of incident occurrence/discovery of incident to time assessment/intervention initiated (e.g., physician assessment and treatment or resident transferred to acute care)
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Dementia significance
Older adults with cognitive impairment have increased risk of falling
Risk of morbidity and mortality post-fall increases with age
Post-fall assessment may be compromised by individual’s agitation
Falls may be unwitnessed and self-reports of injury or distress may be unreliable
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Dementia significance %
Quarter 3
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Pockets of Excellence
Case Example
64 year old male, admitted to Behavioural Neurology unit from long term care home with diagnosis of Alzheimer’s Disease.
Falls risk score 5.
Contributing factors:
difficulty with transfers related to diminished judgement,
problems with ambulation related to visuospatial deficits,
limited concentration, impulsiveness,
pain related to significant osteoarthritis,
aggressive & agitated when unable to communicate needs.
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10. Providing the world with innovations in aging
Pockets of Excellence
Goals
reduce falls & reduce degree of injury from falls
identify triggers to behaviour through A-B-C charting
Plan
Weekly Safe Mobility Rounds – interprofessional discussion with focus on falls and behaviour
bed sensor and chair sensor
trial hip protectors & trial use of rollator walker
noisy environment identified as trigger to aggressive behaviour and increase in restlessness, therefore reduce unnecessary stimulation/relocate to quiet area as necessary
ongoing monitoring of pain
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Focus on Post-fall process
• Post-fall debriefs
• Support for clinical observations made by members of the interprofessional team
• Regular refreshers on documentation
• Ongoing support for leaders and champions within the team
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Next steps
Next steps to include, but not limited to:
WHAT?
WHO?
WHEN?
Audit process to monitor compliance/metrics at unit level
Unit managers
Quarterly
Development of further communication, education and training - focus on sustainability
Unit champions
Staff orientation
Organizational monitoring and control through Falls Steering Committee
Senior Management representation
Ongoing
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13. Providing the world with innovations in aging
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Acknowledgements
A. Bandali & K. Agtarap-Rose; Advanced Practice Nursing
J. Rice, Occupational Therapist, and the Baycrest Behavioural Neurology Team
Baycrest Professional Practice
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Thank you!
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