1. About falls… Working Together to Prevent Falls for Health and Wellbeing Perth Concert Hall 27 th April 2014 Ann Murray National Falls Programme Manager ann.murray3@nhs.net

2. About Falls Consequences

3. Consequences Economic cost of managing the consequences Scottish Ambulance Service Falls are the largest single presentation 35,000+ attendances Scottish Ambulance Service Falls are the largest single presentation 35,000+ attendances Emergency Department Falls are one of the leading causes of attendance Emergency Department Falls are one of the leading causes of attendance Care Home Admissions Falls are implicated in up to 40% admissions Care Home Admissions Falls are implicated in up to 40% admissions Hospital Admissions Falls are responsible for 390,000+ emergency bed days Hospital Admissions Falls are responsible for 390,000+ emergency bed days Falls cost Scotland £471 million+ 45% Long Term Care 40% NHS 15% Care at Home Craig, 2012 In people aged over 65 years…

4. Consequences Personal cost: Hip Fracture Approximately 1-2% of falls results in a hip fracture. Around 6,000 hip fractures in Scotland each year. The average cost of managing a hip fracture (whole system) is £39,500. 50% of people who fracture a hip will never fully recover. 30% will die within 6 months. Falls and bone health/osteoporosis are inextricably linked.

5. Consequences Personal cost; fatalities Falls account for more than 70% of all fatal accidents in the over 65 age group annually.

6. Consequences Personal cost Fall Fear of Falling Again Less Activity Decreased Muscle Strength and Balance Increased Risk of Falling ‘Long lies’ and complications: –pressure sores –hypothermia –kidney damage –pneumonia –death Post-fall syndrome: –fear of falling –depression –anxiety –loss of self confidence Avoidance of activities and social isolation / loneliness The Fear Cycle Todd, 2004

7. A fall can be… …the first sign of a new or worsening health problem … a marker for the onset of frailty …a trigger for a downward spiral of loss of confidence, activity and independence, and increased dependence on family, health and social services. A FALL IS A SYMPTOM NOT A DIAGNOSIS – don’t accept a fall as ‘normal’ ageing. A FALL IS A SYMPTOM NOT A DIAGNOSIS – don’t accept a fall as ‘normal’ ageing.

8. Consequences Presentation to health services: the tip of the iceberg 10% result in major injury (including fracture) 30-50% of falls result in minor injury 40-50% of falls result in no injury The majority of falls are not reported to health care services so there is limited opportunity for advice and support to prevent further falls and enable recovery. Masud, Morris (2001) Rubenstein (2006) Image removed

9. About Falls A personal story

10. About Falls What can be done?

11. Fall ENVIRONMENT Uneven floor or ground surface Inadequate lighting Low temperature Clutter Pets PERSON Strength, balance & mobility Vision Blood pressure / other medical issues Cognition & behaviour Feet & footwear Medication side effects / Alcohol TASK or ACTIVITY Falls are not inevitable Factors contributing to a fall

12. What can be done? Risk profiles Risk tends to be mostly related to: mobility exposure to hazardous environments risk taking behaviours Risk tends to be mostly related to: the effects of conditions such as arthritis and depression medications the functional consequences of long term conditions Risk is influenced by several factors: significant frailty impaired cognition psychotropic medications continence issues unfamiliar environments staffing levels/patterns Image removed

13. What can be done? The evidence base.

14. What can be done? The evidence base Group Exercise (strength & balance) Reduces falls by: 18-37% (29%) Group Exercise (strength & balance) Reduces falls by: 18-37% (29%) Home Safety Assessment and Modification Reduces falls by: 19% (high risk people, delivered by OT) Home Safety Assessment and Modification Reduces falls by: 19% (high risk people, delivered by OT) Home Exercise (strength & balance) Reduces falls by: 20-42% (32%) Home Exercise (strength & balance) Reduces falls by: 20-42% (32%) Multifactorial Falls Programme (based on individual risk assessment) Reduces falls by: 14 - 47% (24%) Multifactorial Falls Programme (based on individual risk assessment) Reduces falls by: 14 - 47% (24%) Medication review & modification Vitamin D Pacemaker Cataract Surgery Medication review & modification Vitamin D Pacemaker Cataract Surgery Gillespie Cochrane Review (2012)

15. What can be done? The Up and About Pathway http://www.scotland.gov.uk/Publications/2014/10/9431

16. What can be done? A Framework for Action 2014-16 16 key actions for health and social care services across the four stages of the Up and About pathway. actions represent the minimum standard of care an older person should expect to receive. relevant to all partners involved in the falls and fracture prevention and management pathway. http://www.scotland.gov.uk/Publications/2014/10/9431

17. What can be done? The Framework in Summary Stage One is about… Providing easy to access information about staying well, falls prevention and bone health, and Sign posting to relevant services which support falls prevention and management. This includes resources, equipment and services which aim to support health and well being, a safe home environment and a safer community. Stage One is about… Providing easy to access information about staying well, falls prevention and bone health, and Sign posting to relevant services which support falls prevention and management. This includes resources, equipment and services which aim to support health and well being, a safe home environment and a safer community. Stage Four is about… Intervention to: identify, then minimise, a person’s risk factors for falling and sustaining a fracture, and also enable recovery and independence following a fall. Stage Four is about… Intervention to: identify, then minimise, a person’s risk factors for falling and sustaining a fracture, and also enable recovery and independence following a fall. Stage Three is about… Providing a rapid response to avoid a long lie on the floor, and An appropriate response, which provides both effective management of the immediate situation and consideration of further health and care needs. Stage Three is about… Providing a rapid response to avoid a long lie on the floor, and An appropriate response, which provides both effective management of the immediate situation and consideration of further health and care needs. Stage Two is about… Through a conversation, identifying people at risk of recurrent falls who would benefit from a more personalised approach to prevention and management. Any older person who reports a fall, or an injury, loss of function or increased care needs due to a fall has the opportunity to access further assessment and support if it is necessary. Stage Two is about… Through a conversation, identifying people at risk of recurrent falls who would benefit from a more personalised approach to prevention and management. Any older person who reports a fall, or an injury, loss of function or increased care needs due to a fall has the opportunity to access further assessment and support if it is necessary.

18. What can be done? The Framework self assessment tool for teams and services http://www.knowledge.scot.nhs.uk/fallsandbonehealth/the-national-falls-programme.aspx

19. What can be done? Do you know your Falls Lead? http://www.knowledge.scot.nhs.uk/fallsandbonehealth/the-national-falls-programme.aspx

20. What can be done? Online Falls and Bone Health Community http://www.knowledge.scot.nhs.uk/fallsandbonehealth ann.murray3@nhs.net

21. What can be done? NHS Inform’s Falls Information Zone http://www.nhsinform.co.uk

22. What can YOU do tomorrow to prevent falls, reduce harm from falls and enable recovery following a fall?

23. About Falls A personal story