identify potential causes of falling particularly in residential care understand the difference...
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Identify potential causes of falling particularly in residential care
Understand the difference between intrinsic and extrinsic risk factors.
What are the implications of falling Have an action plan following a fall
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Heart attacks Strokes Falls
275,000 per year130,000 per year2,700,00 per year
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500 older people a day fall in the home and require hospital treatment.
Every 5 hours one older person dies as a consequence of a fall in the home
40% of Care Home admissions are as a result of a fall
After a hip fracture 50% of fallers can no longer live independently
20% of older people who suffer a hip fracture as a result of a fall, die within 6 months
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“An unexpected event when the person 'falls' to the ground from any level, this also includes falling on the stairs and onto a piece of furniture with or without a loss of consciousness”
National Institute for Clinical Excellence 2004
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Physical injuries Loss of
independence Psychological Social impact Carer impact Cost to services
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A resident falls over.What should go through your mind when
thinking about why they fell?
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Medical Problem
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Syncope (Faint) Postural hypotension (B.P. Drop) Epilepsy BPPV Spinal Cord Compression Diabetes Peripheral Neuropathy (numbness of feet)
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Medication
Medical Problem
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On 4 or more medicines
Hypnotics - temezepam; zopilclone
Anxiolytics - diazepam;lorazepam
Diuretics - bendroflumethiazide;
frusemide
Corticosteroids –prednisolone
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Blood Pressure Medication
Medical Problem
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A drop in blood pressure sufficient to cause an inadequate blood supply to the brain.
A risk factor if there is more than a 20 mmHg drop in systolic pressure between lying and standing.
dizziness, syncope and/or falls when:◦ getting up quickly from lying or sitting positions◦ standing still for any length of time◦ getting out of a warm bath◦ standing up after a big meal◦ these symptoms usually ease if you lie or sit down
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Patient lies down for 3-4 minutes Blood pressure is recorded Patients stands – B.P. measured After one minute – measured again After 2 minutes – measured again Any history of relevant symptoms recorded
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Take particular care in the morning Get out of bed in stages. Avoid sudden changes in posture. Avoid sitting/standing for long periods. Raise the head of the bed Wear support stockings or tights. Medical treatments
◦ Fludrocortisone◦ Pindolol◦ Midodrine
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Blood Pressure Medication
Medical Problem
Urinary Tract Infection
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Asymptomatic Cause confusion Cause urgency Pyrexia
Dipstick urine if someone falls Form from In-reach
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Poor balance
Blood Pressure Medication
Medical Problem
Urinary Tract Infection
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Includes Maintaining a position Changing position Reaching Walking Turning Stepping up/down
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Chronic conditions (Stroke; Parkinsons etc) Vision (bifocals/varifocals) Alcohol Diet/ dehydration Feet Hearing
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Poor balance
Blood Pressure
A trip
Medication
Medical Problem
Urinary Tract Infection
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Why do older people fall?List all the environmental risk factors you
think could make an older person more likely to fall
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Risky Behaviour
Trip Hazards
Slippery Surfaces
Footwear
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Look for the cause!
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Medical problem Medication Postural
Hypotension UTI Balance Environmental
risks
Refer DoctorDoctorDo L/S B.P. Refer DoctorDipstick – treatKeep active;
exerciseRemove hazards
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Complete when older person falls Fill in demographics Turn to back page Yes or no to risk factors Decide if action one you can do – tick when
done Turn back to front and refer appropriately Send a copy to the G.P.
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B.&.N.E.S. G.P. All syncope Unexplained falls – 2 or more in a year Poor balance and at risk of falls
Multidisciplinary team Investigations Balance Exercise Course Referral by clinician – G.P.
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Help the aged research http://www.helptheaged.org.uk/ Google don’t mention F word Older people don’t acknowledge the need Fear of consequences Need to concentrate on the positive
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I wonder why they fell?