Coventry Falls

Physiotherapy

Service Community Therapy Network

Annual Conference

Clare Mee

Community Physiotherapy

Lead and Community Neuro

Rehab Team Operational Lead

Definition

“an unexpected event

in which the

participant comes to

rest on the floor or a

lower level”

(Lamb, 2005)

Report reveals the cost of falls among older people :

Chartered Society of Physiotherapy

PCT population of 320,000 – • 45,000 aged 65+

• 15,500 falls each year

• 6,700 fall twice a year (or more)

• Cost of care and treatment – 70% higher after

fall, compared with previous year

“Physiotherapy lead falls prevention

services…..extremely effective in reducing

falls and fractures among 65+”

Impact

• Reduction in Quality of Life

• Decreased confidence

• Decreased activity levels

• Psychological impact

• Increased isolation

Falls Guidelines

NICE Guidelines CG161 Falls: The Assessment and Prevention of Falls in Older People (June 2013)

• Patient Centred Care

• Case/risk identification

• Multifactorial falls risk assessment

• Multifactorial interventions

• Strength and balance training

• Education and Information giving

• Environmental Adaptations

• Professional education

Access • GP’s ~ 30%

Refer for non medical intervention

by Physiotherapy

• UHCW ~ 30% Dr Chaudhry and Zahid Zaheer

– Falls Clinic (10%)

Emergency Department/REACT

Therapists on wards

Integrated discharge teams

• CWPT ~ 30%

Locality therapists/Fast Response/Community Matron/District Nurses

Coventry Musculoskeletal Service/Podiatry

Community Physio

CMHT

• Other ~ 10%

Criteria to attend

• At risk of falling/ previous falls

• Over 65 years of age – 91% 70yrs +

• Fully weight bearing

• Able to understand/comply

• Balance/physical cause of falls

• Motivated to participate

• Cardiovascular stability

• Able to attend Newfield House

Assessment • Multi-factorial assessment

Poly pharmacy Osteoporotic risk

Cognition Functional ability

Footwear Continence

Vision Assessment of home hazards

Hearing

Physiotherapy assessment;

• Falls History – mechanical, medical, environmental, unexplained

• Past medical history and medication

• Balance – Validated Outcome Measures; TGUG, Berg Balance, Short FES-I, EMS.

• Muscle Strength, ROM, gait analysis, gait aids, pain, ADL’s.

• Person centred goals – Goal Attainment Scale – Quality Goal

• Signposting

Assessment

• Environmental assessment questionnaire; – Completed by patient/carer

prior to attending for assessment

– Onward referral onto • Pathway locality Occ. Therapy

• OPAL – Environmental Adaptations

• Coventry Integrated Equipment services

Treatment • Provided with individualised Otago exercise booklet

– Expected to perform exercises 3-4 x week at home

• Patients attend weekly - – Newfield House for a 7 week programme

• Review week 7 – Group session - Individual exercise plans

– Supervised by physiotherapist and assistant

– Strengthening and balance exercises

– Backward chaining

– Education sessions provided

– Discharge Planning

Review

• Patients receive telephone follow-up after 6

months of discharge from service

• Review short FES-I

• Planning

• Patients can contact during this period if having

problems/further falls

Physical outcome measures

July 2013

improved, on average by 20-30%

Outcomes Patient Satisfaction

• 100% strongly agree/agree

that they were involved with

goal planning

• 100% strongly agree that

they would recommend the

service to friends and family

• 0% in re-attendance at Accident and

Emergency due to a mechanical fall

• 20 % return to reassessment

• 10 % attend classes again

“The falls classes

…gave me

reassurance and

confidence to go out

alone and took away

the vulnerability

when going out

alone..”

“My treatment and care

was excellent and most

helpful as the lessons

progressed I became

much more confident

and sure of myself and

my ability to do the

exercises.”

Challenges Strategy to over come Challenge

Uncertainty regarding substantiation Close working with Commissioners

Substantiated service

Service specification

Inappropriate referrals/ time management Development of new referral form

Discussions/training with other HCP

Bench marking – shadowing service

Back to the Floor

Meeting the NICE Guidelines Multi Factorial Assessment

Individualised treatment programme

Low level patients - on Berg Assessment

Advice/ re-education

Benchmarking – nationally and locally

Transport EAP

Volunteer transport

Taxi

PTS

Dementia in Falls Classes Pilot Group

Train the Trainer

EBP / Networking

Assessment and class capacity/Demand Appointment – 2.0 WTE band 6

Increase capacity – classes and assessment clinics

Maintenance of progress Current Project –Liaison with Age UK, Coventry

Benchmarking

GANTT chart

Developments

Service now substantiated – March 2013 - Community Physiotherapy

Capacity increase - assessments sessions and classes at Newfield House

Falls Awareness week – “BEST FOOT FORWARD” 17th- 21st June 13

Radio Interview – BBC Coventry and Warwickshire

Service promotion – locality, REACT, Age UK, Falls Clinic, GP’s, charities,

organisations,

Back to Floor – Rachel Newson; Chief Executive CWPT

ICON FES to measure objective concern of falling

CSP Quality Goals 2013/14

- Friends and Family Test

- GAS – patient centred goal planning

Patient focus group

Benchmarking - “to be the best we can be” – South Warks

Evidenced based practice - OTAGO, Vestibular Rehabilitation, FES-I, Tai Chi

- Streamlining referral into Community Exercise

classes – AGE UK, One Body One Life

Award Winning Service

Questions

http://nww.covwarkitc.nhs.uk/pt/departmentsservices/falls

Contact; clare.mee@covwarkpt.nhs.uk

024 76 237051 – to discuss referral

References

• Department of Health (2011) ‘Equality and excellence: Liberating the NHS’ Available online - http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353 Accessed 9/12/2011

• Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community (Review). Cochrane Database of Systematic Review.

• Lamb SE, Jorstad-Stein EC, Hauer K, Becker C (2005) Prevention of Falls Network Europe and Outcomes Consensus Group. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. Journal of the American Geriatrics Society

• Sherrington, C. Whitney, J.C., Lord, S.R., Herbert, R.D. Cumming, R.G., Close, J.C. (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. Journal of American Geriantrology Society, 56 (12), 2234

• Tinetti ME, Williams CS. (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med; 337: 1279–84.

• Campbell et al, (1997) Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 25;315(7115):1065-9.

References

• Pothula, VB et al (2004) Falls and Vestibular Impairment. Clinical Otolaryngology 29 179-182

• Li et al (2005) Tai Chi and Fall reductions in older adults: a randomized controlled trial. J.Gerontol A Biol Sci Med Sci. 2005 Feb;60(2):187-94

• Leung DP (2011) Tai Chi as an intervention to improve balance and reduce falls in older adults: A systematic and meta-analytical review

• Lee et al (2011) Systematic reviews of Tai Chi: an overview. J Sports Med 2011 May 16

• Skelton et al (2005) Group exercise reduces falls in Community Dwelling Older frequent Fallers (an RCT) Age and Ageing 34(6):636-639

• Gertrudis et al (2008) The Short Fes-1: A Shortened version of the Falls Efficacy Scale – International to assess fear of Falling. Age and Ageing 37:45-50

Useful Links

• Later Life Training for specialist exercise in falls prevention www.laterlifetraining.co.uk

• National Institute of Clinical Exercise (NICE) Guidelines for Falls Prevention CG 161 www.nice.org.uk

• National Service Framework for Older People www.dh.gov.uk

• Visit Age UK www.ageuk.org.uk/health-wellbeing/national-falls-awareness-week