Sara TaylorSenior physiotherapist

Jan BenfoldSenior Occupational Therapist

Babington Specialist Falls CilincSeptember 2014

Contents• Introduction to falls and statistics• Discussing risk factors for falls• Effects of falls• Discussion of falls prevention (tips to staying

steady)• Outline of falls service for Amber Valley• Practical session on balance• Questions and open discussion to finish

Introduction to fallsWorld Health Organisation defines a fall as:

“An event which results in a person coming to rest inadvertently on the ground or floor or other lower level”.

Excluded:- major internal event e.g. stroke- being hit by an external force e.g. knocked over

Falls statisticsApprox one third of people >65 fall each yearApprox half of people >80 fall each yearApprox 9% of older people who fall will become too

afraid to leave their homes due to fear of falling againEvery year >223,000 people aged over 60 have a

fracture as a result of a fall. This is more than the whole population of Northampton.

Falls in people aged over 60 account for a cost of £2billion a year

10% of hip-fracture patients will die within 1 month of their fracture and 30% will die within the first year

Risk factors for fallsMedicalPolypharmacyPostural hypotensionMedical conditions e.g. PDPoor hydrationAnaemia

PhysicalReduced balanceWalking problemsReduced muscle strength in legs and armsPoor visionPoor hearingLoss of sensation in feet

PsychologicalReduced motivation/ depressionMemory problems/ confusion e.g. dementia

EnvironmentalUnsafe walking aidsInappropriate footwearHome hazards- lighting, dogs, loose mats, grandchildren, wires, hosepipesTransfers- bath, stairs, bed, chair

Effects of fallsPsychologicalLoss of confidenceLoss of motivationIsolation/lonelinessDepression/anxietyFear of further falls

Physical(Hip) fracturesPainBruisingHead injuryHypothermiaInfectionOther MSK injuries

FunctionalLoss of independence/increased dependence- impact on social care costsReduced mobility/activity- impact on quality of life

Quality of life

Negative circle

Falls prevention8 tips to Staying Steady:1.ExerciseTailored exercise programmes can reduce falls by 54%

2.Check your eyes and hearing3.Look after your feet4.Ask about you medicines5.Get enough vitamin D6.Eat a diet rich in calcium7.Check for home hazards8.Visit your GP/local falls service

MDT roles and fallsPhysio:Assess and treat physical problems e.g.- balance- strengthening - increasing movement- exercise tolerance/ staminaSupply aids to help improve safety of mobility

OT:Look to return patient back to full function, by working on the following aspects:- physical- emotional- social Look into safety aspects within the home environmentLifestyle changes

Nurse:Look at medical issues associated with falls:- Obs- BPs etc- BMs- Skin checks- Continence- Medication checks

RSWs:Glue in teamFollow physio/Ot treatment plansComplete nursing obsTrained in specialist falls groups- chair based, OTAGODeliver equipment to patient's homesNamed key workers for individual patientsFeedback info to therapists and nurses

Falls service- AV Runs weekly on Mondays or Fridays 7 week duration 10.30- 15.00 Full multidisciplinary assessment (Physio, OT, Nurse) with outcome

measures:- Berg, TUAG, FES, Number of falls

Structure group therapy:- Chair based exercise class- OT therapy group- Balance circuit exercises- Tai chi style exercises, Wii rehab or relaxation- Educational talks and group discussions (diet, home safety, getting up of the floor, correct foot ware, medication, benefits of exercise)

Week 7:- retested for outcome measures- ongoing rehab (e.g. OTAGO) arranged

Ideally telephone follow up in 6 months

Linked in services GP Orthotics Nurses Dr Skelly (PD consultant) Dietician Health trainers Care coordinators Neuro outpatients- Ripley

Hearing support services Sight support Day centres e.g. the Glebe Strictly no falling Walking groups Active Derbyshire- village

games Be Active Waistwise Age UK Future homescapes- alarms,

adaptations Medequip

PracticalCan you walk on a “tight rope”?Can you stand on one leg for 10seconds with

your eyes shutCan you walk backwards on your tiptoes

Time to exerciseTai chi

Chair based exercises

Spot the hazards

Did you miss anything?Falls hazards:Stairs without handrailLoose extension cords in traffic areasOutdated medications in cabinetOpen bottles of medicineLoose rugsClutter on staircaseFlip-flop slippersNo handle and no deadbolt on door.

Other hazards:Deactivated fire alarmOverloaded outletsCloth on space heaterSmoking. Cigarettes left unattendedNo automatic shut-off on coffee makerNewspapers too close to lamp

Thank you for listening!Any questions?

References C. Todd and D. Skelton (2004) What Are the Main Risk Factors for Falls

amongst Older People and What Are the Most Effective Interventions to Prevent These Falls? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report. Available at: www.euro.who.int/document/E82552.pdf

Age UK http://www.ageuk.org.uk/professional-resources-home/services-and-practice/health-and-wellbeing/falls-awareness-week-18-22-june-2012/

Spotlight Report 2008 (2008) Help the Aged Age UK and Department of Health calculation combined health and social

care based on 2010 Department of Health and Personal Social Services Research Unit figures (unpublished) and 2011 census

Age UK and Department of Health calculation combined health and social care based on 2010 Department of Health and Personal Social Services Research Unit figures (unpublished)

J. Roche et al. (2009) ‘Effect of Comorbidities and Postoperative Complications on Mortality after Hip Fracture in Elderly People: Prospective observational cohort study’, British Medical Journal, 331 (7529): 1374

http://www.who.int/mediacentre/factsheets/fs344/en/ http://www.phac-aspc.gc.ca/seniors-aines/index-eng.php