Falls Prevention

1. Falls Prevention Updated October 2015

2. What is a fall? • A standardised definition of falls: “An unintended change of position which results in the person coming inadvertently to the ground or other surface lower than the person had been previously. This includes impacting against an adjacent surface (eg, wall or furniture), slips, trips and lowering/assisting a patient who is in the act of falling.” Source: Med J Aust 2006; 184 (8): 379-382

3. Classifying Severity of Falls • Levels 1–4: minor injuries, including grazes and bruises; • Levels 5–6: significant injuries, including lacerations/skin tears requiring suturing/bandage/cold pack, or any injury requiring further investigation such as x-ray; • Level 7: injuries resulting in a fracture, head injury or increased length of stay; • Level 8: injuries resulting in permanent disability or contributing to death. Source: Australian Incident Monitoring System from the Australian Patient Safety Foundation

4. Falls Statistics • Serious problem in the community with 30% of adults aged over 65 experiencing at least one fall per year. • Nearly 85,000 older people were hospitalised after a fall in 2009-2010. • Falls occur in nursing homes at six times the rate they occur at home. Source: Australian Institute of Health and Welfare and the ABS

5. Why do falls matter? • Falls account for 40% of injury-related deaths and one percent of total deaths in elderly. • Falls claimed the lives of 1530 people over the age of 75 in 2011. • While 1292 people from all aged groups died in car accidents in the same time period.

6. Common Injuries From Falls • Superficial cuts and abrasions • Bruises • Sprains

7. Common Injuries From Falls • Fractures: • 2-6% of falls in the elderly lead to: • Radius #’s • Ulna #’s • Cervical Neck #’s • More elderly people will have a fracture following a fall than will have a heart attack, cancer or stroke.

8. Serious Injuries From Falls • The most serious fall-related injuries are fractures of the hip. • The elderly recover slowly from hip fractures. • A third of all patients who suffer from a hip fracture are never able to regain their mobility.

9. Hip Fractures Can Kill • 30-day mortality rate after a hip fracture is 9%. • Rises to 17% if patients have an acute medical problem. • Increases to 65% if the patient has pre-existing heart failure. • Increases to 43% if a patient develops pneumonia after a hip fracture. • 12-month mortality of 20-25%

10. Why Are Hip Fractures Fatal? • Peri-operative complications – • Blood loss following a fall, dehydration due to time spent without aid following a fall can lead to hypovolemia and together with pre-existing coronary artery disease lead to myocardial ischemia and cardiac arrest.

11. Why Are Hip Fractures Fatal? • Post-operative complications: • Cardiac Failure and Myocardial Infarction. • Pulmonary Embolism. • Pressure sores leading to systemic infections due to bed rest. • Bronchopneumonia causes majority of deaths due to immobility.

12. Falls on Quality of Life • Post-Fall Syndrome: • Loss of confidence, hesitancy, tentativeness. • Independent of whether fall lead to physical injury. • Following a fall 48% of people report a fear of falling and 25% limit their activities. • Limits independence and leads to isolation. • Disability from fall and decreased mobility increases likelihood of admission to nursing and increased assistance.

13. Cost of Falls • In 2010 there were 240,000 hospital bed days per year due to falls in the elderly. • In 2013 the total direct cost of fall injuries for people over 65 in the US was $34 billion per year. • Falls costs the Western Australian government $68.6 million per year.

14. Why do Residents fall? • Intrinsic factors:

15. Falls in Dementia • Impaired memory. • Poor judgement when mobilising. • Visual field misinterpretation.

16. Falls in Parkinson’s Disease • Bradykinesia (slowing of movement). • Muscle Rigidity. • Freezing • Impaired posture and balance. • Loss of autonomic movements – arm swing when walking.

17. Why do Residents fall? • Extrinsic factors: • Unsafe environment • Inappropriate equipment • Inappropriate assistance provided

18. What can we do? • Yes we CAN prevent falls….. but we all have to work together!! • Assessment for risk factors by RN • When first admitted • Any major change in medication • After a fall has occurred • Review every 3 months

19. After the assessment…. • Those who are deemed at risk identifiable to staff, eg. star on resident door • Keep those who are at higher risk of falling closer to the nursing station

20. If a Fall Occurs • Call RN immediately (eg. Assist button) • Basic first aid attended as directed by RN • RN attends basic assessment • If appropriate RN assists and directs staff to retrieve resident off floor or make comfortable if resident has to stay in place (eg. # evident)

21. After a Fall Occurs • RN informs necessary parties (eg. Family and GP). • Staff attend incident form. • Physio attends review (all falls, and those referred by ED/DOC) • Message left for PTA in communication book. • Residents who frequently fall or increased incidents must have further investigation including GP review, UA etc.

22. After a Fall Occurs- PTA • PTA ‘investigates’. Discusses details with RN and care staff • Perform room audit • Recommendations with assistance from Physio/RN- Sensor mat, Crash mat, Concave mattress, Mobility review

23. Day to day- reducing the risks • Always lower the bed • Depending on mobility: • Very low for high risk fallers • Slightly higher for residents who ambulate reliably • Ensure phones, remotes, blankets, call buttons are close • Monitor blood pressure and dizziness especially when medications change

24. Day to day- reducing the risks • Keep environment safe- uncluttered, protective mats. • Keep watch and answer calls for help • Calcium and Vitamin D supplements may be indicated. • Keep resident well nourished and hydrated (Dietitian or Speech Path?) • Use of appropriate mobility frames. • Exercise- keep strong and active. • Entertain and occupy.

25. Residents room • Good lighting. • Uncluttered, clean and dry surfaces. • Monitor during and after shower- BP can drop following hot shower. • Avoid bed rails. • Appropriate seating (ergonomic height) • Commode- Resident can become anxious if they feel toileting is ‘urgent’.

26. What else can we do to help? • Good footwear and foot care (Podiatrist?) • Clean up spills. • Try to anticipate toilet/fluid/food needs. • Ensure the resident is given time to adjust to position changes. • Encourage wearing of glasses as necessary.

27. Palliative • Specific ideas for residents who are palliating: • Regular monitoring by care staff. • Reduce sources of anxiety where possible, ie. Toileting needs, call buzzer accessible, pain relief at optimum levels. • Harm minimisation strategies may be required, eg. concave mattress, bed or floor sensor, ‘crash’ mats.

28. Use of Traditional Restraints • Why not use physical restraints? • If poorly used, can increase risk of injury! “A restraint-free environment is seen as a basic human right for all and care recipients are entitled to respect and protection of their basic rights and freedoms, regardless of whether the care is being provided in a residential aged care setting or within the care recipients own home” http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-decision-restraint.htm • Restraints are being PHASED OUT! • They are seen as unethical

29. More Information • Google and Google • Lots of great websites dedicated to falls prevention • Department of Health (federal) • QLD health and ACT health