WORCESTERSHIRE FALLS PREVENTION STRATEGY Jackie Threshie Falls Prevention Coordinator Worcestershire Primary Care Trust

1. WORCESTERSHIREFALLS PREVENTION STRATEGYJackie ThreshieFalls Prevention CoordinatorWorcestershire Primary Care TrustApril 2009

2. As the older population within the developed world increases the prevalence of falls is set to rise One third of individuals over the age of 65 experience at least one fall a year (Royal Society for the Prevention of Accidents) This figure increases to more than half in those over 80 years of age. As age and frailty increases individuals are more likely to be admitted to hospital The most common diagnosis necessitating admission is fractured neck of femur.( increase prevalence of osteoporosis) National and local figures show high mortality rates for fractured neck of femur Care home residents fall more frequently. 30 – 50% fall each year and of these 40% experience recurrent falls. FALLS BACKGROUND

3. Current estimated and predicted populations (> 65 years of age) in each of the Worcestershire local authorities and calculated incidence of falls.

4. FALLS BACKGROUND IN WORCESTERSHIRE • Falls account for at least ¾ of accident related admissions • Most falls were on the same level and most occur at home • Rise in falls particularly marked in Wyre Forest, Wychavon, Worcester and Malvern • Between Jan and Dec 2008 there were 2266 individuals over 64 years of age were admitted to hospital (age specific admission rates doubled in over 80’s) • Most common diagnosis fractured neck of femur (33%)

5. FALLS BACKGROUND IN WORCESTERSHIRE • Between Jan and Dec 2008 there were 581 cases of fractured neck of femur in individuals over 64 years of age • Average length of stay is 13 days for a fall, rising to 19.6 for a fractured neck of femur • Total length of stay including community hospital can increase up to 30 days plus • National and local figures for injuries like fractured neck of femur have high mortality rates. (figures for England and Wales estimate mortality as 10-20% in first year. locally in 2002/3 to 2005/6 this figure was found to be 9.5%) • Long term research shows 20% patients with fractured hip are non ambulatory after one year and those who are mobile only half do so independently. 50% require long term care and assistance. Approximately one third become fully dependant.

6. FALLS PREVENTION EVIDENCE • Over 400 risk factors • Multi factorial Interventions – reduces loss of function and independence / reduces financial implications Multi factorial interventions should have opportunities for:- • Increased physical activity – falls prevention specific • Medication review – poly pharmacy/bone health • Reduced alcohol consumption • Regular eyesight review • Improved understanding of potential home hazards • Regular foot care • In addition – Awareness raising / process for identification of those at risk – Level 1 falls risk screening tool

7. FALLS PREVENTION EVIDENCE Residents in long term care also need multi factorial interventions:- • Clinical assessment and medical review • Medication review – poly pharmacy/bone health • Sensory impairment review • Injury minimisation e.g. hip savers • Assisted technology e.g. chair/bed alarms • Environmental modification – general areas and personal space • Training of staff, residents and families • One to one exercise programs – falls prevention specific

8. INITIAL WORK • Stakeholder Day February 2008 – Care planning partnership • Falls prevention group ( also falls pathway, fractured neck of femur and discharge and rehab groups) • Developing a Falls Prevention Strategy • Employment of Falls Prevention Coordinator • Older people remit of Health Improvement Coordinators

9. MAPPING OF CURRENT PROVISION • Hospital based provision – 3 Physician led falls clinics • Community based provision – GP/ Allied health care professionals • Voluntary sector and further health and wellbeing/falls prevention initiatives:- • Care and repair Healthy living projects • Foot care scheme Mobile assessment OT • Extend classes Telecare services • Walking clubs Falls information days • Well check service Falls prevention website • Wise and Well events Postural stability pilot • Awareness raising sessions Falls information

10. MULTI SERVICE PLAN • Five key strands:- • Awareness raising with professionals and agencies • Awareness raising with the public • Specialist training opportunities • Mapping of relevant activity / identification of gaps • Introduction of a Level 1 Falls risk assessment

11. ACTION PLAN - PRIMARY PREVENTION OF FALLS • Develop a County wide falls prevention steering group • Develop Training packages • Work with Communications plan • Carry out Mapping exercise and develop directory • Develop Falls training for care homes and domiciliary agencies

12. ACTION PLAN - PRIMARY PREVENTION OF FALLS • Develop and roll out Falls prevention charter • Encourage a Falls Champion philosophy • Roll out Level 1 falls screening tool • Develop process for monitoring incidence of falls • Review of foot care schemes • Review Bone health