Perth & Kinross Community Alarm/ Telecare Project

1. Perth & Kinross Community Alarm/Telecare Project Wednesday 9th February 2010 Carolyn Wilson Falls Service Manager P&K CHP 01738 473146 carolynwilson@nhs.net Liz Adams Community Alarm Falls Screener P&K Council 01738 458073 EAdams@pkc.gov.uk

2. Aims • To develop a pathway for community alarm clients who are repeatedly falling to be identified early and considered for falls assessment/ intervention to reduce future falls risk • To further enhance the role of Telecare in developing falls prevention/management pathways at a local level • To consider options around potential service models, outlining the implications of each

3. Overall Project Objectives • To reduce number of falls and subsequent injury by developing a robust, streamline and timely system for identifying repeat fallers using the Community Alarm service. • To enable early screening/assessment of repeat fallers with appropriate follow on to specialised service e.g. Falls Clinic or other Health and Social Care service • To increase uptake to the above services by allowing clients to make better informed decisions through providing a greater understanding of the benefits of the services • To reduce number of avoidable admissions/readmissions to hospital and care homes as the result of a fall. • To share good and bad practice/experience Nationally with other Community Alarm/Telecare/Community Care and Falls Services

4. Outcomes from Phase I • From July to September 2009, 36 letters sent to repeat community alarm fallers • 4 contacted/attended the Falls Clinic • Therefore only 1 in 9 responded! • Poor uptake probably due to “cold” letter arriving and requesting client responds.

5. Proposal - Phase II - • Employ a dedicated “Community Alarm Falls Screener” 14 • hours/week • Undertake follow up home visit (anticipate 4/week) to repeat • fallers (Perth/Crieff/Auchterarder clinic areas) to complete falls • screening/assessment to identify causes of falls. • Identify and rectify any remedial interventions • Consider referral pathways to Health or Social Care Service. • If appropriate - discuss with/refer to Falls Clinic • Telephone follow up to clients in Blairgowrie/Aberfeldy clinic • areas with follow on referral to falls clinic if appropriate. • Compare the above two systems

6. Phase II Progress to Date • Community Alarm Falls Screener commenced duty – 9th August 2010 • Induction/Preparation/Training/Falls Clinic • From Sept 10 to Jan 11 - 51 home visits carried out • Client telephoned in advance with follow up letter confirming appointment • Falls screening form developed • GP letter developed • Database developed

7. Identified Causes of Falls

8. Other Causes include • Balance due to ear operation/double vision • Light headedness • Missed door handle/rail • Slid off bed while wife using slide sheet • Multiple Sclerosis weakness/symptoms • Problems transferring from wheelchair • Diabetes • Low blood glucose associated with too high dose insulin

9. Interventions Required

10. Referral for Telecare Equipment

11. Further Advice offered includes • Appropriate use of Zimmer • Use of bath lift and on not bathing when alone. • To attend GP to discuss light headedness • To not use towel rail to pull himself off toilet • On bi-focal glasses • To always using walking sticks • Not to furniture walk • Regular eye tests • Healthy diet and keeping active • To always wear Community Alarm • Dangers of trailing wires

12. Client’swishes • Reluctant to attend clinic • Happy to attend clinic. Would like rail for back steps into garden • To be left alone – to be independent • Wants to regain confidence • Wants to be able to mobilise more • Wants to go on as she is – doesn’t think she needs or wants any follow up • Looking for advise exercising/appropriate use of wheelchair and zimmer • Left alone – not co-operative with suggested changes • Increase confidence and go back to being independent • Couple feel they are managing well and very happy with OT and Community Physio input • Feels mobility is improving and he is doing fine

13. Findings • From the 25 clients who have been on > 3 months there was a reduction of 28 falls compared with the 3 months prior to the service. i.e. 59 falls 3 months prior to the service compared to 31 post service. • 5 clients have reached 5 month post service. Compared to the number of falls 6 month pre-service the falls rate have reduced from 41 to 31. (client 3 falls have increased from 14 falls 6-month prior to the service to 19 falls 5 months after the service!) • Of the 51 clients seen 14 have been referred on to a Falls Clinic i.e. 27%.

14. Client 3 • 70 year old lady, retired nurse • Diagnosis: Postural hypotension • Osteoporosis • Recent fractures of T9 and L2 following a fall • Previous fractured neck of femur • Alcohol predominant factor • Culprit drugs include Bisoprolol, Oxybutynin, Citalopram • Mobility – WZF however could manage sticks • Referral to Social Work OT’s for provision of a walking trolley • Referral for day care placement • Lonely and isolated. • 14 falls, 6 month prior to service to 19 falls, 5 months after intervention. • 8 of these falls occurred between the 9th and 17th December.

15. Time offalls

16. Developments required • Identify cost savings in terms of reduced callouts. • Organise direct interview and/or questionnaire how the falls screening/falls assessment has impacted on outcomes for service users using Talking Points.