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Falls Prevention Awareness. Mary McElroy Quality, Safety and Patient Experience Lead Nurse Public Health Agency. Content. Introduction to Falls Prevention Risk factors for Falls Why do people Fall? Effect of Falls What can we do? Hazards. Introduction to Falls.
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Falls Prevention Awareness • Mary McElroy • Quality, Safety and Patient Experience Lead Nurse • Public Health Agency
Content • Introduction to Falls Prevention • Risk factors for Falls • Why do people Fall? • Effect of Falls • What can we do? • Hazards
Introduction to Falls • World 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 levels’ • Excluded: • -major internal event e.g. stroke • Being hit by an external force e.g. knocked over
Falls Statistics • Approx one third of people >65 fall each year • Approx half of people >80 falls each year • Approx 9% of older people who fall will become too afraid to leave their homes due to fear of falling again • 10% of hip fracture patients will die within 1 month of their fracture and 30% will die within the first year • 40 - 60% of falls result in injury • •20% of older people require medical attention after a fall • 5% sustain a fracture. • Injurious falls add to the pressures on health services • A significant number of falls are preventable
Risk Factors for Falls • Psychological • Reduced motivation/depression • Memory problems/confusion e.g dementia • Environmental • Unsafe walking aids • Inappropriate footwear • Home hazards – lighting, dogs, loose mats, grandchildren, wires, hosepipes • Transfers – bath, stairs bed, chair • Medical • Polypharmacy • Postural hypotension • Medical condition e.g. PD • Poor Hydration • Anaemia • Physical • Reduced balance • Walking problems • Reduced muscle strength arms/legs • Poor vision • Poor hearing • Loss of sensation in the feet
Effects of Falling • Physical • Fractures (hip) • Pain • Bruising • Head injury • Hypothermia • Infection • Other MSK injuries • Psychological • Loss of confidence • Loss of motivation • Isolation/loneliness • Depression/anxiety • Fear of further falling • Functional • Loss of independence • Increased dependence • Impact on social care cost REDUCED QUALITY OF LIFE
Those with a fear of falling have been shown to have: • An increased risk of falling • • Reduced activities of daily living • • Lower self-confidence • • Higher medication use • • Lower 36-Item Short Form Survey (SF-36) scores (quality of life) • • Higher levels of social isolation and depression • • An increased dependence on social care support/earlier admission to care facilities.
Fear of falling and falls self-efficacy can be improved • with appropriate regular exercise. • .
First Fall • Not all falls will be prevented and of those who fall, half will fall again within the next twelve months. • Identifying the first fall is therefore important as this provides an opportunity to implement evidence based interventions to reduce the likelihood of a second fall from occurring.
The National Institute for Health and Care Excellence (NICE) Clinical Guideline 161 • NICE Clinical Guideline 161 recommends:- • All older people who have had a fall or are identified as having gait or balance problems should have a multifactorial falls assessment and a multifactorial intervention plan by a healthcare professional with appropriate skills and experience. NICE have identified the following interventions as being common to successful multifactorial interventions: • 1. Strength and balance training • 2. Home hazard assessment and intervention • 3. Vision assessment and referral • 4. Medication review with modification/withdrawal • To implement the evidence base, a person may require a multi-professional and multiagency approach.
Falls prevention • 8 tips to stay steady • Exercise - tailored exercise programmes can reduce falls by 54% • Check your eyes and hearing • Look after your feet • Ask about your medication • Get enough Vitamin D • Eat a diet rich in calcium • Check for home hazards • Visit your GP/ local falls service
Practical • Can you walk on a ‘tight rope’? • Can you stand on one leg for 10 seconds with your eyes closed • Can you walk backwards on your tiptoes
Time to exercise Tai chi Chair based exercises
Northern Ireland Falls Awareness Campaign • Public Health Agency (PHA), in partnership with councils across Northern Ireland, has produced a falls prevention video to raise awareness of the measures we can take at home to prevent falls. (Jan 2019) • “Falls continue to be the leading cause of serious injury and accidental deaths at home with the incidence of falling increasing as people get older. The Health Survey for Northern Ireland 2017/18 found that 23% of respondents aged 55+ years reported having had a fall in or around their home in the last two years.” • incorporating small changes into your everyday routine can be really beneficial in preventing an accident at home.
Protective measure • Remove hazards that could cause a trip. • Engaging in regular physical activity to develop and maintain strength and balance are particularly important as we get older. • Exercises designed to improve muscle strength, some of which are highlighted in the video, can reduce your risk of a fall by improving your posture, coordination and balance,” • Keeping an eye out for potential hazards can make your home a safer place
Steps you can take you cantake to helpprevent a fall in the home include: • •Keep your stairs free of clutter – do not leave items lying on the stairs that could cause a trip or fall; • • Ensure your home is well lit (use high wattage low energy light bulbs) and always put lights on at night, especially when getting up during the night; • • Remove all loose/ worn mats; • • Avoid trailing leads/ wires; • • If you use slip resistant mats in the bath and shower, ensure they are used appropriately, removing them after use to air dry and cleaning the soap suds that can build up and cause a slip; • • Mop up any water/ spillages as soon as possible; • • Have broken or uneven pathways outdoors repaired.
Home Adaptation • Your home can be adapted or equipment provided in order to minimise your risk of falling. You can be referred to an Occupational Therapist who can assess your needs and potential safety risks in the home. For social housing tenants you can obtain additional lighting, stair rails and other minor adaptations directly from your housing provider. For more information contact the Home Safety Officer at your local council.
A number of simple checks canalso be carried out to reduce the risk • Check your eyesight – good vision has a major role in how you maintain your balance. Eye tests are free for everyone over the age of 60; • Look after your feet – as you get older, the size and shape of your feet may change so always have your feet measured when buying new shoes. Choose footwear that has a back with a strap, velcro or preferably laces to secure them tightly. Avoid high heels and slip-ons; • Bone health – osteoporosis is known as the silent illness and results in more fragile bones that will break more easily, often as a result of a fall. There are a number of risk factors that can increase your likelihood of developing osteoporosis such as family history, smoking, drinking alcohol, long term immobility, early menopause, previously fractured bones and certain medical conditions. If you think you might be at risk of this condition you should contact your GP;
Simple checks to reduce the risk • Exercise and physical activity – activities that improve muscle strength in our legs, arms, back, shoulders and chest are particularly important as we get older. They can make it easier to get up out of a chair, and improve our posture, co-ordination and balance which reduces our risk of falling. Exercise must be performed at least three times a week for effective falls prevention. • Be aware of your alcohol intake, as people get older their tolerance to alcohol decreases. The alcohol guidelines recommend that both men and women drink no more than 14 units per week and that it is best to spread this evenly over three days or more. You may also need to be mindful of how alcohol can affect medication that you may take – always ready the label.
http://pha.site/StaySteady • https://www.nidirect.gov.uk/articles/keeping-mobile-and-preventing-falls
Did you miss anything • Other hazards: • Deactivated fire alarm • Overloaded outlets • Cloth on space heater • Smoking – cigarettes left unattended • No automatic shut-of on coffee maker • Newspapers to close to lamp • Falls hazards: • Stairs without handrails • Loose extension cords in traffic areas • Outdated medication in cabinet • Open bottles of medicines • Loose rugs • Clutter on staircase • Flip-flop slippers • No handle on door
For further information or advice on falls prevention or to get a copy of the Strength and Balance Exercise book contact the Home Safety Officer at your local council
