sara taylor senior physiotherapist jan benfold senior occupational therapist babington specialist...
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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
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