Dame Kate Harcourt DCNZDame Kate Harcourt DCNZ

STORY BOOK

PHOTO ALBUM

This resource has been prepared by the Health Quality & Safety Commission’s national programme, Reducing Harm from Falls, for use by health service providers in their falls prevention programmes.

It comprises:

Key messages about falls prevention

Short and long form stories about Dame Kate’s fall

Images presented with falls prevention messages and suggested captions. No permissions are needed. Each image is available as a high resolution download from the webpage here.

For further information, please contact: Linley Boniface, Communications Advisor, Health Quality & Safety Commission

Mobile: 027 948 1700 Email: linley.boniface@hqsc.govt.nz

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 1

[KEY MESSAGES]

Preventing falls in the community

Reducing the harm caused by falls like Dame Kate’s was the first focus area of the national patient safety campaign, Open for better care.

The campaign began with a focus on reducing the harm caused by falls in hospital, and has since moved on to concentrate on falls in age-related residential care and the community.

In the community, the emphasis should be on managing older people’s underlying medical conditions, maintaining their independence and keeping them safe at home – these are priorities on discharge from hospital and in primary care.

Measures that can help prevent falls among older people living in the community include:

asking if they have had a fall in the past year as one of three simple falls risk screening questions (see the Ask, assess act project for a pocket card and further information)

offering multifactorial assessment and intervention for older people who answer positively to any one of the three screening questions

working on reducing falls risk in partnership with older people and their family/whānau

making homes safer by reducing potential trip hazards (eg. by using the home safety checklist ACC5128 How safe is your home?

encouraging older people at risk of vitamin D deficiency to seek advice from their GP or the health professional they see the most on whether they should be prescribed a vitamin D supplement.

supporting older people to stay active and exercise regularly

referring older people to exercise programmes to improve balance and increase lower body muscle strength - key contacts for matching patient/client needs with local programmes are Green Prescription coordinators and ACC community injury prevention consultants (enquire for contact details at information@acc.co.nz).

For more information, see /www.hqsc.govt.nz/our-programmes/reducing-harm

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[SHORT STORY]

Dame Kate Shares Her Falls Story

Veteran actress Dame Kate Harcourt has had first-hand experience of the impact of a fall.

Dame Kate, 86, suffered a broken arm, nose and eye socket after tripping on a piece of wood outside in her front yard.

Dame Kate lives in Wellington with her daughter, actress Miranda Harcourt, son-in-law Stuart McKenzie and their three children: Thomasin, 13, Peter, 14, and Davida, 5. Miranda and Stuart were away when Dame Harcourt fell, but the three children joined forces to help.

Thomasin phoned an ambulance and contacted both sets of neighbours, Davida sponged the blood off Dame Kate’s face, and Peter went with his grandmother to hospital.

Falls can happen to anyone – neither Dame Kate nor her family expected her to fall.

Dame Kate’s fall exacerbated a back problem that made walking painful. Three months on from the accident, she was still having physiotherapy to recover movement in her hand.

The worst thing about the fall, says Dame Kate, was being unable to drive for six weeks, restricting her trips to the library and to see friends.

Dame Kate’s experience gave her a new awareness of the risk of falls, the importance of keeping homes free from hazards, and the need for older people to tell their GP if they’ve had a fall so that any contributing health problems can be investigated.

“I know I’m jolly lucky my fall wasn’t a lot worse, but it has still had a big affect on my life,” says Dame Kate. “I think it’s important for everyone to work together to do everything possible to prevent falls.”

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[LONG STORY]

Dame Kate Shares Her Falls Story

Veteran actress Dame Kate Harcourt has had first-hand experience of the impact of a fall.

Dame Kate, 86, was leaving her Wellington home in the early evening to pick up her grandson when she tripped on a piece of wood in her front yard. She tumbled into the bonnet of her car and was knocked unconscious.

Her next memory is of waking up in hospital with a broken arm, nose and eye socket.

Dame Kate lives with her daughter, actress Miranda Harcourt, her son-in-law Stuart McKenzie, and their three children: Thomasin, 13, Peter, 14, and Davida, 5. Miranda and Stuart were away when Dame Harcourt fell, but Thomasin heard her grandmother moaning.

Fearing Dame Kate had been attacked, Thomasin went to the balcony of the house to see what had happened. When she saw Dame Kate was alone, she phoned an ambulance and contacted both sets of neighbours.

One neighbour went to pick up Peter while the other – a doctor – stayed with Dame Kate until the ambulance arrived.

Davida brought out a bowl of water and a sponge to clean away the blood on her grandmother’s face, and Peter arrived home in time to go to hospital with Dame Kate in the ambulance.

“My grandchildren were marvellous. I’m very proud of them,” says Dame Kate.

Falls are the leading cause of injuries to older people, and can happen to anyone. Neither Dame Kate nor her family expected her to fall, even though she’d broken her arm tripping over a garden hose a few years ago.

The worst thing about the fall, says Dame Kate, was being unable to drive for six weeks. Her family did her grocery shopping, but she wasn’t able to go to the library – she reads five books a week – or attend a regular Monday lunch with friends. She also had to cancel a voiceover job.

Three months after Dame Kate’s fall, the cast on her arm had been removed but it hurt to carry anything heavy. She was having physiotherapy to recover movement in her hand.

The fall also exacerbated an existing back problem, which made walking difficult. Walking is her main way of keeping fit, and Dame Kate knows fitness can help prevent falls.

Home safety is another way to reduce the likelihood of a fall. All the rugs in Dame Kate’s house have been removed, and she has a torch on her keyring to use whenever she goes outside in the dark.

Dame Kate is now more aware of the danger of falls, and of the need for older people to tell their GPs if they’ve had a fall so that any contributing health problems can be investigated.

“I know I’m jolly lucky my fall wasn’t a lot worse, but it has still had a big affect on my life,” says Dame Kate. “I think it’s important for everyone to work together to do everything possible to prevent falls.”

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 4

GENERAL PORTRAITS

ID Image Falls message Possible caption/s or text Use with

HQSC342 Dame Kate Harcourt had a fall at home, fracturing her wrist. She has agreed to be the ‘face’ of the Health Quality & Safety Commission’s national falls programme.

“I know I’m jolly lucky my fall wasn’t a lot worse, but it has still had a big effect on my life,” says Dame Kate. “I think it’s important for everyone to work together to do everything possible to prevent falls.”

General falls prevention communications

HQSC356 Dame Kate Harcourt has agreed to be the ‘face’ of the Commission’s national falls programme. She had a fall at home, fracturing her wrist.

Any fall, with or without injury, is a reason to implement an individualised plan of care that addresses an older person’s risk factors for falling.

In particular, a fracture in an older person should prompt assessment of bone health for risk of osteoporosis.

(See below for a note about fractures related to osteoporosis).

General falls prevention communications

Brief note about osteoporosis and risk of fragility fracture Fractures in both women and men aged 50 years and over should be considered fragility fractures until osteoporosis is ruled out.1 Individuals who suffer a first fragility fracture are at double the risk of future fractures compared with those who have never broken a bone, 2

and at least half of those who break their hip have suffered a prior fragility fracture. 3,4

1 Eisman JA, Bogoch ER, Dell R et al. 2012. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. Journal of Bone and Mineral Research 27(10): 2039–46.2 Kanis JA, Johnell O, De Laet C et al. 2004. A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2): 375–82.3 Gallagher JC, Melton LJ, Riggs BL et al. 1980. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clinical Orthopaedics and Related Research 150: 163–71.4 Port L, Center J, Briffa NK et al. 2003. Osteoporotic fracture: missed opportunity for intervention. Osteoporosis International 14(9): 780–4.

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 5

THEME: PREVENTING FALLS AND PROTECTING INDEPENDENCE

ID Image Falls message Possible caption/s Use with

HQSC289 The risk of falling does increase with age, but the good news is, you can do something about it.

Older people (or their families and caregivers) can go online to learn about falls. Dame Kate has opened ACC’s booklet ‘Standing up to falls’ (ACC 2383 Standing up to falls). Find the booklet and other resources at www.acc.co.nz/older-people .

Ask, assess, act project

Topic 1Topic 2Topic 3Topic 4

HQSC082 The risk of falling does increase with age, but the good news is, you can do something about it.

ACC’s booklet ‘Standing up to falls: your guide to preventing falls and protecting your independence’ is a good resource (ACC 2383 Standing up to falls).

Ask, assess, act project

Topic 1Topic 2Topic 3Topic 4

HQSC093 The risk of falling does increase with age, but the good news is, you can do something about it.

Advice about falls prevention from health professionals has credibility – family members and caregivers can also follow and reinforce these messages.ORACC’s booklet ‘Standing up to falls: your guide to preventing falls and protecting your independence’ is a good resource (ACC 2383 Standing up to falls).

Ask, assess, act project

Topic 1Topic 2Topic 3Topic 4

HQSC108 The risk of falling does increase with age, but the good news is, you can do something about it.

Genuine concern helps establish rapport and trust for a positive conversation about preventing falls and protecting an older person’s independence.

Ask, assess, act project

Topic 1Topic 2Topic 3Topic 4

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 6

THEME: EXERCISE FOR BALANCE AND STRENGTH

ID Image Falls message Possible caption/s Use with

HQSC004 Balance and strength exercises can be done at home.

Dame Kate looks at a balance and strength exercise leaflet with Gillian Watson, physiotherapist for older adults, Capital & Coast DHB.

Ask, assess, act project

Topic 9

HQSC031 Balance and strength exercises can be done at home.

Dame Kate is using the kitchen bench for support in these exercises. ORGillian Watson encourages Dame Kate to maintaining good posture while exercising – “Think of a plumb line”.

Ask, assess, act project

Topic 9

HQSC037 Balance and strength exercises can be done at home.

The single leg stand exercise is very effective for improving balance. Ask, assess, act project

Topic 9

HQSC044 Balance and strength exercises can be done at home.

Dame Kate on tip toes (the calf raise exercise), which helps balance and lower limb strength.

Ask, assess, act project

Topic 9

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 7

HQSC304 Balance and strength exercises can be done at home.

Gillian Watson says: “Lots of people find it hard to get out of a low chair. Lean forward and use your hands to push forward.”

(However, if an older person cannot get out of a dining chair without using their hands, then they have a high fall risk because of poor lower limb strength. Using a dining chair for the ‘sit-to-stand’ exercise is good for balance and lower limb strength.)

Ask, assess, act project

Topic 9

HQSC426 Keeping active and enjoying the outdoors is important.

Enjoying the sunshine outdoors also helps vitamin D levels. From September to April, take a walk or do outside activities in the

early morning or late afternoon. Remember to be SunSmart through the middle of the day.

From May to August, take a walk or do outside activities in the middle of the day, with your face, arms and hands uncovered.

Topic 9(see also images 406, 410, 412 with messages about safe sun exposure to increase vitamin D levels)

HQSC433 Keeping active and enjoying the outdoors is important.

Keeping active and enjoying the outdoors is important.ORGillian Watson says, “Pick an activity you enjoy for your exercise routine, such as walking outdoors”.

Topic 9

HQSC436 Keeping active and enjoying the outdoors is important.

Gillian Watson says: “Walking on a slightly uneven surface such grass is a good challenge for your balance – use it or lose it!”

Topic 9

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 8

THEME: ENSURE APPROPRIATE FOOTWEAR

ID Image Falls message Possible caption/s

Use with

HQSC168 Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability.

Gillian Watson says: “This shoe ticks all the boxes: it’s fitted around the heel with straps over the top and it has a medium weight flexible sole.”

Ask, assess, act project

Topic 2Topic 3Topic 4

HQSC177 Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability.

Dame Kate likes the velcro straps on this shoe – it makes it easy to get them on and off, and easy to adjust if your feet swell.

Ask, assess, act project

Topic 2Topic 3Topic 4

HQSC190 Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability.

Gillian Watson says: “Slippers like this aren’t so good. Avoid loose-fitting, slip-on styles. They change how you walk - you’re ‘scuffing to keep them on, and it’s easy to trip”.

Ask, assess, act project

Topic 2Topic 3Topic 4

HQSC197 Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability.

Gillian Watson says: “A low heel is best, but a modest heel like this could be worn on special occasions.”

Ask, assess, act project

Topic 2Topic 3Topic 4

HQSC204 Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability.

Safety and style - you can have a good range of nice, lightweight shoes that support your feet and help you walk safely.

Ask, assess, act project

Topic 2Topic 3Topic 4

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 9

THEME: OPTIMISE VISION

ID Image Falls message Possible caption/s

Use with

HQSC115 Optimise older people’s vision to reduce their risk of falling.

Many falls are caused by wearing bi-focals or reading glasses outdoors. Advise older people to use their reading glasses only for reading, and to ask their optician for single lens glasses to wear when active outside.

Ask, assess, act project

Topic 2Topic 3Topic 4

HQSC132 Optimise older people’s vision to reduce their risk of falling.

Ask older people: “When did you last have your eyes tested?”.ORAdvise older people: “Wear your reading glasses only for reading. Ask your optician for single lens glasses for when you are out and about”.

Ask, assess, act project

Topic 2Topic 3Topic 4

HQSC137 Optimise older people’s vision to reduce their risk of falling.

“Keep your glasses clean.”

Ask, assess, act project

Topic 2Topic 3Topic 4

HQSC150 Optimise older people’s vision to reduce their risk of falling.

Advise older people to take extra care until they are used to their new glasses.

Ask, assess, act project

Topic 2Topic 3Topic 4

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 10

THEME: PRESCRIBED VITAMIN D

ID Image Falls message Possible caption/s Use with

HQSC049 Prescribed vitamin D is widely recommended around the world for preventing falls in older people at higher risk of falling.

Dame Kate with ACC’s card: ‘Vitamin D: is it right for you? Ask your GP’.ORVitamin D: is it right for you? Ask your GP.ORAsk your GP about vitamin D.

Prescribed vitamin D initiatives

Topic 7

HQSC058

HQSC406 Your doctor may suggest that you spend more time in the sun to increase your vitamin D.

From September to April, take a walk or do outside activities in the early morning or late afternoon. Remember to be SunSmart through the middle of the day.

From May to August, take a walk or do outside activities in the middle of the day, with your face, arms and hands uncovered.

Prescribed vitamin D initiatives

Topic 7

HQSC410

HQSC412

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 11

THEME: HOME SAFETY

ID Image Falls message Possible caption/s

Use with

HQSC067 The risk of falling does increase with age, but the good news is, you can do something about it.

Dame Kate works through the ACC home safety checklist

(ACC5128 How safe is your home?)ORComplete the ACC home safety checklist – as it says, “You may know your home like the back of your hand, but the things you see every day could be potential hazards that can lead to a fall”. (ACC5128 How safe is your home? )

Topic 4

HQSC080

HQSC227 The risk of falling does increase with age, but the good news is, you can do something about it.

Do your rugs lie flat, without frayed corners or rolled up edges?

Topic 4

HQSC255 The risk of falling does increase with age, but the good news is, you can do something about it.

Dame Kate takes up a rug that could cause a trip or fall.ORRemove rugs that could cause a trip or fall.

Topic 4

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 12