Reducing Falls & Fractures

What is Osteoporosis ?

Normal Bone Osteoporotic BoneOsteoporosis means fragile bones

Fracture statistics

• 25% of people admitted to hospital with a broken hip live in care homes

• 30% will die as a result of the hip fracture• Many have had a more minor broken bone

before they break their hip• Most of these broken bones are due to

osteoporosis

What do we need for strong bones ?

• Calcium• Vitamin D3• Weight-bearing exercise• Avoid smoking, too much alcohol, too

much caffeine• Avoid too many fizzy drinks particularly

Coca Cola

What is important about Vitamin D3 ?

• Enables the body to use calcium• Affects mood• Affects muscle strength• Reduces likelihood of infections

Those who are housebound or live in residential settings are often low in Vitamin D

Why are the elderly more at risk of breaking bones ?

• Poor appetite so don’t eat enough calcium• Go outside less• Make less vitamin D• Less mobile and active• More likely to fall

What can we do?

• Give calcium/vitamin D3 supplements after lunch and evening meal.

(eg Calcichew D3 forte, Adcal D3 caplets, Adcal D3 Dissolve)

• Ask the GP to change the type of calcium/vitamin D prescribed if the resident doesn’t like it.

• Consider all new residents and ask the GP to prescribe calcium/vitamin D3 for them

What if they won’t take it?

• Try different types first.• If patient cannot tolerate any, then ask GP

to prescribe Fultium D3 which is vitamin D3 without the calcium.

• Very rarely has any side effects.• Try to make sure the patient has good

amount of dietary calcium.

How to give osteoporosis medication

Once weekly tablet- Alendronic acid or Risedronate. (bisphosphonates)• Same day each week. Take as soon as the resident

gets up with large glass water. Remain sitting upright for at least half an hour.

• Nothing else to eat or drink during the half hour.• No Calcium/vitamin D supplements to be taken until

at least 4 hours later.

Contacts

• The Fracture Liaison Service can be contacted for any advice regarding the calcium/vitamin D3 supplements and bone protection medication and are happy to help.

• Please call 01803 655603

Falls Prevention

If a person doesn’t fall they won’t break a bone!!

Reduce the risk of falls

First 4 hours - identify risk

Is the resident:

• Walking unsteadily/ unsafe to walk alone?• Confused/disorientated?• Having falls before or since arrival?• Taking tablets to calm them down or help

them sleep?• Being incontinent/needing the toilet

frequently?

Orientate

• Orientate to home environment– Toilets and wash areas - location, use of lights, alarm

cord– Call bell – check their ability to use it and alternatives

if not able to, demonstrate and explain its use

Observe• Observe

– Can resident be placed where they can be seen regularly/easily?

– Confusion; is this acute or chronic? Ask family/friends to establish this and discuss with GP.

• Comfort Rounding– Ensure all residents are checked at least 2

hourly for personal needs, drinks, toileting & position change/standing (to prevent pressure sores)

DAME to assess falls risk

• Drugs• Ageing• Medical conditions• Environment

Drugs• Side effects of Drugs

• Poly-pharmacy (more than 4 medications)

• Culprit groups: sedatives, water tablets, blood pressure tablets, sleeping tablets, antidepressants, strong pain killers.

• Alcohol/recreational drugs

• Check resident has at least yearly medication review, particularly after a fall.

Ageing• Impaired vision

• Hearing problems

• Reduced strength, balance, gait, bone density

• Cognitive impairment, dependence

• Bereavement/depression

• Fear of falling/reduced confidence

Medical conditions• Any medical condition in combination with ageing

can increase the risk of fallsStrokes and Parkinson’s disease increase the risk of falls dramatically

• A sudden drop in blood pressure when a resident stands up is a common cause of falls.

• Confirm by taking lying/standing

blood pressure

EnvironmentIll-fitting footwear Bed rails and

height of beds/chairs

Trip hazards

Risky behaviour Slippery floors Poor lighting

Ask all residents about falls

Involve GP toexclude any acute illness/heart or neurological causes

Physiotherapy

TreatmentIf any medical cause identified

MedicationReview by

Pharmacy/GP

OccupationalTherapy

What can we do to reduce falls?

Identify the risks & complete falls care plan

Put in place appropriate interventions to minimise

risks of falls

Re-assess risks and interventions regularly. Consider

onward referral if necessary

Ensure all staff are aware of falls risk

Resources -Telecare sensorsMost homes have these

• Where are they stored?• Who takes responsibility for them?• Are they in working order?• Do staff know how to use them and

who they are appropriate for?

Staff can get advice on these from the Trust’s Telehealth care team on 0300 456 4861

Resources 2

There are pages on falls, fractures and bone health on the Trust’s website:www.tsdhc.nhs.ukA national resource is Age UK on www.ageuk.org.uk

OT and Physiotherapy assessments are available by contacting your local team

Resources 3

Care home falls prevention page now on the public website

• Links to free downloadable resource Living Well through Activity toolkit

• 5 specific modules for:• Residents and families• Staff• Owners/managers• Commissioners• Occupational Therapists