FALLS MANAGEMENT FILE

General Consequences of Falls
Leading cause of death from injury in over 75’s Fallers 2.5 times more likely to go into a nursing home 10% of all call-outs for London Ambulance Service are for over 65’s who have fallen 31% of falls result in minor injury and 6 - 9.9% in serious injury (Morse et al 1987, Chu et al, 1999)
Environmental Hazards Postural Hypotension Transfers Walking Nutrition and Alcohol Reduced Confidence Coping Strategies Comprehension/Memory
History of Falls
Parkinson’s Disease
Does the patient have a diagnosis of Parkinson’s disease? Postural Instability inevitable Medication can cause postural hypotension Unsteady gait with small steps, p
16 Point Screening Tool
History of falls 4 or more medications Parkinsons Disease or Stroke Balance Standing Up Footwear and Footcare Vision Hearing
16 Point Screening Tool
Physical Injury
Hip fracture Wrist fracture Cuts/Lacerations Deep bruising Soft tissue injuries Dislocations Sprains Joint pain
Long Lie
Over one hour in length Can predict death within 6 months Increased mortality rate. Medical complications. Access to help.
What is a Fall?
“Unexpectedly arriving at a lower level than intended” (Tinetti) “an event which results in a persons coming to rest inadvertently on the ground or other lower level” (Kellog) “a trip or slip that results in a person, with or without consciousness unintentionally landing on the floor or lower level” (Skelton and Dinan)
Reduced Muscle FALL Strength, Balance & Confidence
Reduction in activity
Risk Assessment
NSF states Falls Risk Assessment should be implemented by April 2003 No suitable validated tool available: MORSE; STRATIFY; FRASE. Therefore suggest use of Multiprofessional 16 point screening tool to identify and address falls risk factors
Associated with reduced arm function Decreased response times Decreased balance reactions Misjudgement of depth, distance ect Lack of concentration Poor quality of movement
Consequence of Falls for Individuals
Fractures Cuts and Bruising Dislocations Strains and Sprains Increase in joint pains Long lie (over 1 hr) Falls and instability contribute to 40% of nursing home admissions Post Fall Synfrome Depression Social Isolation Reduction in Activity Dependence
Parkinson’ Disease
66.6-90% Fall at some stage Turning and reaching most common cause of falls High anxiety of falls even among those who haven’t fallen Co-morbidity Cognitive Impairment
Physio Romaine Ellul
Falls Nurse Specialist Nicky Rice

Falls Service Provision
Falls clinic Friday morning MRI Domiciliary visits from Multi-disciplinary Team for assessment and treatment Postural stability exercise classes 2 x week Education, Advise and Liaison Resource to Acute and Community Trusts In-patient assessments if warranted
Post-Fall Syndrome
Fallers & Non-Fallers Social Isolation Dependence Depression Reduction in/Avoidance of activity Fear of falling Anxious when walking or transferring?
Background: NSF for Older People March 2001
Standard Six: Falls ‘The NHS, working in partnership with councils, takes action to prevent falls and reduce resultant fractures or other injuries in their populations of older people. Older people who have fallen receive effective treatment and rehabilitation and with their carers, receive advice on prevention through a specialised falls service’.
Stroke
At higher risk than the general population 14-39% have one of more falls in hospital 75% have one or more falls post dischargen ?R CVA > L CVA
Stroke
Referral Criteria
Over 65 with a history of or a high risk of falling Score 4 or more on 5 pt risk assessment tool Resident within Central Manchester Acute Trust boundary or registered with a Central Manchester GP Previously seen by Community Falls Team and more specialist assessment required Multi-Disciplinary needs ie Medical, Nursing and Therapy
Cost of Falls to NHS
Fractures cost NHS 1.6 billion per year Hospital spending > £10 billion Local authority, residential care > £3 billion Non-residential care > £2 billion
FALLS MANAGEMENT FILE
Compiled by:
Bernie O’Dowd Clinical Specialist Physio Nicky Rice Falls Nurse Specialist March 2006
The Falls Team
Consultant Physician Dr. Hanley Rehab Assistant Tracey Andrews Clinical Specialist Physio Bernie O’ Dowd Occupational Therapist Vacant