Guide to Action to Prevent
Falls (GTA)
Community version – in use
Care Home version – under evaluation
Dementia version – in development
Robertson K, Logan P, Conroy S, Dods V, Gordon A, Challands L, et al. Thinking Falls- Taking Action:
development of a Guide to Action for Falls Prevention British Journal of Community Nursing
2010;15(8):406 - 410.
Robertson K, Logan P, Ward M, Pollard J, Gordon A, Williams W, Watson J. Thinking falls-taking action: a
falls prevention tool for care homes.Br J Community Nurs. 2012 May;17(5):206-9
Logan, PA; Coupland, CAC; Gladman, JRF, et al Community falls prevention for people who call an
emergency ambulance after a fall: randomised controlled trial. . British Medical Journal 2010; 340 c2102
Professor Pip Logan
Division of Rehabilitation & Ageing
University of Nottingham
Developing the GTA
 Group of clinicians, social services, fire service, local
authorities, older people, commissioners, researchers
2008- to date
 Incorporates clinical guidelines, research findings, clinical
expertise
 Checklist outlining 37 risk factors and recommended
interventions
 Training by falls specialists: Two hours, groups 4-8,
interactive session
 Intervention manual, GTA forms, falls incident record
sheet
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FALLS HISTORY
MEDICAL HISTORY
MOVEMENT & ENVIRONMENT
PERSONAL
History of Falls
History of falls prior to admission to
the care home
Falls reason for admission to care
home
Medical history
Stroke, Parkinson’s Disease, dementia,
epilepsy, blackouts, diabetes, short of
breath,
heart disease, arthritis,
high / low blood pressure
Medication
On 4 or more medications,
on sedatives, antidepressants, diuretics
Transfers
Needs help on/off chair, bed,
toilet
Unsteady when transferring,
tends to rush
Nutrition
Needs encouragement to eat
Poor appetite,
Recent weight loss
Balance
Holds furniture when moving,
unsteady when walking,
loses balance on turning,
cannot walk unsupported due to
unsteadiness
Stumbles or trips
Noted to stumble / trip even if no
obstacle, near misses noted
Continence
Incontinent of urine / faeces,
toilet difficult to access,
frequency, urgency,
gets up at night to use
toilet/commode,
concerned about continence
/ getting to toilet in time,
difficulty managing clothes,
catheter, constipation
Fluid
Drinks less than 5 cups of
fluid a day,
needs encouragement to
drink, often leaves drinks
History of Falls
History of falls since admission
Recent Falls
2 or more falls in the past 6 months
(A fall is defined as inadvertently
coming to rest on the ground or at a
lower level, including slipping from
side of bed)
Dizziness
Complains of dizziness, dizzy on first
standing up
Fractures
Has broken bones as result of fall:
Wrist, hip, humerus, pelvis, spine,
ribs, collar bone, shoulder, ankle
Cognition
Does not recognise own limitations, poor
understanding of space and distance,
unaware of hazards ,
poor short term memory
Gait
Shuffles, leans to side,
leans backwards, walks fast
Walking
Needs supervision when walking,
needs assistance of 1 or 2 to walk
Hospital admission
Attended A&E due to fall, Ambulance
called - not taken to hospital
,admitted to hospital due to fall
Behaviour
Agitated, unsettled, anxious,
periods of aggression, risk to others
Walking aids
Uses incorrectly,
refuses to use, forgets to use,
poor condition
Sleep
Unsettled at night,
sleeps a lot during the day,
feels tired
Other injury due to falls
Head injury, cuts, bruises, skin tears
Comprehension
Has difficulty understanding verbal
instructions / questions
Heating / body temperature
Feels cold,
sits for long periods at a time,
doesn’t recognise when cold
Vision
Has diagnosed sight loss,
wears varifocal / bifocal
glasses
refuses to wear glasses
Coping strategies
Inability to get up or summon help
Mood
Low mood, depression. anxiety, fearful
Alarm
Unable to reach alarm, forgets to use,
does not call for assistance
Fear of Falling
Is anxious / worried about falling,
lacks confidence,
remains seated for much of day due
to fear of falling
Communication
Unable to express needs verbally, unable
to make self understood,
difficulty making self understood clearly
Flooring
Rugs, clutter, flexes,
Floor coverings, spillages
Lighting
Poor lighting day and/or night,
location of light switches
Footwear
Unsupportive footwear,
footwear too loose / tight,
painful feet
Pain
Has specific / general pain,
pain not helped by pain
killers,
on meds for pain that cause
side effects e.g. constipation,
dizziness,
unable to communicate in
pain
FALLS HISTORY
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MEDICAL HISTORY
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MOVEMENT &
ENVIRONMENT
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PERSONAL
History of Falls
Review all incidents using Incident Analysis
Form, look for any patterns to falls e.g. time of
day, activity at time of fall, inform GP of falls
history / recent falls
Postural blood pressure to be checked in lying,
sitting and standing - alert GP if drop of more
than 20mmHg,
Request medical review to identify any medical
causes of falls e.g. infection, stroke, low blood
pressure, heart problems
Identify any possible causes of falls and take
steps to reduce those risks
Medical history
Check for signs of acute illness / infection, consider
medical review from GP if condition not been reviewed
in last 6 months, if low blood pressure prompt to stand
still on 1st standing up
Transfers
Consider use of alternative furniture,
refer to OT for advice if required
Nutrition
Encourage to eat small amounts regularly,
ensure teeth well fitted, review reasons for
poor appetite and weight loss - refer to GP,
dietician
Medication
Medication should be reviewed by GP every 6 mths,
consider side effects of meds i.e. dizziness, sedation,
confusion. and refer to GP if concerned
Balance
Encourage to stand still on first standing
Advise to keep head and feet in line when turning,
increase supervision, consider referral to
physiotherapist
Dizziness
Postural blood pressure to be checked in lying, sitting
and standing - alert GP if drop of more than 20mmHg,
Advise to move legs and feet before standing and to
stand still and count to 10 on first standing up
Stumbles or trips
Document incidents, review incidents for time,
location, activity at time. Review possible causes
e.g. footwear, eyesight
Continence
Ensure continence assessment completed,
refer to comm. nurse or continence service,
test urine, assess for constipation, consider
signage to toilet, refer to OT if required,
consider commode for night use, check
regularly if requires toilet
Fractures
At risk of osteoporosis,
Ask GP to review if person is falling and has had
previous fracture(s)
Cognition
Refer to GP if not reviewed in last 6 mths, use signage
for toilet, bedroom, lounge, use physical gestures and
prompts, Repeat information when person unable to
remember, inc super
Gait
Prompt to lift feet, stand upright, refer physio
Hospital admission
Review causes of fall, initiate any treatment
recommended, inform GP
Behaviour
Refer to GP if medical review required, Mental Health
services,
Ensure no acute illness or infection, be aware of risk of
introducing / increasing psychotropic medication
Walking aids
Check correct height, check ferrules,
prompt to use correctly
Sleep
Encourage activity during the day, consider
time goes to bed, be aware of risk of
medication to aid sleep increasing risk of
falls, increase night supervision, consider
use of sensor mats
Other injury due to falls
Review causes of fall, initiate any treatment
recommended, inform GP
Comprehension
Speak clearly, in short sentences, with simple
instructions, use physical gestures and prompts
Heating / body temperature
Ensure draft free environment, consider
temperature if person sitting for long periods,
mobilise regularly
Vision
Ensure access to regular sight checks (every
2 yrs), ensure adequate lighting day and
night, advise against bifocal glasses
Coping strategies
Ensure call buzzer easily accessible and working
Consider use of sensor equipment Increase
level of supervision and document
Mood
Reassure, encourage socialisation,
Be aware of risk of introducing / increasing
psychotropic medation
Alarm
Ensure able to access alarm call system in rooms,
consider use of sensor equipment, increase
supervision
Footwear
Advise on suitable footwear, check footcare,
- nails, corns, callouses, refer to podiatry
Fear of Falling
Consider reasons for fear of falling, increase
supervision, ensure mobility maintained,
encourage and reassure
Communication
Consider alternative communication methods, physical
gestures, observe behaviour and routines for insight
into how the person may be feeling
Flooring
Ensure floor free from clutter, rugs and flexes, avoid
patterned flooring, avoid thresholds, keep floors dry
at all times
Pain
Refer to GP if pain poorly controlled, review
medication if side effects to prescribed
tablets, observe behaviour and facial
expression for signs of pain if unable to
communicate
Walking
Refer to Physiotherapist, assist in completing
exercise programme prescribed
Lighting
Ensure good lighting with no glare, consider use of
night light, ensure switches accessible
Fluid
Encourage to drink 6-8 cups of fluid a day,
stay with person whilst having a drink,
document poor fluid intake if does not finish
drinks, review reasons for poor fluid intake
eg worried about getting to toilet
Feasibility testing of the GtACH
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20 minutes versus 2 hours for non-training completers.
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26 residents were assessed
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179 risk fall factors were identified
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163 recommended interventions were recorded
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86 (53%) of these interventions were completed and
recorded in the care plan.
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9/11 participants with abnormal blood pressure received
treatment to rectify.
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7/8 participants who were having difficulties alerting
staff when needing help, received a better placed buzzer
and sensory alarm mats placed next to the bed.
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5/10 incontinent participants were given a management
plan or referred to the continence service or district nurse
 To estimate important parameters that are
needed to design the main study.
 To test the feasibility of completing an RCT to
evaluate a falls prevention intervention (GtACH)
in care homes.
 To determine whether to proceed with a large
trial
 To decide the best approach to adopt for the
design of the definitive trial
Future directions
 Evaluate GTA ?
 Implement GTA ?
 Lots of interest
 Already used locally
Thank you
Pip.logan@nottingham.ac.uk