Sara Taylor
Senior physiotherapist
Jan Benfold
Senior Occupational Therapist
Babington Specialist Falls Cilinc
September 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 falls
 World 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 statistics
 Approx one third of people >65 fall each year
 Approx half of people >80 fall each year
 Approx 9% of older people who fall will become too afraid
to leave their homes due to fear of falling again
 Every 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 falls
Medical
 Polypharmacy
 Postural hypotension
 Medical conditions e.g. PD
 Poor hydration
 Anaemia
Psychological
 Reduced motivation/ depression
 Memory problems/ confusion e.g.
dementia
Physical
 Reduced balance
 Walking problems
 Reduced muscle strength in legs
and arms
 Poor vision
 Poor hearing
 Loss of sensation in feet
Environmental
 Unsafe walking aids
 Inappropriate footwear
 Home hazards- lighting, dogs,
loose mats, grandchildren, wires,
hosepipes
 Transfers- bath, stairs, bed, chair
Effects of falls
Psychological
 Loss of confidence
 Loss of motivation
 Isolation/loneliness
 Depression/anxiety
 Fear of further falls
Physical
 (Hip) fractures
 Pain
 Bruising
 Head injury
 Hypothermia
 Infection
 Other MSK injuries
Functional
 Loss of independence/increased dependence
- impact on social care costs
 Reduced mobility/activity
- impact on quality of life
Quality of life
Negative circle
Risk
factor(s) for
falls
Depression,
reduced
motivation
Reduced
activity e.g.
socialising
Fall
Loss of
confidence
What can we do?
Falls prevention
8 tips to Staying Steady:
1. Exercise
Tailored exercise programmes can reduce falls by 54%
2. Check your eyes and hearing
3. Look after your feet
4. Ask about you medicines
5. Get enough vitamin D
6. Eat a diet rich in calcium
7. Check for home hazards
8. Visit your GP/local falls service
MDT roles and falls
Physio:
 Assess and treat physical problems e.g.
- balance
- strengthening
- increasing movement
- exercise tolerance/ stamina
 Supply 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 environment
 Lifestyle changes
Nurse:
 Look at medical issues associated with falls:
- Obs- BPs etc
- BMs
- Skin checks
- Continence
- Medication checks
RSWs:
 Glue in team
 Follow physio/Ot treatment plans
 Complete nursing obs
 Trained in specialist falls groups- chair based, OTAGO
 Deliver equipment to patient's homes
 Named key workers for individual patients
 Feedback 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
 Hearing support services
 GP
 Sight support
 Orthotics
 Day centres e.g. the Glebe
 Nurses
 Strictly no falling
 Dr Skelly (PD consultant)
 Walking groups
 Dietician
 Active Derbyshire- village games
 Health trainers
 Be Active
 Care coordinators
 Waistwise
 Neuro outpatients- Ripley
 Age UK
 Future homescapes- alarms,
adaptations
 Medequip
Practical
 Can you walk on a “tight rope”?
 Can you stand on one leg for 10seconds with your eyes
shut
 Can you walk backwards on your tiptoes
Time to exercise
 Tai chi
 Chair based exercises
Spot the hazards
Did you miss anything?
Falls hazards:
 Stairs without handrail
 Loose extension cords in traffic
areas
 Outdated medications in
cabinet
 Open bottles of medicine
 Loose rugs
 Clutter on staircase
 Flip-flop slippers
 No handle and no deadbolt on
door.
Other hazards:
 Deactivated fire alarm
 Overloaded outlets
 Cloth on space heater
 Smoking. Cigarettes left
unattended
 No automatic shut-off on coffee
maker
 Newspapers 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
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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-andpractice/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