



Identify potential causes of falling particularly
in residential care
Understand the difference between intrinsic
and extrinsic risk factors.
What are the implications of falling
Have an action plan following a fall
Heart attacks
 Strokes
 Falls

275,000 per year
130,000 per year
2,700,00 per year





500 older people a day fall in the home and
require hospital treatment.
Every 5 hours one older person dies as a
consequence of a fall in the home
40% of Care Home admissions are as a result
of a fall
After a hip fracture 50% of fallers can no
longer live independently
20% of older people who suffer a hip fracture
as a result of a fall, die within 6 months

“An unexpected event when the person 'falls'
to the ground from any level, this also
includes falling on the stairs and onto a piece
of furniture with or without a loss of
consciousness”
National Institute for Clinical Excellence
2004






Physical injuries
Loss of independence
Psychological
Social impact
Carer impact
Cost to services
A resident falls over.
What should go through your mind when
thinking about why they fell?
Medical
Problem







Syncope (Faint)
Postural hypotension (B.P. Drop)
Epilepsy
BPPV
Spinal Cord Compression
Diabetes
Peripheral Neuropathy (numbness of feet)
Medication
Medical
Problem

On 4 or more medicines

Hypnotics

Anxiolytics -
diazepam;lorazepam

Diuretics
bendroflumethiazide;
-
-
temezepam; zopilclone
frusemide

Corticosteroids –prednisolone
Blood
Pressure
Medical
Problem
Medication



A drop in blood pressure sufficient to cause
an inadequate blood supply to the brain.
A risk factor if there is more than a 20 mmHg
drop in systolic pressure between lying and
standing.
dizziness, syncope and/or falls when:
◦
◦
◦
◦
◦
getting up quickly from lying or sitting positions
standing still for any length of time
getting out of a warm bath
standing up after a big meal
these symptoms usually ease if you lie or sit down






Patient lies down for 3-4 minutes
Blood pressure is recorded
Patients stands – B.P. measured
After one minute – measured again
After 2 minutes – measured again
Any history of relevant symptoms recorded







Take particular care in the morning
Get out of bed in stages.
Avoid sudden changes in posture.
Avoid sitting/standing for long periods.
Raise the head of the bed
Wear support stockings or tights.
Medical treatments
◦ Fludrocortisone
◦ Pindolol
◦ Midodrine
Blood
Pressure
Medical
Problem
Medication
Urinary Tract
Infection






Asymptomatic
Cause confusion
Cause urgency
Pyrexia
Dipstick urine if someone falls
Form from In-reach
Blood
Pressure
Medical
Problem
Poor balance
Medication
Urinary Tract
Infection
Includes






Maintaining a position
Changing position
Reaching
Walking
Turning
Stepping up/down






Chronic conditions (Stroke; Parkinsons etc)
Vision (bifocals/varifocals)
Alcohol
Diet/ dehydration
Feet
Hearing
Blood
Pressure
Medical
Problem
Poor balance
Medication
Urinary Tract
Infection
A trip
Why do older people fall?
List all the environmental risk factors you think
could make an older person more likely to fall
Trip Hazards
Footwear
Slippery Surfaces
Risky Behaviour
Look for the cause!






Medical problem
Medication
Postural
Hypotension
UTI
Balance
Environmental risks
Refer Doctor
Doctor
Do L/S B.P.
Refer Doctor
Dipstick – treat
Keep active; exercise
Remove hazards







Complete when older person falls
Fill in demographics
Turn to back page
Yes or no to risk factors
Decide if action one you can do – tick when
done
Turn back to front and refer appropriately
Send a copy to the G.P.








B.&.N.E.S. G.P.
All syncope
Unexplained falls – 2 or more in a year
Poor balance and at risk of falls
Multidisciplinary team
Investigations
Balance Exercise Course
Referral by clinician – G.P.






Help the aged research
http://www.helptheaged.org.uk/
Google don’t mention F word
Older people don’t acknowledge the need
Fear of consequences
Need to concentrate on the positive
I wonder why they
fell?