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 year130,000 per year2,700,00 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 - temezepam; zopilclone

Anxiolytics - diazepam;lorazepam

Diuretics - bendroflumethiazide;

frusemide

Corticosteroids –prednisolone

Blood Pressure Medication

Medical Problem

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 Medication

Medical Problem

Urinary Tract Infection

Asymptomatic Cause confusion Cause urgency Pyrexia

Dipstick urine if someone falls Form from In-reach

Poor balance

Blood Pressure Medication

Medical Problem

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

Poor balance

Blood Pressure

A trip

Medication

Medical Problem

Urinary Tract Infection

Why do older people fall?List all the environmental risk factors you

think could make an older person more likely to fall

Risky Behaviour

Trip Hazards

Slippery Surfaces

Footwear

Look for the cause!

Medical problem Medication Postural

Hypotension UTI Balance Environmental

risks

Refer DoctorDoctorDo L/S B.P. Refer DoctorDipstick – treatKeep active;

exerciseRemove 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?