lord falls network rural conf 2010 1

8/22/2019 Lord Falls Network Rural Conf 2010 1

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Falls Prevention Guidelines,

Falls Risk Assessmentand Vision Interventions

in Older People

Professor Stephen Lord


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Preventing Falls and Harm from Falls in OlderPeople: Best Practice Guidelines for

Australian Hospitals, Residential Aged CareFacilities and Community Care 2009


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Guideline contents

Guidelines Consisting of three documents:

Hospital;

Residential Aged Care;Community.

Additions:

Cost effectiveness evidence

Discharge


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Guideline resources

Guidebook and other support materials Guidebook from each guideline; smaller

versions for frontline health professionals

Fact sheets for residents/patients, healthservice managers, nurses, doctors, alliedhealth professionals, support staff

Implementation guide for hospitals andresidential care facilities


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What is the result?


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Whats in the Guidelines

Each part contains

Evidence based recommendations

Good practice tips

Points of interest

Case studies


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Availability of Guidelines

Guidelines available at ACSQHC website :

www.safetyandquality.gov.au/

Go to Our Work Section and choose Falls

Prevention Guidelines
http://www.safetyandquality.gov.au/http://www.safetyandquality.gov.au/


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Contact details

NSW Falls Prevention Network

www.fallsnetwork.neura.edu.au

[email protected]
http://www.fallsnetwork.neura.edu.au/http://www.fallsnetwork.neura.edu.au/http://www.fallsnetwork.neura.edu.au/


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Falls Risk Assessment

in Older People


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Screening or assessment?

Screening identification of people at risk

Increased surveillance

Referral for further assessment andintervention

Assessment - identification of risk factorsamenable to treatments / correction

Tailoring intervention strategies


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Simplest screen

Have you fallen in the past 12 months?

Degree of difficulty easy

Sensitivity and specificity reasonable

Information gained about preventionstrategies nil


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Community Falls Risk Assessment


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QuickScreen Clinical Falls RiskAssessment

Falls

Has the patient had any falls in thepast 12 months?

Medications

Does the patient take 4 or more

medications?(excluding vitamins and minerals)

Does the patient take any

psychoactive medications?


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Low contrast visualacuity test

Read all of the

letters on the 5thline

Tactile sensitivity test

Must feel at least 2 of

the 3 trials


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2.5cm

2.5cm

Near tandem stand test

Stand for 10 secs with

eyes closed

Alternate step test

8 foot taps, must

complete within 10

secs

Sit to stand test

5 repetitions with arms

folded, must complete

within 12 secs


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QuickScreenassessmentform


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Hospital Assessments


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Most important falls risk factors inhospital

Previous falls Agitation, confusion or impaired judgement Urinary incontinence, frequent toileting

Gait instability Lower limb weakness Prescription of psychoactive medications

Low body mass index Low bone mineral density

Fragile skin

Oliver, Age and Ageing 2004


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Hospitals: STRATIFY (Oliver 1997)- Ontario refinement

Items falls as a presenting complaint agitation

frequent toileting visual impairment transfer and mobility score

Sensitivity 93% and specificity of 88% indevelopment hospital

Sensitivity 92% and specificity 68% indifferent hospital

M difi d St tif SS MR N b


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Modified Stratify SS

Falls Risk Screening

Please read instructions for use

MR NumberSurname .Date of Birth ..

Please fill in if no patient label is available

Date: / /

Item Falls Risk Screening Assessment Value Score

1. History of falls.

Did the patient present to hospital with a fall orhave they fallen since admission? No Yes

If not, has the patient fallen within the last 2

months? No Yes

Yes to any = 6

2. Mental Status

Is the patient confused (i.e. unable to makepurposeful decisions, disorganised thinking andmemory impairment) No Yes

Is the patient disorientated (i.e. lacking awareness,being mistaken about time, place or person)

No Yes

Is the patient agitated (i.e. fearful affect, frequentmovements and anxious) No Yes

Yes to any = 14

3. Vision

Does the patient require eyeglasses continually?No Yes

Does the patient report blurred vision ?No Yes

Does the patient have glaucoma, cataracts ormacular degeneration? No Yes

Yes to any = 1

4. Toileting Are there any alterations in urination (i.e.frequency urgency, incontinence, nocturia) ?

No Yes

Yes = 2

5. Transfer score (TS)[means from bed to chair

and back]

Independent use of aids to be independent isallowed

Minor help, one person easily or needssupervision for safety

Major help one strong skilled helper or twonormal people; physically can sit

Unable no sitting balance; mechanical lift

0

1

2

3

6. Mobility score (MS) Independent (but may use any aid e.g. cane)

Walks with help of one person (verbal orphysical)

Wheelchair independent including corners etc

Immobile

0

1

2

3

Addtransferscore

(TS) andmobilityscore(MS)

If valuetotalbetween0-3 thenscore =0

If valuestotalbetween

4-6 thenscore =7

Ontario Stratify -

SS


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Residential Aged Care

Assessments


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FREE Screening Tool

2005 residents (aged 65 to 104) 898 from intermediate care RACFs 1107 from high care RACFs

Baseline risk factor assessments: Medical conditions, cognitive status,

medication use, urinary incontinence, fallshistory, use of assistive devices

Standing balance and sit-to-stand ability

Falls follow-up for 6 months from incidentreports

Delbaere K et al. MJA, 2008


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Can the resident standunaided?

Yes

Can the resident stand ona foam mat?

No Yes

Do any of the 2 following apply:Falls historyHigh care RACF

Incontinent

Yes No

Low falls riskHigh falls risk

Does any of the following apply:Falls historyLow care RACF

Polypharmacy (9+)

No

Yes No

Low falls riskHigh falls risk



Incontinent


Polypharmacy (9+)

Can the resident stand ona foam mat?



Incontinent


Polypharmacy (9+)


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VISION & FALLS

Impaired vision a risk factor for falls & hip

fracture

visual acuity

contrast sensitivity

visual field size

depth perception


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Cataract surgery on the first eye

306 women aged 70 years and over

Expedited (4 weeks) or routine (12 months wait) surgery

Visual acuity, contrast sensitivity, depth perception, visual

disability, activity levels, anxiety, depression, falls efficacy(balance confidence), handicap and Euroquol quality of life

improved significantly in the operated group

Falls in the operated group were reduced by 34%

(IRR=0.66, 95% CI=0.45-0.96)

Four subjects in the operated group (3%) suffered fractures

compared with 12 (8%) in the control group (p = 0.04)

Harwood et al. Br J Ophthalmol 2005;89:53-59.


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Updating glasses can increase fall risk

Intervention primarily comprised updating glasses

A small percentage also received cataract surgery

Intervention significantly increased the risk of falls by

more than 50% (IRR=1.57, 95%CI=1.20-2.05)Falls increased across 12 month follow-up, but particularly

soon after glasses change

Authors speculate that the change, irrespective of vision

improvement, may have increased falls

Cumming et al, J Am Geriatr Soc, 2007


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Impair ability to see

contrast and judge

depth

Increase the risk of

falls

Due to trips

On stairs

Outside the home

Multifocal

glasses


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VISIBLE Trial for multifocal glasses

wearers

Intervention comprised an optometry assessment, provision

of additional single lens glasses and counseling

Intervention reduced the risk of falls by 8% (IRR=0.92,

95%CI=0.73-1.15)

not significantIntervention reduced the risk of falls in those who regularly

went outside by 40% (IRR=0.60, 95%CI=0.42-0.87)

significant

Increase in outside falls in those who less regularly wentoutside

Haran et al, BMJ, 2010


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Conclusions - interventions

Cataract surgery prevent fallsSimply updating current glasses does not appear

to prevent falls, and may be harmful in the

absence of advice about vision changes and/or

other interventions

The provision of single lens glasses for older

people who take part in regular outdoor activities

is a simple and effective falls prevention strategyThe intervention may be harmful for frail older

people who take part in little outdoor activity

lord falls network rural conf 2010 1

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