RoSPA CONFERENCE BELFAST. From little acorns. Goal. Jane Steven GOAL BACKGROUND EFFECTS OF FALLS & FRACTURES FALLS COLLABORATIVE DEVELOPMENTS

Transcription

1 RoSPA CONFERENCE BELFAST From little acorns Jane Steven Falls & Fracture Prevention Coordinator GOAL BACKGROUND EFFECTS OF FALLS & FRACTURES FALLS COLLABORATIVE DEVELOPMENTS Goal To reduce falls in the over 65s and the impact of falls on older people, their families and the community 1

2 Background 1992 Health of the Nation 1999 Saving Lives Our Healthier Nation 1999 DTI Avoiding Slips, Trips and Broken Hips 2001 NSF Older People, Standard 6 Falls Guidelines AGS, BGS, AA Orthip, NICE Research Collaboratives Healthy Communities, Falls Background Falls Common Significant morbidity and mortality Hip fractures most serious consequence Osteoporosis, falls & fractures inextricably linked Osteoporosis Hip Fracture > 95% of hip fractures due to a fall > 90% of hip fractures due to osteoporosis Falls Background National Statistics 30% of over 65s and 50% of over 85s fall once a year Every 5 hours an older person dies as a result of a fall After a hip fracture 50% lose independence and 25% die (DOH) 40% Care Home admissions are the result of a fall Falls in institutions are 3 times those of community dwellers 2

3 Background Cost of falls & fractures million million billion Total cost of falls in 1999 = 3.3 times the total NHS funding earmarked for mental health, coronary heart disease and primary care in England (Scuffham 2003) Ageing population Background Costs of Falls & Fractures In Northumberland Hip Fractures: 2003/4-455 Cost over two years 9.1 million Ambulance Service: Jan 2005-Jan fallers over (28%) not conveyed to hospital 537 (22%) frequent fallers Effect of falls & Fractures Personal Loss of self confidence Reduced activities and fear of falling Disempowerment Isolation Reduced quality of life Disability Decreased mobility Increased dependency 3

4 Identifying risk factors Factors for falling Extrinsic factors Poor lighting Steep stairs Loose carpets/rugs Lack of safety equipment Inaccessible lights/windows Intrinsic factors Problems with balance, walking, mobility Visual impairment 4 or more medications Impaired cognition Depression Postural hypotension Source DOH 2001 NSF Older People However evidence shows Number of falls and negative consequences can be reduced if health and social care work together effectively to address falls and their impact (DOH 2003 How can we help older people not to fall again?) Falls Collaborative Different way of working Partnership Culture change New initiatives Sharing best practice 4

5 SELECTED SITES 4 practices Population = 11,237 (3 practices) % over 65 = 24% Population = 10,948 (1 practice) % over 65 = 18.75% How was progress measured? Data collected in 2003 compared with 2002 Targets Set up falls registers 30% on register personal risk assessment 30% on register environmental risk assessment Reduce numbers who had fallen by 30% Reduce number of falls in designated care home Reduce numbers requiring admission to acute care Setting up Falls Registers PDSAs for limited period Every person over 65 was asked if they had fallen in the last 12 months Practices set up systems Guidelines drawn up and distributed 5

6 Are you over 65? Have you fallen recently? If you have please complete the following questions: Risk Assessment 1. Have you fallen in the last year? 2. Do you take 4 or more medications? 3. Have you got Parkinsons or had a stroke? 4. Do you have any problems with balance 5. Do you have difficulty getting out of a dining chair of knee height (which has no arms) without using your arms? Same tool used by: Rehab. Team Care Managers OTs A & E Aln & Dewar Wards STARS Falls Prevention Cards POCKET GUIDE TO FALLS PREVENTION 1. Do you think the person is at risk of falling? 2. Confused/unrealistic perceptions of their ability? e.g. attempts alone activities which require help. 3. Visual impairment a cause for concern? 4. Prescribed 4 or more medications/recent change of medication/not complying with directions? 5. Signs of dizziness/poor balance (unsteady on feet)? 6. Any environmental hazards: Flooring Poor/inappropriate footwear Carpet strips/rugs Poor lighting Trailing wires Bed height Trailing bedding Cluttered furniture Inappropriate clothes Existing safety rails inappropriate Safety rails required 7. Using their walking equipment/furniture inappropriately? 8. Incontinence a cause for concern? 9. Use of alcohol/other substances cause for concern? 10. Any recent falls/trips/stumbles in the last 6 months? If the answer is yes to any of the above contact your manager 6

7 List of Partners Local communities Service users Doctors Nurses Occupational therapists Physiotherapists Podiatrists Pharmacists Dolphin View Home Carers Dieticians Optometrists Social workers Ambulance Service Speech therapists District Councils County Council Community Psychiatric Nurses Leisure Clubs Care Homes Age Concern Wansbeck Hospital Day Care Centres Community Hospitals Sheltered housing Voluntary organisations. Community Initiatives Autumn Falls Fair Sloppy Slippers Bottle in the Fridge Intergenerational Project Flu vaccinations Eye Tests at home Other Initiatives Medication Chart Exercise Trial Education and upskilling programme Resources Ambulance Service 7

8 Dolphin View Care Home Dolphin View Care Home Range of initiatives Reduced falls by 39% Reduced number admitted to acute sector by 33% Key Learning Develops integrated working Needs strategic support Collaborative methods effective PDSAs useful Uses existing networks Creates new networks Changes working practices 8

9 Key Learning (continued) Involving service uses and grass roots staff essential Takes time to develop teams Spreads good practice Needs finance Developments Appointment of Falls & Fracture Prevention Coordinator Target over 65s with high risk of falls, fracture and osteoporosis in: Care Homes Primary Care NOS Care Home Project Accreditation Scheme for Care Homes Integrated Falls, Fracture & Osteoporosis Strategy North East Falls Forum Extension of existing projects Handyman Bottle in the Fridge Education and Upskilling Intergenerational video Flu Vaccination packs 9

10 POPP (Partnerships for Older People Project) Older People s Partnership Board Accreditation Education & Training Exercise HIA and Handyman Assessment Intermediate Care Communication Evaluation Health Economics Enabled interagency and multi professional working across health and social care and the voluntary sector in a way not previously achieved. National Primary Care Development Team website: My Jane.steven@northumberlandcaretrust.nhs.uk 10