Healthcare Professionals Perspectives of Footwear and Falls in the Elderly

1
Healthcare Professionals Perspectives of
Footwear and Falls in the Elderly

• Olga Frankowski, Specialist Podiatrist, Private
  Practice
• Deborah Craddock, University of Southampton

2
Introduction

• Falls are among the most common and serious
  problems facing 75 of the elderly population
  Lord, Sherrington and Menz, 2002
• Cost UK Government 981 million Scuffman et al.,
  2003 Menz et al., 2006.
• Risk of falling increases with the number of risk
  factors NICE, 2004
• Key Government objective NSF, 2001 NICE, 2004

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• Older people wear potentially hazardous shoes
  Finley, 1986 Dyer et al., 1998
• Footwear affects balance, posture, gait and
  mobility Lord and Bashford, 1996 Robbins et
  al., 1998 Menz and Lord, 1999
• Multi factorial interventions Gillespie et al.,
  2001
• Podiatrists within specialist falls prevention
  teams and services in all NHS Trusts NSF, 2001
• Need for the study

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AIM Explore
whether HCPs specialising in the area of falls
prevention attribute falls to footwear
within the elderly.

• OBJECTIVES
• Facilitate a better understanding of the
  perceived role (a) footwear (b) podiatrists play
  in falls prevention
• Identify strategies to improve podiatric care in
  the elderly.

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Methodology

• Ethics Approval
• Key informants were identified who were
• Healthcare professionals registered with the HPC
  with specialist knowledge and/ or clinical
  experience in the area of falls prevention
• Semi structured interviews Mays and Pope, 1995
  Patton, 2002
• Interview Schedule Patton, 2002 Bowling 2002
• Credibility and transferability

• Pilot Study
• Thematic Analysis

6
Results

• 4 key themes identified
• Falls and risk factors
• Footwear as a predisposing risk factor
• Footwear and falls prevention strategies
• Podiatrists roles in falls prevention

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Falls and Risk Factors

• All healthcare professionals articulated
  knowledge in relation to the definition and
  understanding as to what is meant by a fall AGS,
  BGS, AAOSP, 2001
• Predisposing risk factors were identified to be
  directly related to falls within the elderly
  Interviewee BCF
• Inappropriate styles of footwear may negatively
  impact upon the patient in relation to gait,
  balance proprioception
•   when older persons gets frail they become
  less able to cope with footwear that is
  inadequate...so you tend to see...gait and
  balance problems contributing to potential fall
  riskswe very often see patients who appear to
  have a gait and balance problem and we actually
  only need to correct their footwear
  Interviewee E
•  

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Footwear - a Predisposing Risk Factor

• patients need to remain mobilised and need to
  be able to feel the ground thickened solesmeans
  they elderly patients are not able to feel the
  ground slippers are often non-slipthey slip off
  their feet andactually contribute to about 50
  of falls Interviewee A
•  
• If people dont have right footwearthey might
  not be able to feel where they are putting their
  feetand are less likely to be balanced your
  feet need to be on the groundto get that
  proprioception to keep you balanced...so shoes
  are really important with posture and stability
  Interviewee B

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Footwear and Falls Prevention Strategies

• All participants expressed awareness as to what
  constitutes appropriate footwear
•  
• slippers arentthe best footwear that you can
  actually have but in the real worldif people
  are going to carry on wearing slippersthen the
  best we can do is provide them witha better
  pair on this schemeif they patients meeting
  certain criteria agree to give up their old
  slippers we will replace them with a new pair
  there will be different typesslip-onsVelcro
  bootee type, allsorts andits the best if you
  like of a bad job Interviewee C

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• The knowledge of falls prevention programmes and
  strategies were communicated by all interviewees.
  
•   National Service Framework Standard 6 for
  Older PeopleNICE guidelines on falls
  prevention Interviewee F
• National Service Framework Standard 6NICE
  GuidelinesHealthier Nation 1999hip
  protectorsFall prevention programmes, postural
  stability training, GP funded gym membership, Tai
  Chi, Extend Interviewee A

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Podiatrists Role in Falls Prevention

• The role of the podiatrist in falls prevention
  was considered to be limited to reviewing
  patients feet and foot care only Interviewee A
  B
• Others further supported the role of podiatrists
  within falls prevention
• podiatrists are part of the multidisciplinary
  teamand are vital in the assessment and
  screening of patients.they are in the position
  to refer to other professionalsmaintain patient
  foot health correct biomechanical problemsissue
  foot health education to allow patients to care
  for their own feet Interviewee F
•  
• ...podiatrist should actually be part of the
  multi-disciplinary team I think that it is
  essential that they see people about their foot
  care... andgive us, as clinicians, advice on
  footwear... Interviewee C
•  
•  

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Conclusion
1. Falls and risk factors

• Risk Factors omitted by all participants
• Neurological impairment
• Cognitive impairment
• Urinary incontinence
• Diabetes
• Neuropathy
• Arthritis and pain
• Only the minority of HCPs acknowledged footwear
  as a potential risk factor for falls within the
  elderly

• Multiple, diverse risk factors of falls Lord et
  al, 2002
• History of falls NICE, 2004., Luukinen et al,
  1995., Luukinen et al, 1997
• Fear of falling NICE 2004, Arfken et al, 1994
• Mobility impairment NICE, 2004., Perell et al,
  2001
• Muscle weakness NICE, 2004., Lord et al,1994
• Gait deficit NICE, 2004 balance deficit NICE,
  2004., Thornby, 1995
• Medication polypharmacy NICE, 2004., Burker,
  1995
• Visual impairment NICE, 2004., Campbell et al,
  1990., Healey, 1994
• Environmental hazards NICE, 2004., Campbell et
  al, 1990., Healey, 1994  

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Conclusion
2. Footwear as a Predisposing Risk Factor

• Universal awareness and agreement as to the
  recommendable features of safe footwear lord et
  al, 2002., Menz and Lord, 1999., Finlay, 1986.,
  Sherrington and Menz, 2003., Edelstein, 1987
• Preliminary evidence to suggest an association
  between footwear and falls Lord et al, 2002.
• Certain styles and aspects of footwear, may
  influence balance and postural stability Menz
  and Lord, 1999., Sherrington and Menz, 2003.,
  Robbins et al., 1992

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Conclusion
3. Footwear and Falls Prevention Strategies

• Based upon individual risk factors
• A patient focused approach NICE, 2004
• Medication review NICE, 2004
• Exercise programmes NICE, 2004
• Balance training NICE, 2004
• Issuing of hip protectors NICE, 2004
• Vision assessment and correction NICE, 2004
• Nutritional / hormonal supplementation Cumming
  et al, 2000
• Patient and staff education programmes NICE,
  2004
• Home hazard assessment and modification NICE,
  2004
• Rehabilitation strategies NICE, 2004
• Management of the psychological impacts of
  falling NICE, 2004

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Conclusion
4. Podiatrists Role in Falls Prevention

• This includes
• Assessing treating foot pain
• Identifying correcting biomechanical and gait
  abnormalities
• Prescribing exercise programmes
• Issue foot health footwear advice

• Podiatrists have an important role to play in
  reducing the risk of falls within the elderly.
• Podiatrists roles focus on
• patient foot health
• education
• promotion
• rehabilitation
• mobility

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Podiatrists Role in Falls Prevention cont

• Within falls prevention teams or services
• Undertake further training of other clinical
  staff in the recognition of medical factors
  influencing postural stability, gait and footwear
  
• Promote the role of the podiatrist

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Implications for Practice

• Further strategies are needed to
• Enhance the role of podiatrists in falls
  prevention to improve elderly podiatric care to
  prevent unnecessary injury or trauma, improve
  quality of life, reduce the incidence of falls,
  and lower morbidity and mortality rates as a
  direct result of a fall
• Encourage podiatrists to actively market podiatry
  services with particular emphasis on their roles
  and responsibilities Craddock and OHalloran,
  2004

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Recommendations for Further Research

• Extend the target population so as to incorporate
  the views of other healthcare professionals
• Explore podiatrists views in relation to
• Falls prevention
• Awareness of what is meant by a fall
• The role of the podiatrist within falls
  prevention
• Importance of collaborative working within
  healthcare