Falls and Older People

1
Stepping into falls management for residential
aged care facilities
Working together to prevent falls

• Education presentation developed by Goulburn
  Valley Health
• This staff education package was developed by
  Goulburn Valley Health for nursing and personal
  care staff in residential aged care facilities.
  It consists of a 4-hour module including training
  on
• The extent of the problem of falls
• The definition of a fall
• Falls risks, and
• Strategies to address falls risks.
• (Downloadable)
• ---???????????---
• In 2005 the Department of Human Services funded
  the National Ageing Research Institute to review
  and recommend a set of falls prevention resources
  for general use. The materials used as the basis
  for this generic resource were developed by
  Goulburn Valley Health as part of the National
  Demonstration Hospitals Project Phase 3, funded
  through the Commonwealth Department of Health and
  Aged Care. Permission to modify, reproduce and
  include this booklet on the departments Aged
  Care website was kindly provided by Goulburn
  Valley Health. This and other falls prevention
  resources are available from http//www.health.vi
  c.gov.au/agedcare.

2
Stepping into falls managementfor residential
aged care facilities
Add Organisations logo
Working together to prevent falls
3
Section 1

• The problem with falls in residential aged care

4
Definition of a fall

• Kellogg, 1987
• An unintentional event that results in a person
  coming to rest on the ground, or another lower
  level, not as a result of a major intrinsic event
  such as stroke or epilepsy) or an overwhelming
  hazard (such as being pushed).

5
The extent of the problem

• An estimated one in three people aged 65 suffers
  a fall at least once a year, about half of those
  suffer multiple falls
• For people aged 75, and those in residential
  care the figure increases to one in two people
• Falls can account for up to 83 or reported
  incidents in residential aged care

6
The extent of the problem

• Falls are the leading cause of unintentional
  injury and death among people aged 65 years and
  over
• Direct health care costs for Australia for falls
  related injuries in 2001 were estimated to be
  498 million dollars
• Of those admitted to hospital following a fall
  about 50 will die within 12 months

7
Consequences of falls

• Physical injury
• Emotional trauma
• Psychological problems
• Social consequences
• Financial impact

8
Consequences of falls

• 70 of falls result in an injury
• One third of people who fall seek medical
  treatment
• Major injury such as dislocation or fracture
  occurs in 13 of falls

9
Consequences of falls

• Approximately 1-2 result in
  a fractured femur or hip
• Of those who suffer fractured femurs, 50 will
  not fully recover, and 30 will die within 12
  months
• Less than 15 of people who fracture their hip
  regain their pre-ambulatory status

10
People at risk of falls

• Advanced in age
• Female
• Those living alone
• Those with one or more diseases
• People with acute illness
• People on multiple medications (4 or more)
• People with walking (gait) disorders

11
People at risk of falls

• People suffering increased postural sway / poor
  balance
• People with decreased mobility
• Cognitively impaired people
• Previous history of falls
• Home bound
• Decreased vision

12
When do falls occur?

• In residential aged care facilities statistics
  show that most residents fall in the late
  afternoon or early evening

13
Where resident falls occur

• From or near the bed
• Corridors
• Bathrooms
• Toilets

14
Activity during a fall

• Transferring clients
• Walking
• Toileting/commode chair
• Using wheel chair

15
Section 2

• Causes and management of falls

16
Causes of falls

• Falls are usually multifactorial that is, they
  have more than one cause
• Always look for other possible causes for a fall
• The cause of a fall can be intrinsic, extrinsic,
  or a result of risk taking behaviour

17
Causes of falls

• Intrinsic causes
• An internal cause, such as a disease or
  condition that affects the person individually,
  eg vision impairment, or muscle disease
• Extrinsic causes
• An external cause such as an unsafe environment
• Activity related causes
• Risk taking behaviour such as residents not
  using their prescribed walking aid

18
Causes of falls

• Chronic disease
• Acute illness
• 4 or more medications
• Poor balance and gait
• Impaired vision
• Lack of physical activity
• Environmental hazards (inside outside)
• Foot disorders
• Unsafe footwear

19
Falls education

• Education needs to be provided to
• Staff
• Residents
• Relatives
• Significant others

20
Risk assessment

• Residents need to be assessed for falls risks
• Interventions are required for each risk
  identified

21
Chronic iIlness

• Musculoskeletal
• Neurological
• Visual
• Cardiovascular
• Psychological
• Endocrine
• Renal

22
Falls management chronic illness

• Regular medical checkups, and referral to
  specialist services to
• Prevent worsening of the condition
• Restore lost ability
• Keep as well and active as possible

23
What residents and families need to know about
their chronic illness

• How their condition will affect them
• What treatments are available
• What assistance can be provided for them
• The signs and symptoms of a flare-up
• What to do if they suffer a flare-up
• What can be done to reduce the risk of the
  condition causing a fall

24
Acute illnesses

• Examples
• Chest infections
• Urinary Tract infections
• Diarrhoea
• Surgical procedures

25
Acute illness

• Seek medical attention
• Close observation of vital signs and condition
• Closer supervision with activities
• Check resident frequently
• Increase assistance to the resident
• Monitor diet and fluid intake
• Resident and family/friends education
• Provision of aids

26
Continence and bladder problems

• Incontinence (loss of bladder or bowel control)
• Frequency (Needing to pass urine often)
• Urgency (Needing to go in a hurry)
• Nocturia (Needing to go to the toilet more than
  twice per night)
• Urinary Tract Infections

27
Incontinence, frequency urgency

• These condition may require referral to
• Doctor
• Continence Clinic (for advice, continence aids,
  and exercises to help bladder control)
• Physiotherapist (for exercises to help bladder
  control)
• Urologist (for a specialist opinion)

28
Urinary Tract Infections

• Symptoms
• Mental confusion
• Frequency
• Urgency
• Foul smelling urine
• Incontinence
• Burning when passing urine

29
Treatment for Urinary Tract Infections

• Urinary tract infections are the most common
  cause of septicaemia in the elderly, and can
  cause confusion.
• Seek medical advice
• Monitor resident carefully
• Ensure adequate fluid intake
• Educate residents and family/friends
• Cranberry juice or tablets can help to reduce
  urinary tract infections.

30
Postural hypotension

• A drop in the systolic blood pressure of
  20mmHg systolic or 10mmHg diastolic or more on
  standing up
• Causes
• Dehydration
• Cardiac disease
• Drug side affects
• Prolonged bed rest
• Dysfunction in the nervous system
• Certain chronic acute illness

31
How to ensure the resident stands up safely

• Suggest they
• Sit on the edge of the bed or chair with feet on
  the floor for a few minutes before getting up
• Stand up slowly using both arms to push up for
  support
• Make sure that they have good balance and do not
  move off if they feel lightheaded or dizzy
• Use support when bending down and stand back up
  slowly

32
Reducing falls from postural hypotension

• Regular medication reviews
• Inform doctor of any side affects from
  medications (prescribed or other)
• Ensure adequate fluid intake
• Treatment and control of associated diseases

33
DizzinessDizziness needs to be properly
investigated by a doctor or specialist

• Causes
• Medications
• Chronic disease
• Acute illness
• Psychological disorders
• As with postural hypotension residents need to
  be encouraged to stand up safely

34
Strategies for preventing falls due to impaired
vision

• Annual check ups with optometrist
• Specialist referral for eye problems
• Ensure the environment is safe
• Occupational therapy assessment
• Vision Australia referral
• Colour contrasting
• Adequate lighting
• Glare reduction
• Orientating clients to new surroundings

35
Hearing problems

• Medical examination
• Audiology referral
• Hearing aids
• Specialist referral
• Raise awareness of the deficit amongst
  carers/family and friends

36
Medications

• 80-90 of people over 65 use medications
• Some medication can cause or contribute to falls
• Older people can have altered sensitivity to
  medications
• Side affects from medications are greater when
  multiple medications are used

37
Medication Risks

• Multiple medications (4 or more)
• Medication side effects
• Inappropriate use of medications (prescribed or
  other)
• Difficulty taking medications
• Lack of information or instruction to residents

38
Falls management medications

• Regular review of medications
• Provide residents with a medication list
• Use of Webster packs or dosettes
• Use the same doctor or pharmacist if possible
• Provide information on side effects
• Inform doctor/pharmacist of any side effects
  suffered
• Inform doctor about herbal medications being
  taken

39
Balance gait disorders

• Medical assessment
• Physiotherapy
• Prescribed walking aids
• Ensure safe environment
• Occupational therapy assessment
• Exercise

40
Lack of physical exercise

• Reduced activity leads to
• Reduced muscle tone
• Reduced bone density
• Loss of strength
• Poor balance and coordination
• Reduce mobility
• Increased frailty
• Reduced quality of life

41
Exercise training

• Strength and balance training
• Hydrotherapy/water exercise
• Exercise programs
• Tai Chi
• Walking for 20 minutes 3 times per week
• Dancing

42
Reducing falls from foot disorders

• Purchase of properly fitting shoes
• Referral to podiatrist for treatment of foot
  disorders
• Referral to podiatrist for advice on purchasing
  of shoes
• Referral to a specialist for treatment of foot
  disorders

43
Reducing falls from unsafe shoes

• Encourage clients to purchase safe footwear
• Flat sole
• Broad rounded heel
• Flexible sole
• Good grip
• Lace ups if possible or velcro fasteners
• Shoes that are enclosed at the front and back
• Avoid scuffs, thongs, high heels, and sling backs
• Dont wear socks without shoes

44
Shoe Sole to Ground Contact
Flat Shoe
Court Shoe
Shoes with greater ground contact help to
reduce the risk of falls
45
Nutrition and falls
Optimal nutrition is important to reduce the risk
of falling and to enhance recovery if a falls
occurs

• The incidence of falls has been linked to
• Vitamin and mineral deficiencies
• Malnutrition

46
Nutrition and falls

• Effects from under-nutrition include
• Reduced muscle mass
• Weight loss
• Iron deficiency - aenemia
• Balance and gait abnormalities
• Vision disorders
• Hypotension
• Decrease in folic acid (can lead to confusion)

47
Nutritional status of people who fall

• Falls can lead to malnutrition
• Fallers have been found to have a poorer
  nutritional status than non fallers
• Falls induce stress which in turn can reduce food
  intake

48
Strategies to reduce nutrition related falls

• Referral to dietician
• Medical review
• Resident family/friends
  education

49
Vitamin D and calcium

• Vitamin D and calcium deficiencies are common in
  older people in residential aged care
• Vitamin D and calcium are
  essential for healthy bones

50
Vitamin D and calcium

• A diet with 1200-1500mg of calcium per day is
  recommended
• 15-20 minutes of direct sun exposure 4-6 times a
  week to the face and hands is required to absorb
  adequate vitamin D
• Supplements are advised for residents not
  receiving adequate amounts

51
Strategies for confused residents

• Place residents near nurses station
• Involve family in resident care
• Assessment and medical treatment of confusion
• Assessment and treatment of delirium
• Adequate pain relief
• Orientation and reorientation
• Increase staff ratio
• Harm minimisation strategies
• Provision of safe environment

52
Fear of falling

• 50 of those who fall will suffer fear of further
  falls
• Fear of falling causes people
  to restrict their
  activities
• Strategies for fear of falling
• Seek help from doctor, physiotherapist,
  psychologist or social worker

53
Fear of Falling

• Fear of falling
• Reduced activity
• Reduced muscle tone Social isolation
• Mobility Balance Problems Reduced Mental
  Well-being
• Falls

54
Treatment of fear for falling

• Assessment of medical condition
• Identification of fears
• Counseling and education
• Physiotherapy
• Behaviour modification and treatment of fears and
  phobias

55
Hazards in the facility

• Rugs mats
• Slippery damaged floors
• Electrical cords
• Poor lighting
• Unsafe bathrooms
• Steps and stairs
• Hazardous gardens and paths
• Furniture

56
Hazards in the facility

• Environmental safety checklist to identify areas
  that need to be addressed in the facility
• Occupational therapy assessment to identify and
  advise on changes needed to optimise safety

57
Risk taking behaviour

• Encourage residents to store things they need
  within reach (eg. on the bedside table) to reduce
  the need to over-stretch or move to reach things
• Discourage risk taking behaviour, such as walking
  without prescribed aid

58
Safe environment for residential aged care
facilities

• Reduce clutter
• Improve lighting
• Safe furniture
• Color contrasting
• Resident orientation
• Keep surroundings familiar
• Non-slip, impact absorbing floors

59
Other interventions

• Alarms
• Personal alarms
• Hip protectors
• Involving family in resident care
• Bus stop chairs

60
Falls and Balance Clinics

• Falls and Balance clinics are specialist clinics
• which provide a multidisciplinary approach to
  falls
• diagnosis and prevention
• A typical team would include
• Nurse
• Physiotherapist
• Occupational therapist
• Geriatrician or rehabilitation specialist

61
What to do when a fall occurs

• Staff and residents need to be taught what to do
  when a fall occurs
• Doctors need to be informed of falls
• Records need to be kept
• Do not try to lift a resident who cannot get up -
  use lifting equipment
• Review residents risk of falling

62
Incident reporting

• Reports need to be descriptive in order help to
  identify the cause of the fall
• Reports should not be used to apportion blame
• An action plan should be developed following each
  fall
• The data from reports should be used to help to
  identify trends in falls

63
Acknowledgement

• In 2005 the Department of Human Services funded
  the National Ageing Research Institute to review
  and recommend a set of falls prevention resources
  for general use. The matierials used as the
  basis for this generic resource were developed by
  Goulburn Valley Health as part of the National
  Demonstration Hospitals Project Phase 3, funded
  through the Commonwealth Department of Health and
  Aged Care. Permission to modify, reproduce and
  include this booklet on the departments Aged
  Care website was kindly provided by Goulburn
  Valley Health. This and other falls prevention
  resources are available from http//www.health.vi
  c.gov.au/agedcare