Prevention of Falls In Older People

A Community of Practice for Falls

A collaborative project between NHS Quality Improvement, NHS Education and NHS Health Scotland

Background

• NHS QIS Practice Development Unit identified falls as a priority topic (Dec 05)

• SEHD convened a falls working group (April 06)

• QIS Falls Scoping Workshop (Dec 06)

• SEHD Rehab Framework published (Jan 07)

• NHS Health Scotland Falls Mapping Project (Jan 07)

• SEHD HDL on Falls and Rehab (Feb 07)

Falls - An International Concern

World Health Organization 2004

“Policy, research and practice are interconnected components necessary for the effective and sustainable program of falls prevention for older persons “

3 consistent themes in existing guidelines in the development of falls policies

• Leadership• Partnership• Education

Falls - An International Concern

International activity demonstrates that strong leadership

has led to falls prevention policies

• Canada ( British Columbia ) Falls and Injury Coalition

• USA National Action Plan (2005)

• Australia - National Falls Prevention Programme(2004)

Existing Guidelines/Frameworks

• Skills for Health Competency Framework Older People Falls and Stroke ( 2007)

• Nice Clinical Practice Guidelines for the assessment and prevention of falls in older people (2004)

• SIGN 71 Management of Osteoporosis ( 2003)• SIGN 56 Prevention and management of hip

fracture ( 2002)• AGS,BGS: Guideline for prevention of falls in

older person ( 2001)• Health Education Board Falls Pathway• Professional Guidelines ( CSP, COT, RCN )

The size of the problem

Over a million falls a year

1 Hip Fracture every 9 minsCost £12-18k

1 Wrist Fracture every 10 minsCost £450

500 admitted to Hospital every day

33 will never go home

Falls- Some Statistics

Community dwelling older people

• Approx 10% of UK ambulance service calls are to people over 65 who have fallen, about 60% of cases are taken to hospital

• Falls are the leading cause of injury deaths amongst people over 65 and older, half occur in their own home

• Older adults who falls once are two or three times as likely to fall again within a year

WHO Health Evidence Network (HEN) 2007

Falls- Some Statistics

Older people in residential care

• Approx 50% of older people in residential care facilities fall at least once a year

• Falls are recorded as a contributing factor in 40% of admissions to nursing homes

• The incidence of falls can double after older people are relocated to a new environment and then return to baseline after the first three months

WHO Health Evidence Network (HEN) 2007

Sedentary vs active lifestyles

>3 hrs per week targeted exercise

myocardial infarct - 3 x less likely

Osteoporosis - 2 x less likely

Fall-related injuries - 2 x less likely

Hip fracture - 2 x less likely

WHO, 1996 “regular physical activity helps to

“preserve independent living” and

“postpone the age associated declines in balance and co-

ordination that are major risk factors for falls”

Key Risk Factors for falls

• Muscle weakness• Abnormality of balance or gait• Poor eyesight• Drug therapy• Neurological disease• Foot problems/Arthritis• Layout of home

SIGN 56

Falls Mapping Study

• High Level evidence from 2003

• The Scottish Context

• Mapping Falls Prevention Activity– On line questionnaire to each board area– Three health board areas reviewed in-depth with 6 depthinterviews with key personnel

Falls Mapping Study

Evidence• Desk based literature search from 2003 ( after the NICE guideline ) found 856 relevant

publications on falls prevention, risk minimisation, assessment demonstrating a high level of activity this area

Scott Porter Research and Marketing

Falls Mapping Study

The Scottish Context• All Our Futures: Planning for a Scotland with an Ageing

Population (2007)• Delivery Framework for Adult Rehabilitation (February 2007)• HDL Rehabilitation and Falls (2007)• SEHD Falls Working Group (April 2006)• Changing Lives (2006)• National Framework for Service Change (2005)• Delivering for Health (2005)• Taking Positive Steps to Avoid Trips and Falls’ (February

2003)• Adding Life to Years: Report of the Expert Group on

Healthcare of Older People (January 2002)• Falls Prevention Conference (November 2002)• Joint Future (2000)

Falls Mapping Study

Mapping Exercise

– focusing on:

• existing falls prevention strategies/implementation plans

• systems and facilities in place for assessing those at risk of a fall

• extent of implementation of multifactorial interventions

• tools developed to support falls prevention

• falls prevention training/education currently available to staff

• health promotion approaches used with older people

• existing network and support groups

• examples of good practice.

Falls Mapping Study

Summary of Key Issues

• Need for a culture change in relation to falls• Need for clear direction from policy, board and local

authorities• Falls coordinators/leads are a crucial link• Need for standardised assessment tools and data

capture• Sharing and dissemination strategy• Available evidence base and best practice • Training for staff• Health Promotion• Primary prevention as well as secondary prevention

Rehabilitation and Falls HDL

• NHS Boards need to have a combined falls and bone health strategy which CHP will implement

• CHPs need to appoint a falls prevention lead or coordinator to work along side the rehab coordinators

• CHPs need to develop an operational falls prevention and bone health implementation strategy

Next Steps

• Falls Programme Manager (October 2007)

• Managed Knowledge Network ( rehabilitation and falls)

• Community of practice for falls ( 2 year work programme )

Evidence used to inform decision making

Explicit Knowledge

Service Knowledge

Tacit Knowledge

Patient and Public

Knowledge

Outcome Safe

Effective Person Centred

Care

PD SupportChange Process

Shared Learning

National Ministerial Implementation GroupImpact & Evaluation Group

Long-Term Conditions Older People Vocational Rehabilitation

Managed KnowledgeNetwork for Rehabilitation &

Falls

Action Group:Rehabilitation Co-ordinators

(x14)Falls Programme Manager

Rehabilitation and Falls(Health & Social Work

Networks)

Falls Steering Group:NHS QIS Falls Steering

Group

REHABILITATION & FALLS REPORTING STRUCTURES

FALLSPROJECT

GGCHT

FV

AAA

LO

LAWI SH

OR

B

D & G

GR

F

DundeeVocational Rehab

Pilot

Project Board

Impact EvaluationGroup

Links to CMO ProgrammeLTC Toolkit

LTCAS