The Reality of a Fall

Kate Sheehan

Director, The OT Service

The OT Service provides high quality advice, consultancy and training to manufacturers, retailers and service providers. It also provides occupational therapy clinical services in housing and equipment to case managers, solicitors and private individuals via its handpicked network of occupational therapists.

For more info email kate@theotservice.co.uk

Gerry up and onto a trolley. Off they went and brought back the Mangar Elk, they carefully supported her to move side to side to get the cushion into position under her bottom and lifted her one segment at a time, making sure she felt safe and secure. Once up to the top, they could put the trolley alongside her in the room and she was assisted to complete a sliding transfer onto the trolley, the paramedics kicked the Elk out of the way and proceeded with checking vital signs again. A quick visit to A&E, nothing broken, and back to the hotel with the most amazing bruising appearing within hours. The situation really made me reflect, both personally and professionally, on what happened; the return to her residential care home, the impact on us as family, and the long-term impact for my mother-in-law. The professional reflections have been really useful for my ongoing clinical practice:

Falls rarely happen in the middle of a room.

Falls that involve ‘slumping’ tend to happen in awkward places, in doorways, in front of the chair or by the side of a toilet. 3 Knowing the weight of someone is critical to equipment use - my mother-in-law is 25.5 stone and therefore above some equipment weight limits.

Prescribing equipment that allows ease of use in confined spaces is essential to support someone up and off the floor.

Equipment should enable use even when the fallen person is 6 not in an anatomically perfect prone position.

The ability to complete a side transfer from lifting equipment is key to non-ambulant transfers

Kit that can be kicked out of the way without impacting the use of that equipment in the future to concentrate on the patient is critical.

The ease of assembly is important, however what is more important is the disassembly as the carer/paramedic needs to concentrate on the fallen person, not on how to get the equipment back in its carrying bag.

Following the initial intervention of getting someone up and off the floor, what are we doing to support that person going forward to rebuild strength and confidence? As professionals, we really need to critique the equipment we prescribe, its features and benefits, where and how it can be used. Getting someone off the floor is only one part of the intervention; we should be providing rehab following the fall to improve function, confidence and well-being.

THE REALITY OF A FALL

There is a wealth of evidence about the impact of a fall on an older person, much of which I have read over the years whilst working in social care and the independent sector. However, the reality of it and the personal impact on a member of your family makes you reflect on our role, the equipment we prescribe, and the post fall support we provide. We recently took my mother-in-law Gerry over to the Isle of Wight to see her daughter and extended family. She hadn’t seen them for over three years due to the pandemic and failing health of her husband, so she was really looking forward to the visit and especially meeting her new greatgranddaughter. Gerry is 80 years old; she lives with dementia and mobility impairments, she still maintains some insight but walks slowly without equipment as she is unable to work out how to sequence walking using a stick or frame. She spent a day with the extended family celebrating the new arrival and catching up with her daughter, and on picking her up she walked towards us holding a cup of coffee, tripped over a child’s scooter and fell, slumped into the doorway to the garden. Professional mode kicked in and I checked for any obvious injuries and with help supported her into a sitting position. We knew that we would not be able to assist her to stand due to her weight and poor mobility, so the emergency services were called. The ambulance arrived extremely quickly and following an assessment of any potential injuries, they wanted to get 1 2 4 5 7 8

...The situation really made me reflect, both personally and professionally