Falls In Care Homes: Advice Guidance and Best Practice On Preventing Falls. Risk Assessment, Technology, Training

By Raj Senniappan, founder and Managing Director of Therapies on Thames (www/therapiesonthames co uk)

Falls and fractures are a common and serious health issue faced by elderly people in the UK According to Public Health England individuals aged 65+ have the highest risk of falling with around a third of people aged 65 and over and half of people aged 80+ falling at least once a year Around 5% of falls lead to a fracture and hospitalisation

For the individual, a fall can have serious consequences, causing distress pain injury loss of confidence depression and loss of independence In a 1992 study by Lord et al, frequent fallers (3+ falls per year) were found to have particularly poor outcomes with nearly a third admitted to hospital transferred into nursing care or dying a year later

Fall causes are multifactorial and include muscle weakness visual impairment cognitive impairment neuropathy changes in balance and gait, and underlying physical conditions However, that is not to say that fall risk cannot be managed and reduced With appropriate assessment and training, care home residents can significantly improve their strength balance and mobility minimising their fall risk

The reduction of risk starts with a multifactorial falls risk assessment of the individual as defined by the clinical guidelines published by NICE (CG161 Falls in Older People) This assessment should be performed by a healthcare professional with appropriate skills and experience normally in the setting of a specialist falls or physiotherapy/occupational therapy service It is likely to include a discussion of the individual’s falls history an assessment of gait balance and mobility and muscle weakness an assessment of osteoporosis risk perceived functional ability and fear of falling, an assessment of visual impairment, cognitive impairment and urinary incontinence a cardiovascular exam and medication review and an assessment of environmental hazards

As a result of this risk assessment an individualised multifactorial intervention plan will be produced which targets each of the areas of weakness identified In successful multifactorial intervention programmes common components will include strength and balance training environmental hazard assess-

Ment And Intervention And A Recommendation For Medication Review

Of these interventions strength and balance training is one area in which care homes can offer their residents basic exercise programmes which reduce their fall risk

One such exercise recommended by the NHS is the sit to stand whereby the individual sits on the edge of the chair with feet hip-width apart They should then stand up slowly (using their legs not arms) looking forward (not down) as they do so Once standing upright they should then slowly sit back down repeating this exercise 5 times

Other exercises which are particularly good for improving leg strength, balance, and co-ordination in the elderly are walking lifting light weights (i e bicep curls) yoga walking up stairs and pilates Exercises should be performed to the point at which it would be difficult to do another repetition without help with a typical exercise session taking less than 20 minutes

Alongside these physical activities it may be necessary to increase motivation and adherence among care home residents Educational programmes and social support strategies are particularly important where residents are encouraged to stay active improve their strength and balance and stay hydrated In addition to exercise programmes, hi-low (adjustable) beds are an important tool in minimising the fall risk for elderly people at high risk of confusion Falls sensors such as personal alarms can ensure that care home staff are immediately alerted to a fall minimising the risk of additional injury

Where a resident has had a series of falls specialist physiotherapy or occupational therapy is often required to identify the underlying cause of the issue and to create a targeted specific and progressive exercise programme to reduce the risk of falls This will often include strengthening the muscles around the hip knee and ankle improving the flexibility of the trunk and lower limbs and introducing some light endurance training

Reducing fall risk is one of the greatest challenges that a care home can face However, by implementing targeted, specific interventions with guidance from physiotherapy professionals with a speciality in elderly care this risk can be significantly reduced allowing care home residents to maintain their mobility and independence for longer