Falls (health and wellbeing needs in South Tyneside)

NICE Clinical Guideline 161 "Falls in Older People" clearly states recommended interventions as follows:

Case / risk identification

Older people in contact with healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the frequency, context and characteristics of the fall/s.

Older people reporting a fall or considered at risk of falling should be observed for balance and gait deficits and considered for their ability to benefit from interventions to improve strength and balance.

Multifactorial falls risk assessment

Older people who present for medical attention because of a fall, or report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should be offered a multifactorial falls risk assessment. This assessment should be performed by a healthcare professional with appropriate skills and experience, normally in the setting of a specialist falls service. This assessment should be part of an individualised, multifactorial intervention, which may include the following: falls history, gait, balance and mobility, and muscle weakness, osteoporosis risk, perceived functional ability and fear relating to falling, visual impairment, cognitive impairment and neurological examination, urinary incontinence, home hazards, cardiovascular examination, and medication review.

Multifactorial interventions

All older people with recurrent falls or assessed as being at increased risk of falling should be considered for an individualised multifactorial intervention In successful programmes the following specific components are common: strength and balance training, home hazard assessment and intervention, vision assessment and referral, medication review with modification/withdrawal.

Following treatment for an injurious fall, older people should be offered a multidisciplinary assessment to identify and address future risk and individualised intervention aimed at promoting independence and improving physical and psychological function.

Strength and balance training

Those most likely to benefit are older people living in the community with a history of recurrent falls and/or balance and gait deficit. A muscle-strengthening and balance programme should be offered. This should be individually prescribed and monitored by an appropriately trained professional.

Carande-Kulis, et al in 2015 demonstrated significant return on investment for interventions ranging from the Stepping Out programme (64% ROI) to Otago exercise programme (127% ROI) to Tai Chi (509% ROI)

Extended care settings

Multifactorial interventions with an exercise component are recommended for older people in extended care settings who are at risk of falling. Vlaeyen et al reviewed numerous studies in 2015 and were able to demonstrate a 21% decrease in recurrent falls from multifactorial interventions in care homes.

Home hazard and safety intervention

Older people who have received treatment in hospital following a fall should be offered a home hazard assessment and safety intervention/modifications by a suitably trained healthcare professional. Normally this should be part of discharge planning and be carried out within a timescale agreed by the patient or carer, and appropriate members of the health care team. This is shown to be effective only in conjunction with follow-up and intervention, not in isolation.

Psychotropic medications

Older people on psychotropic medications should have their medication reviewed, with specialist input if appropriate, and discontinued if possible to reduce their risk of falling.

Cardiac pacing

Cardiac pacing should be considered for older people with cardioinhibitory carotid sinus hypersensitivity who have experienced unexplained falls.

Encouraging the participation of older people in falls prevention programmes

To promote the participation of older people in falls prevention programmes the following should be considered; Healthcare professionals involved in the assessment and prevention of falls should discuss what changes a person is willing to make to prevent falls, Information should be relevant and available in languages other than English, Falls prevention programmes should also address potential barriers such as low self-efficacy and fear of falling, and encourage activity change as negotiated with the participant.

Practitioners who are involved in developing falls prevention programmes should ensure that such programmes are flexible enough to accommodate participants' different needs and preferences and should promote the social value of such programmes.

Education and information giving

All healthcare professionals dealing with patients known to be at risk of falling should develop and maintain basic professional competence in falls assessment and prevention.

Individuals at risk of falling, and their carers, should be offered information orally and in writing about: what measures they can take to prevent further falls, how to stay motivated if referred for falls prevention strategies that include exercise or strength and balancing components, the preventable nature of some falls, the physical and psychological benefits of modifying falls risk, where they can seek further advice and assistance, how to cope if they have a fall, including how to summon help and how to avoid a long lie.

Public Health England echoes these recommendations in their publication "Falls: applying All Our Health" (PHE, 2015) with further emphasis on:

• Training of service providers on fall prevention
• Promotion of physical activity
• Examining primary care and its role in prevention of falls
• Making it easier for older adults to be active and connected socially
• Public education on fall prevention
• Ensuring inpatient providers are following established guidance and recommendations.