Joint runner up in the 2005 Guidelines in Practice Award was a collaborative initiative to reduce falls and their impact in the elderly. Linda Macpherson explains how it works
Falls are a major cause of disability and the main cause of mortality resulting from injury in individuals aged over 75 years.1
Standard Six: Falls of the NSF for Older People aims to reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen.
The Standard recommends: "The NHS, working in partnership with councils, takes action to prevent falls and reduce resultant fractures or other injuries in their populations of older people. Older people who have fallen receive effective treatment and rehabilitation and, with their carers, receive advice on prevention through a specialised falls service.”
An integrated falls service can help to prevent falls and reduce their impact.This not only improves outcomes for older people and helps them to remain independent, but also reduces pressure on the NHS and social care services.1
A falls service in Falkirk
One of the milestones of the NSF is that by April 2005 an integrated falls service should be established across all local health and social care systems.
The Falkirk Falls Management Project began in March 2002 as a joint initiative between NHS Forth Valley and Falkirk Council to reduce the number of falls being experienced by older people in their own homes.
The project, which also won the older people category in the 2005 Guidelines in Practice Awards, built on the council’s successful mobile emergency care service (MECS).This was already providing services for 4213 individuals, some of whom were experiencing falls. It also drew on the expertise of NHS Forth Valley’s Falkirk elderly outreach team (FALGO) and Windsor Day Hospital.
The project aimed to identify at an early stage those at risk of falling, and to offer a range of interventions, including education on prevention, environmental assessment, medication review, therapy and equipment.
Reducing the number of falls would reduce the potential for injury and adverse longer term consequences for the individuals concerned. It would also mean fewer attendances at A&E and admissions to Falkirk and District Royal Infirmary.
Supporting independent living
Referrals are made to MECS from a variety of sources since there is a completely open referral system – anyone can refer. On referral, the older people are given information leaflets or audio tapes with advice on how to avoid falls. They are also offered an alarm to enable them to call the MECS wardens if and when they need help.
The MECS wardens are trained in first aid and moving and handling older people. In an emergency they will offer assessment, personal care, support and reassurance and will call the ambulance and notify the individual’s next of kin, GP, district nurse or social worker if necessary.
When a fall occurs
Falls are recorded in a MECS database, enabling us to identify individuals who are falling frequently and to respond appropriately.
Individuals who experience two or more falls within 6 months are visited at home by our mobile operations co-ordinator.
MECS informs the individual’s GP about the falls and also whether he or she has agreed to be referred to the clinic.
Figure 1: Standard referrals form (front)
Figure 2: Standard referrals form (back)
Falls management clinic
Consultant-led assessments lead to attention from a multidisciplinary team, including physiotherapists and occupational therapists, who carry out an holistic assessment, including a hazard assessment and a medication review, and can arrange to provide protective equipment if needed.
Patients also attend group sessions where they receive information about falls.
All individuals who are referred to the falls management clinic are asked to sign a confidentiality waiver form. This enables information about the individual’s pattern of falls to be shared between his or her GP and MECS and NHS Forth Valley staff.
As part of the project, we developed a falls risk assessment form (Figure 3) for use in the falls management clinic as well as for assessing hospital in-patients.2 This is used to guide the choice of further intervention.
Those at highest risk of further falls are offered an automatic fall detector to wear at home.This is triggered automatically when the individual falls, summoning a MECS warden.
Figure3: Falls risk assessment form
How successful was the project?
In the time the project has been running, we have provided almost 2000 new MECS service users with information booklets or tapes, and the MECS mobile wardens have attended 5798 falls.
Table 1 gives the figures gathered by MECS, covering the period from the beginning of the project on 1 March 2002, until 31 December 2005.
|Table 1: Falls among MECS service users|
|Year||Service users||Falls attended||Falls per service user|
*1 March to 31 December
This shows that the number of falls per service user dropped from 0.35 in 2002 to 0.27 in 2005. The service users are predominantly older people with a range of medical conditions. Most of them live alone.
Although the figure for 2005 maintains the downward trend, it was slightly higher than anticipated because in November and December we expanded the service to include many first-time users who had been on the waiting list and had been referred specifically because of falls.
Some 144 people who experienced more than two falls in 6 months were offered referral to the falls management clinic, and 101 of them accepted. Twelve refused and the remaining 31 were already known to FALGO and were receiving falls advice from FALGO staff.
Automatic fall detectors have been given to 27 MECS service users. In fact, we have found the automatic fall detectors so useful that we now offer them as part of the mainstream MECS service.
Rolling out the project
The Falkirk Falls Management Project has been recognised for its contribution to the reduction of falls in the NHS Forth Valley area.
It has provided the model for the development of similar services in the Stirling and Clackmannan areas. The project was the winner of the ‘community involvement and partnership working’ category in the Falkirk Council Celebrating Success 2005 Awards.
We plan to widen the scope of our service by training home care assistants in sheltered housing settings to deliver a programme of balance and strength exercises.
- Department of Health. National Service Framework for Older People. London: DoH, 2001.
- Cannard G. Falling Trend. Nursing Times 1996; 92(2): 36-7.