Open | Falls prevention toolkit for clinicians aids integrated approach
Falls are the most common and costliest cause of injury in older people, with around 30 to 60 percent of people aged 65 and over falling each year and 10 to 20 percent of those falls resulting in injury such as hip fracture, hospitalisation or death.[1] Falls can result in fear of falling, with older people who have fallen avoiding physical activity, which can in turn affect their balance and strength and increase their risk of further falls.
With the population of New Zealand aged 65 and over projected to grow nearly three times by 2050, and those aged 85 and over to grow six times, there is a strong rationale for investing funds, time and energy in preventing falls.
We recognise the importance of reducing harm from falls in New Zealanders over the age of 65; this is a message not just for the frail but for all of us as we age. We need to "normalise" the risk of falling and encourage all older people to stay as active as possible, minimising their risk of falling, maintaining their independence and improving their overall quality of life.
Falls prevention requires a partnership approach between the older person, their family and their health care team.
To help those providing care in the community identify older people at risk of falls, the Health Quality & Safety Commission, in association with bpacnz, has developed the Stay Independent Falls Prevention Toolkit for Clinicians and the Ask, assess, act pocketcard to aid primary care teams in their assessment of an individual's risk of falling and practical strategies to reduce this risk. The interventions are evidence-based, taken from the CDC- STEADi resources and adapted for the New Zealand context.
A small-scale implementation ‘road-test’ with Central PHO resulted in very positive feedback from both GPs and nursing staff. Patients were also very enthusiastic about the assessment and informative brochure.
The Ask, assess, act pocketcard is a guide to remind us to have the conversation, listen to what we are being told, reflect on it and take action. The conversation needs to involve the older person, their family/whānau and other carers, in the identification of falls-related problems and risks that are real for the older person, and lead to shared decisions about actions which will be most helpful and manageable.
Integrated approach key to preventing older people’s falls
The stay independent toolkit can be used as part of a DHB’s integrated approach to falls prevention. Regions are encouraged to have multidisciplinary teams that can identify an older person’s falls risk factors and intervene to reduce their risk of falling.
Each DHB is encouraged to find what works best for them, balancing the interests of those at higher risk of falling with the wider population of generally healthy older people for whom support outside hospital now can prevent admission later.
An integrated approach will take into account the whole of the person’s health, as falls in older people are often due to underlying conditions such as cardiac issues, osteoporosis or poor eyesight.
DHBs at varying stages in their journey to achieve integrated falls prevention programmes include Canterbury, Nelson Marlborough, Tairawhiti, Whanganui, Capital & Coast, Hutt Valley and Wairarapa.
Canterbury’s community-based falls prevention programme includes a GP, practice nurse, pharmacist, physiotherapist and falls champion (usually a physiotherapist but in some cases a practice nurse) working together around the overall care of a person in their own home.
‘Not only are we delivering strength and balance exercises in people’s homes, we are incorporating a home hazards checklist provided by the same person,’ says Ken Stewart, Canterbury DHB’s falls prevention clinical lead and regional clinical lead.
The safety net is wider than falls prevention, he says. ‘Part of the strategy is to facilitate fantastic communication among that team, and to highlight other issues that come up as part of that in-home care.’
He says a physiotherapist may find issues a GP doesn’t know about because they’ve not seen the older person’s home – for example, their cupboards are bare because they have transport issues and they are not eating.
‘I’ve seen it myself with patients who have had perhaps a fall and I’ve referred them off to the falls prevention team. They’ve gone and they’ve done a wonderful assessment. Really checked the house out. They’ve done strength and balance testing. They’ve got the patient motivated,” says Dr Michael Thwaites, GP liaison for Canterbury DHB’s community-based falls prevention programme.
“The pharmacy people have come in, checked their medication, made sure that’s all good. Sometimes they’ve even prompted me to put the patient on vitamin D. It’s a great collaboration, really, and just makes our job in general practice a lot easier, and it’s obviously much better for the patient.’
The Stay Independent: Falls Prevention Toolkit for Clinicians can be downloaded from the Health Quality & Safety Commission website. More information about an integrated approach to falls is also available on the Commission’s website.
References:
- Robertson MC and Campbell AJ. 2012. Falling costs: the case for investment. Report to Health Quality & Safety Commission. Dunedin: University of Otago. www.hqsc.govt.nz/assets/Falls/PR/Falling-costs-case-for-investment-report-June-2013.pdf
