Enhanced Health in Care Homes (EHCH)

Lincolnshire Primary Care Network Alliance

Go to home page: Lincolnshire Primary Care Network Alliance (lpcna.nhs.uk)

See Annual Report 2019-20 and page 8-9 for information on support for care home residents.

Falls Prevention, Strength and Balance

NHS England and Improvement approved resources

1. What is a fall?

A fall is defined as an event which results in a person coming to rest on the ground/floor or other lower level, for example a chair.

Resources:

Videos

Later Life Training - Bex and Dawn's Glossary of Terms part 1 (Video - 14.29)

React to Falls – Part 1 – What is a fall and why is it important to prevent falls? (Video – 7.21)

Web Pages

ROSPA – 'Falls Fighter' (Web Page)

Falls Assistant - Introduction to falls (Webpage)

All Our Health (AOH)- ‘Falls and Fractures’ e-learning – (Web Page)

Public Health England - Falls: Applying ‘All Our Health’ (Web Page)

2. Why do people fall, who is at risk and how do we reduce that risk?

As we get older or more unwell, falls can become more common and the consequences of a fall can become much more serious. We need to be aware of the risks that could lead to falls. Some examples are:

Those living with moderate or severe frailty.
Requiring walking aids to move about the home.
Taking multiple medications.
Cognitive decline.
Person needs glasses.
Having a history of falls.

We need to recognise and work with residents where possible to reduce potential causes for falls. Some examples could be:

Loose fitting clothes.
Poorly fitting footwear or foot sores.
Trip hazards, such as rugs or loose mats.
Slippery surfaces.
Poorly lit spaces.

It is important to understand the people that you are providing care for and whether they have any risk factors for falls; these should be detailed in the person’s Personalised Care and Support Plan.

Resources:

Videos

Cardiff and Vale University Health Board - Falls Prevention Fuel Tank (Video - 6.24)

OUH NHS – Fallsafe – Put the patient first. Preventing falls in hospital (Video – 8.07)

React to Falls – Part 2 – Why do residents fall and what are the risks? (Video – 7.27)

React to Falls – Part 3 – React to reduce the risk of falls (Video - 8.52)

Documents

Health Education England - Taking Positive Steps to Prevent Falls (Document)

Public Health England – Wider impacts of Covid-19 on physical activity, deconditioning and falls in older adults (Document)

Web pages

NHS – Falls – Overview (Web Page)

Careskills Academy - Falls Awareness (Training course)

World Health Organization – Falls fact sheet (Web Page)

British Geriatrics Society (BGS) - The Fallsafe Project (Web Page with links)

National Institute of Health Research – Older people and frailty – Rapid responses (Web Page)

3. What are the consequences of a fall?

Falls and the consequences of falls can significantly impact a person’s wellbeing, mobility and confidence. People living in care homes are much more likely to fall due to their complex needs and consequences of these falls can be serious, including fatal.

Falls are the second leading cause of deaths from unintentional injury worldwide and adults older than 60 years of age suffer the greatest number of fatal falls.

Physical consequences from a fall can be a direct injury which results in a loss of ability to carry out their usual daily activities. For residents who are very frail this loss of ability may be permanent because of their complex conditions.

As well as the pain from injury, a fall can be psychologically distressing for residents resulting in a loss of confidence, increased anxiety, and being fearful of it happening again.

When a person falls and waits for a long period of time for assistance, there can be additional physical and psychological consequences including pressure sores, hypothermia and developing a deep fear of further falls.

Resources:

Videos

React to Falls – Part 1 – What is a fall and why is it important to prevent falls? (Video – 7.21)

Web Pages

All Our Health (AOH)- ‘Falls and Fractures’ e-learning – (Web Page)

Health Hub - ABCs of Falls: Consequences of falls in the elderly (Web Page)

4. What is deconditioning and what is the impact of reduced activity?

Deconditioning is the syndrome of physical, psychological and functional decline that occurs as a result of prolonged inactivity and associated loss of muscle strength. Deconditioning will affect a person’s ability to carry out activities of daily living independently.

Deconditioning can occur at any age but can occur more rapidly amongst older adults (symptoms experienced within one week), be more severe, and be extremely challenging to reverse.

It is important to recognise that these things can happen to us normally as we age, without illness or disease e.g. reduced muscle mass and loss of cartilage affecting mobility as we get older. The frailty score can be used to identify how someone is deconditioning.

Providing care that supports independence and promotes physical activity is important in preventing and reversing the effects of deconditioning.

Physical activity involves exercise or movement of any description that keeps the resident mobile and promotes independence. This can involve day to day movements such as brushing their teeth or getting out of bed, as well as longer range movements such as walking unassisted.

It is important that the resident feels comfortable and supported with any type of physical activity. This may involve having ‘stopping stations’ around the home to rest along the way.

Resources:

Videos

Health Service 360 - Prevent Deconditioning - Professor Brian Dolan OBE (Video - 4.21)

Health Service 360 - Deconditioning - Fast Facts (Video - 1.00)

CareInspectorate - Care about physical activity resource (Video - 9.35)

Later Life Training – Sit Less, Move More (Video – 9.40)

Better Care Fund / ICARE – Jackie’s Story (Video – 4.52)

Documents

Rockwood Clinical Frailty Scale (Document)

Later Life Training – Encouraging people to be more active for physical and mental recovery – (Document)

Web Pages

Moving Medicine - Why moving matters (Web Page)

Falls Assistant - Home Page (Web Page)

NHS England - News Article - End PJ Paralysis (Web page)

Medicine Encyclopedia - Prevention and treatment of deconditioning (Web Page - Article)

Jackie's Story - Promoting and planning for ageing well (Web Page)

5. What to do when someone has fallen and the impact that should be considered in the immediate, short, and long term?

IMMEDIATE:

Ensure the resident is safe from further harm and no other residents are at risk of harm, before notifying a senior carer.
With the help of a senior carer ensure your homes policy related to falls is followed, which includes instruction on documentation and where and who to access health care support from if required.
This includes that the person’s family or next of kin have been informed if this is detailed in their care plan.

SHORT TERM:

It is important to recognise that a fall is often a very traumatic event for the resident and the carer providing support.
Follow up from a fall for the resident should include emotional support as well as ensuring any injury has been properly addressed, including pain relief if needed.
For the next days they may need additional support to help then regain confidence in moving about the home.
Along with encouragement and emotional support, managing pain can be an important part of an individual to help them return to their usual level of daily activities.

LONG TERM:

Your allocated clinician should be notified in the weekly home round if not already aware of a residents fall.
The Multi-Disciplinary Team (MDT) should also be engaged to ensure any additional assessments for safety are completed e.g. the occupational therapist may assess for supportive aids or the pharmacist may review medication.

Resources:

Videos

React to Falls – Part 4 – What should your home be doing to react to falls (Video – 4.11)

React to Falls – Part 5 – Managing behaviour to reduce falls (Video – 4.15)

Yorkshire Ambulance Service – Response to patients who have fallen (Video – 4.35)

Documents

National Falls Prevention Coordination Group (NFPCG) – Managing a fall that may require an ambulance (Document)

Perth and Kinross council - Falls Education power point (Document)

Web Pages

Independent Living - What to do after a fall (Web Page)

ROSPA – 'Falls Fighter’ (Web Page)

E-Learning for Health - Preventing falls in hospitals (Web Page)

Ageing Well in Wales - Falls Prevention Resource Hub (Web Page)

6. What is strength and balance training? How is this different from physical activity?

We can all encourage people to remain physically active but to further prevent their risk of fall we should also promote strength and balance training.

This type of training involves increasing strength and balance of the resident rather than focusing solely on movement. Strength and balance training is evidence based, more structured in nature and can be individualised for the resident.

Resources: