Overview • Falls and fractures in people aged 65 and over account for over 4 million hospital bed days each year in England alone • The healthcare cost associated with fragility fractures is estimated at £2 billion a year • Injurious falls, including 70,000 hip fractures annually, are the leading cause of accident- related mortality in older people • After a fall, an older person has a 50 per cent probability of having their mobility seriously impaired and a 10 per cent probability of dying within a year • Falls destroy confidence, increase isolation and reduce independence, with around 1 in 10 older people who fall becoming afraid to leave their homes in case they fall again
Hounslow Context • Total annual spend on falls in Hounslow is estimated at £3,830,033 (£3,792,201 on treatment, and £37,833 on prevention). • The current expected annual number of falls in the 65+ years is around 2,670, which is expected to rise to 8,852 by 2020. • The report identified key recommendations as a means of reducing falls and related injuries in Hounslow’s elderly population, such as:- • More should be spent on prevention as there are clear returns on investment • Preventative physiotherapy can have an impact on reducing the number of falls in Hounslow by 576 per year, resulting in an annual cost saving of over £800,000. • In-depth analysis of the falls prevention pathway is essential for understanding the most effective interventions within the pathway that can prevent multiple hospital admissions due to recurrent fall currently 38% of those who suffered a fall had two or more falls related hospital episodes). Source: Falls deep dive (Public Health 2016)
Falls prevention co-ordinator: • A new role of falls co-ordinator was created and appointed to in May 2016 reflecting the need to address the issue of the high number of falls in Hounslow. The role is funded by IBCF. • Remit: • The Falls Prevention co-ordinator provides specialised assessment and treatment for people in the community who have had falls, have a fear of falling or poor balance/mobility or who are considered to be at risk of falls. • The falls prevention co-ordinator provides an accessible service that helps to reduce the risk of falls, trips and slips within the home and in the community. Although not all falls can be prevented, advice and information can be provided to minimise the risk. • The Falls Prevention Co-ordinator works closely with ICRS, CRS, housing, social care, CIDS team, hospital discharge team, SIS, community opticians, occupational therapists, physiotherapist, The Mulberry Centre, GPs and voluntary sector organisations. • Identify collaboratively develop pathways of referrals and access to services. • Addition new role of LAS falls prevention officer created specifically to work with the London Ambulance Service to reduce repeat hospital admissions.
Key work streams: • Assessment- Develop and provide effective, targeted falls assessments in line with NICE guidance. Aim to deliver 470 in a 12 month period. Effectiveness measured by evidenced reduction in A&E attendances/admissions through QIPP tracking. • Training- Develop tailored training programs for staff of residential in borough care homes and PCF domiciliary care workers. • OTAGO- Implement pilot OTAGO program; working with colleagues from ICRS/CRS, identification & recruitment of older people aged 65+. Monitor and track results. Pilot results will inform and shape the role out to wider audience.
Assessment so far…. • 270 falls assessments completed between June 16- August 17 • Most common issues arising from falls assessments: • Medication reviews not taking place • Balance problems not identified by GP or other are professionals • Eye/ hearing issues - professionals are not asking if they can see or hear • Hydration- very few older people understand the importance of hydration • Most common referrals from assessments: • Community recovery service (CRS/ICRS)- physiotherapist, equipment assessment • Handy persons grab rails- appointments to measure and fix rails • Home eye tests
Training Planned Delivered • Deliver tailored training programs for staff in: • Stay Well event 2017 x 2 • Residential and nursing in borough care • Chiswick War Memorial homes • Cloisters care home • PCF domiciliary agency care workers • Sandbanks care home • Sheltered housing scheme managers • Jessop Sheltered Housing Coffee morning • Carers event Sainsbury • Social Care team meetings • CRS team meetings • Melody Court- housing association
OTAGO- strength & balance program Implementation of the OTAGO program; working with colleagues from ICRS/CRS, identification & recruitment of older people aged 65+ to participate in the strength and balance program. Pilot: • 10 week program hosted at a local venue • Providing strength & balance exercises • Provide opportunity for external services to attend and provide education of services that exist to complement program • Assess and review progress of attendees during and integrate in to existing activities on completion • Pilot finding/results will inform recommendations re the role out to wider audience.
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