Patient presentation notes Older Persons Day 2019 ***Note these - PDF document

Patient presentation notes Older Persons Day 2019 ***Note – these notes are for guidance only*** Slide No Slide Title Accompanying Notes 1 CSP Title None 2 OPD slide None 3 ‘Falls are a common…..’ Population is ageing – likely to live another 20 years over the age of 65. This is great news! The question is what can you do to ensure you are well enough to enjoy this time to the full? 70% of hospital admissions are for older people and older people account for 70% of NHS expenditure. This not only has cost implications for our cash strapped NHS but also for the high numbers of older people admitted into hospital. However, 1 in 4 of these admissions are avoidable. Everyone wants to enjoy the best quality of life they can, remain independent and get back to independence as soon as possible after illness or injury. Falls are a common but often overlooked cause of injury. The exact number of falls in the UK is not known as many go unreported if no serious injury is sustained and people often feel that a fall (especially if it is a one off) is nothing to be concerned about. They don’t realise th e impact a serious fall can have on their lives and ability to function and remain independent. If you worry about getting out and about or have had a fall, ask your GP to refer you to a physiotherapist or you can self-refer in some areas. Physios can help prevent falls and increase your independence and confidence about being active. 4 What causes a fall? There are a number of reasons why people fall including the following:  Previous falls: research shows that people who have a fall are more likely to have further falls  Medication: medication is a major contributor to falls, especially if you are on 4 or more medications. There are a number of groups of culprit medications including BP tablets, sleeping tablets, anti-depressants and pain killers. If you are concerned ask your GP or pharmacist for a medication review.  Getting up at night: this is normally related to issues with balance in the dark and when you are tired or more disorientated. Make sure you turn on a light if you get up to use the toilet even if it is only a night light.  Postural hypotension: often characterised by people feeling dizzy on standing, this is a major cause of falls. Get your GP to check this if you have these symptoms.

 Foot wear and foot care: slippers with trodden down backs, kitten heels, in-growing toenails and other issues with feet can often affect balance and contribute to the risk of falls.  Slips and trips also contribute to falls.  Long-term conditions: the presence of one or more long -term condition has a major effect on the risk of falls.  Home environment: can be a key factor - clutter, trailing wires and loose mats can all cause falls as can reaching up to cupboards or bending down low. These are all things that can be easily rectified.  Alcohol: as people get older their alcohol tolerance decreases meaning their balance is impaired more easily with less alcohol intake.  Lack of strength, balance and mobility: this is a huge factor in causing falls and something that can be easily rectified by undertaking simple exercises regularly.  Vitamin D levels: lack of vitamin D is a common problem in the elderly especially those who are housebound and again is a major contributor to causing falls.  Vestibular issues: many older people have issues with dizziness which are not always correctly diagnosed and treated. If you suffer with dizziness other than standing up, get your GP to refer you to your local ENT or vestibular specialist for an assessment. 5 ‘After a fall…’ However, i t doesn’t have to be this way. P hysiotherapy can help prevent falls, improve balance and increase self-confidence, strength and stamina. If you are concerned about your risk of a fall, consult a physiotherapist for expert advice. 6 What happens after a After someone has had a fall they often lose confidence and become serious fall wary or frightened of mobilising. They then stop being so active due to this fear and consequently lose muscle strength and balance. This leads to people becoming more unsteady which increases the fear and leads to a further decrease in activity. This feeds into a downward spiral where the person continues to lose even more strength, which leads to a greater loss of confidence and a further decrease in activity. The consequences of this include a lack of ability to mobilise, social isolation and further falls with more serious consequences. Physio-led falls prevention services improve strength, balance and coordination, reducing the risk of a fall and identifying other risk factors. If you are concerned about your risk of a fall ask your GP to refer you to a physiotherapist. 7 Other consequences As per slide 8 So what can be done As per slide plus – It is important to see a physiotherapist because physios are ideally placed to provide expert advice on keeping active and building strength and balance – to support general health and prevent falls in older age. 9 Filler slide 10 TUAG The Timed Up and Go is a simple test that can be used to determine if someone is potentially at risk of falls (can show video in slide if preferred). It can be carried out in most environments including your own home. If you are unsteady on your feet make sure you have someone to help you.

Sit on a standard chair, place your back against the chair and rest your arms on the chair’s arms. Regular footwear and customary walking aids should be used. Walk to a line that is 3 meters away, turn around at the line, walk back to the chair, and sit down. The test ends when you sit down. Make sure you use a comfortable and safe walking speed. A stopwatch should be used to time the test (in seconds). If it takes you 14 seconds or longer to complete the test you could be at higher risk of falls and should seek a referral to the local falls service for a multi-factorial assessment including assessment by a physiotherapist. 11 Gait Speed Gait speed or walking speed is another simple measure that can be used to determine if you are at risk of falls. It again can be carried out in most environments. (can show video if preferred) It is carried out in the following way: Measure and mark a standard distance, e.g. 3metres or yards Then measure and mark 1metre before the start, and 1metre after the end. Put a marker at the start and the finish line and start walking. Get someone to time you from the second to third markers. Then divide the distance by the time to get a measure. 12 How to get up from a fall If you have fallen but are uninjured there is a simple method for getting up from the floor if you are able (talk through backward chaining technique on slide or maybe even demonstrate!). If you are injured or unable to get up then the paramedic service should be called as they will have the correct equipment to assist you and will be able to assess your injuries. 13 Evidence for exercise As per slide Physiotherapists are the experts at providing tailored exercise programmes based on people’s needs following an assessment. Exercise can be carried out in either an individual or group setting – the most important thing is to do it! Some basic exercises in the Get Up and Go animation and leaflet (on the CSP website) can help you to get started whilst waiting to see a physiotherapist or for those beginning to have issues with their balance. 14 Increase strength and By improv ing strength and balance you’ll be steadier when up and balance moving around. This leads to increased confidence which promotes activity so we move more. This further improves our strength and balance so we move even more – we get into an upward spiral of increasing activity and decreasing falls. 15 Physical activity The CSP have created another short animation (Never Too Late) to show animation how decreased physical activity can impact on your strength and balance and how this can be reversed with the right type of activity. DISCLAIMER: The activities described here should not cause any harm. They might not, however, be suitable for all people, particularly those at risk of falls and fractures. Consult a chartered physiotherapist or your GP before embarking on any new fitness regime, and if you do experience pain or discomfort as a result of any of the exercises, stop immediately.

16 In conclusion As per slide 17 Closing statement If you are worried about getting out and about, think that you are at risk of a fall or have had a fall, ask your GP to refer you to a physio. Or you can refer yourself in some areas. 18 Filler slide None 19 Filler slide None 20 Useful links Add in own if appropriate 21 OPD slide None 22 CSP title slide None