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Falls and fractures are a major hazard for older people. Our ability to balance, to be agile and have good bone strength can decline as we get older. These can combine and contribute to a greater risk of falls and injuries.
In care homes, many other factors can contribute to prevent or increase the risk of falling: some floor surfaces can provide poor grip, as can incorrect footwear. Also, the layout and design of the building can assist in falls prevention. Good health, particularly maintaining leg and ankle muscle strength, together with a well-balanced diet, contribute to avoid the risk of falls.
Falls are said to be the leading cause of accidental death for people over the age of 75. Many are due to risk factors which can be dealt with to prevent falls and reduce their incidence.
New Scottish guidance on falls and fractures
The Care Inspectorate has, jointly with the NHS, reviewed and updated guidance to care homes on this issue. It aims to help care home services adhere to the Scottish best practice framework ‘The Prevention and Management of Falls in the Community. A Framework for Action for Scotland 2014-16’.
The guidance booklet is available online, and states its purpose as helping to:
Recognise quality care you are already giving.
Identify and prioritise areas for improvement.
Test out and put into practice (implement) new ways of working that both staff and residents will benefit from.
Maintain the improvements you have implemented.
The guidance can also be used in staff induction and used generally in training to increase awareness, and reduce the incidence of falls and consequent injuries. It also gives clear guidance on what to do, and not to do, when there is an actual fall. All of the guidance is useful, and I thought it would be helpful to consider three areas to look at.
Care Homes are advised to set up and maintain an ongoing written assessment of how well they are helping to prevent falls. This itself can contribute to awareness for staff, service users and families, of the dangers. It is best practice to involve service users, and families in this assessment, and to link to or include it in the general self-assessment which the service is required to maintain by the Care Inspectorate.
It is important that this assessment is updated regularly, and that it has an action plan, with timescales to implementing identified improvements.
Prevention of Falls and Fractures
This advises on issues such as foot care, footwear, individual risk assessment for falls (including pre-admission questionnaire). Environmental factors are important here also, including handrails and other occupational therapy aids, flooring, furniture, visual design and well-lit areas.
Regular activities, including walking and leg exercises are invaluable also, from my past experience. The guidance gives advice on training and other resources for carrying out group and individual activities.
An important but sometimes overlooked factor is medication. The guidance recommends the risk assessment for the individual is reviewed each time there is a change of medication. Clearly, risk factors can include the side effects of the medication itself or the condition for which it is it is prescribed. Regular medication should be independently and regularly reviewed by the prescriber, which will help to reduce unintended side-effects.
Managing falls and partnership working
When a person has been found to have fallen, the next steps are vital in assisting recovery. The guidance gives the steps to take before attempting to move the person or indeed whether to move the person at all. A first aid trained person on each shift is invaluable here, in knowing how to help the person without causing further harm. Medical help, including ambulance service if needed, should be called for.
When the situation has been properly managed, the incident should be recorded in the general accident records, as well as in the person’s case notes. As soon as possible, the risk assessment for the person should be updated and any measures needing to be taken are recorded.
The guidance notes the importance of working together with other health and social care services generally, in pursuit of the best practice and policy on falls management and prevention.
Towards best practice
This new guidance promises to provide services with sufficient resources and be used by them, to minimise the problem of falls: this will help maintain and improve people's quality of life as they are cared for.