Falls Prevention in

Care Homes

Aim

To raise awareness of the causes and

prevention of falls and fractures in older people

living in residential or nursing homes.

Outcomes

By the end of the session delegates will be able

to: Identify risk factors for falls Identify risk factors for Osteoporosis Understand that some risk factors can be

modified or reduced and some are not modifiable at all.

Definition A fall is an unexpected event resulting in the

Person coming to rest on the floor or other

lower level.

It includes: Falling out of bed Falling off a chair or toilet Falling while walking Falling downstairs.

Risk factor

Something associated with a condition or

an event that makes it more likely to

happen.

Falls

Falls in older people are due to the interaction of their personal risk factors with their environment.

Falls in older people are multi-factorial – not caused by one factor.

Risk factors for falling Personal Environmental BehaviouralOf these, some are Modifiable or reversible Non-modifiableThe more risk factors a service user has, the greater the risk of falling.

Risk factors

Reversible/modifiable Non-reversible

Poor footwear

Environmental hazards

Taking lots of medicines

Postural Hypotension (Blood pressure dropping on standing)

Muscle weakness

Poor balance

Unsteady walking

Confusion due to urine infection

Medical conditions e.g. Stroke

Vision e.g. blindness

Loss of feeling in feet and legs due to Diabetes

Confusion due to Dementia

Bone Health

Bone density reduces with ageOsteoporosis affects 1 in 2 women and 1 in 5 men over the age of 50

A person with osteoporosis is at very high risk of breaking a bone if they fall

95% of hip fractures are caused by a fall

Vertebral (spinal ) fractures occur without falling, are often unrecognised and very painful

normal osteoprotic

What Osteoporosis looks like

Preventing hip fractures Assess and reduce fall risk factors for every resident as

much as possible Check all residents’ weight and think about their food

intake Encourage weight-bearing exercise, good posture and

back care Discourage smoking and excess alcohol intake Encourage residents to sit outdoors in the summer for 20

minutes Check that all residents are having Calcium & Vitamin D

supplementation to help their bones and their balance Hip protectors can reduce the risk of a hip fracture if

worn and correctly fitted.

How can we reduce falls?Evidence suggests that the number of falls andinjuries can be reduced when: an older person receives an individual

assessment of their risk factors their reversible risk factors are identified and

reduced their care plan shows action taken to reduce fall

and fracture risk all staff are aware of residents likely to fall everyone works together – falls need team work!

Comfort checksA method of providing care to a resident on a regular basisA comfort check would include: Asking how the person is, if they have any pain Asking if they would like to go to the toilet or for a walk Offering a drink Checking they have good footwear on Checking the area around them for trip/fall hazards Ensuring that their walking aid/glasses/call bell are close

at hand Telling the resident that you will be back again to see

how they are in an hour.

Posture and SeatingGood posture is important for residents

Poor posture can cause: Pressure ulcers Pain in muscles and joints Risk of falling out of the chair Difficulty eating, talking, breathing Poor balance and higher risk of falls when

standing

Top tips Change position often – stand up every 2 hours Rest on the bed for an hour after lunch, allows joints

and muscles to stretch and takes weight off the bottom When sitting, ensure feet are on the ground or footrest Hip, knee and ankle should be at 90° Encourage residents to sit symmetrically, not leaning to

one side If the chair is too low, raise the height through the legs,

rather than adding extra cushions If a resident can’t move well in a chair, help them to

stand up and sit down again Encourage activity and mobility

Top tips for maintaining mobility

Regular (daily if possible) exercise Encourage residents to walk whenever

possible, check walking aids are clean and in good condition and the right size

Ensure you use the correct techniques for assisting residents to stand up and walking

Ensure (as far as possible) that all residents have good, safe footwear, light shoes are better than loose slippers.

Bedrail use

Falling out of bed can cause a head injury or fractured hip

Bedrails are not to be used to prevent residents getting out of bed i.e. as a restraint

Do not use for residents who are confused and mobile enough to climb over or round them

There is a risk of limbs becoming trapped in bedrails, so bumpers/covers should be used

Action following a fall: 1

Most falls in Care Homes are un-witnessed Assume a head injury may have been sustained

unless proven otherwise Refer to post fall protocol Consider whether the resident needs to be

moved – ‘don’t add insult to injury’ Head injury observations for un-witnessed falls

as well as when there is clear evidence of a head injury

Action following a fall: 2

Complete accident/incident book Inform the GP Inform the relatives Complete the resident’s falls register Update the falls care plan Ensure all staff are aware of the fall

1 2

3 4

5 6

7 8 9 10 11 12

13 14 15 16 17 18

19 20 21 22 23 24

25 26

Days since last fall

27 28

___ days 29 30 31

To prevent falls you need to Carry out regular audit by managers/senior

staff of fall numbers, times, locations, injuries Feedback to all staff about fall rates Have good handover and communication

between staff Ensure there are regular falls training updates

and induction for new staff Involve residents and families in falls

prevention measures and education