February 11, 2013 3 Comments
As regular readers will know, my main practice interest is in mental health, however, all OTs are trained in both mental and physical health. Providing holistic care to the people I’m working with is enhanced by this training. For instance, in mental health services for older people, falls are as relevant as in orthapaedic OT, so it’s always useful to revisit other practice area specialities and share knowledge within the profession.
With this in mind, it is always a pleasure to get drawn in to chats on Twitter about areas of practice that use knowledge that would otherwise become rusty due to lack of use: and it’s an exciting challenge for me to revisit my knowledge of falls prevention and to participate in #fallschat recently, on Twitter.
I was excited to be asked by Dr Clare Gerada (who had attended a workshop on falls prevention) to contribute to her weekly RCGP Blog about falls prevention. I sent her my “Ten Top Tips for Falls Prevention”, repeated below.
My 10 Top Tips for Falls Prevention:
- Make sure the hallway and stairs have working lights- if possible, replace with low-energy light bulbs and keep lights on overnight.
- Wear slippers with an appropriate heel, so that they stay firmly on the feet.
- Regular, gentle exercise can help reduce risk of falling and also fear of falling. Exercise such as Tai Chi is particularly helpful at improving balance.
- Check out signs that a person is unsure on their feet such as “furniture walking”, or clear dirty marks where walls are used for support. Having grab rails installed at key sites around the home or at the entrance to the home can be arranged by local community OT services.
- Fasten any torn bits of carpet or lino down- gaffer tape is ideal for this, if an older person can’t afford to replace floor coverings.
- Tripping over the edges of rugs is really common- either remove rugs, or fasten down the edges to reduce this risk.
- Medication management- GPs are well placed to review medications and watch for interactions, non-compliance etc.
- Check for use of alcohol- which increases falls risk and may interact with medications, or even be used to self-medicate undiagnosed depression.
- Poor foot care can be a reason for not wearing slippers, and can contribute to falls. GPs can check if a person would like a Chiropody referral, if foot care is difficult for an individual.
- Multi-disciplinary teamworking can solve many issues- so don’t be shy about asking for help! Occupational therapists, physiotherapists and chiropodists can be really useful contacts for falls prevention.
A Few Falls Facts:
- A fall at home that leads to a hip fracture costs the state £28,665 on average (726 million a year in total). This is 4.5 times the average cost of a major housing adaptation and over 100 times the cost of fitting hand and grab rails to prevent falls (Heywood et al 2007).
- The provision of a home safety programme and exercise programme delivered by occupational therapists was found to reduce falls significantly (Campbell AJ et a, 2005).
- A community based occupational therapy based falls prevention service cut the number of falls among older people by half according to evidence published in the BMJ“
(from COT website available at http://www.cot.co.uk/ot-helps-your-client/falls-prevention)
Can I use the “Top 10 Tips” as a resource for my work/ care setting?
The “10 Top Tips and a Few Falls Facts” post is available as a free-to-use PDF that you may print off and use in your care setting (or as a reminder when visiting an older relative?) please see the following link:
I was delighted that the post was so warmly received by many health professionals and carers, who said they would be interested in using it. I was also pleased to hear further information from professionals with expertise that I don’t possess- from Optometrists, Pharmacists, Telecare consultants and Cardiac Doctors- who all had further info to share. I bookmarked Tweets that contained further links, so that I could share them with you, here.
8th Feb from @helen_whiteside: NECESSARY drugs increase falls risk too- need reg. review/monitor. ref selection 4 ur doc Google scholar search for medications and falls
8th Feb from @ClarkMike: Falls tip -make sure any daily living equipment is well-maintained and meets your needs – secondhand could be poor quality/unsafe
8th Feb from @ClarkMike: Falls tip -
#telecare can turn on lights when you get out of bed or raise the alarm if you fall or don’t return to bed
8th Feb from @ClarkMike: “Falls tip- telecare and falls- Exploring the use of Telecare
10th Feb from @cardiacdoc1: “Don’t forget this… The overlap between syncope and falls in the elderly“ Shaw and Kenny (1997) The overlap between syncope and falls in the elderly. Postgrad Med J. 1997 October; 73(864): 635–639.
Obviously, no quick “Top 10 Tips” guide can ever be a substitute for good multi-disciplinary assessment and intervention to prevent and manage falls. I thought our experiment in crowd-sourcing tips from the was a big success. It stimulated discussion among healthcare professionals who self-select to collaborate on Twitter, and was widely spread through their networks. It was critiqued as being quite basic, but the point of it was to show how small actions can help to keep someone safer at home- it was never meant to be a piece of post-graduate medical education.
And yes, next time, I’ll be sure to add in tips about how regular sight checks, telecare solutions, and underlying medical explanations can all add to our understanding of falls prevention! Perhaps we could see similar guides produced by others with more education about these areas than I?