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Injurious falls in Cambridgeshire
Falls Prevention Slideset
March 2016
Public Health, Cambridgeshire County Council
Slideset Notes
• This slideset has been developed by Public Health at
Cambridgeshire County Council for use in training an...
Contents
1. Background and definitions of falls
2. Quick facts
3. Risk factors
4. Consequences of falls including fear of ...
1. Background & Definitions
Falls are a major health problem in older adults
• At least 30% of persons aged over 65 years ...
2. Quick facts
• Falls are a major cause of disability and the leading
cause of mortality due to injury in older people ag...
3. Risk factors for falls
Intrinsic risk factors Extrinsic risk factors
A history of falls Environmental hazards (poor lig...
4. Consequences of falls
• Injuries due to the fall
1. Fractures
• Wrist, spine, and other fractures
• Hip fractures
2. Ot...
5. Data on falls in Cambridgeshire
• Overarching indicators – hospital admissions due to falls
 Injuries due to falls in ...
Overarching indicators: injuries due to falls
http://www.phoutcomes.info/Public Health Outcomes Framework
By Region
By Dis...
Overarching indicators: hip fractures
http://www.phoutcomes.info/Public Health Outcomes Framework
By Region
By District
Injury due to falls in people aged 65 and over
Source: Public Health England (PHE). Primary diagnosis code for Injury (ICD...
• Around 2,450 admissions per year in Cambridgeshire
• Around 660 admissions per year in Peterborough
• 71% in over 80s
• ...
Rate of hip fractures in people aged 65 and over
Source: Public Health England (PHE) Primary diagnosis ICD 10 S72.0, S72.1...
Key data on hip fractures 2014/15
• Around 630 hospital admissions per year in
Cambridgeshire
• Around 190 hospital admiss...
Type of fall and place of fall (ICD 10)
How do older people fall?
• Slips and trips: 53% in 65-79 and 40% in
over 80s
• Fa...
0
50
100
150
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Cambridge
0
50
100
150
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Ja...
Limitations of data on falls
• Falls: coding is known to be variable between hospital trusts, although
this is thought to ...
6. Impact of falls on health and care
• In 2013, results were published from a Scottish study which aimed to
estimate the ...
7. Guidance on measures for falls
prevention
• NICE 2004 Clinical Guideline (CG 21) replaced by an extended Clinical Guide...
NICE: Falls in older people pathway
8. Evidence for the effectiveness of key
interventions
Cochrane Review: preventing falls in older people living in the com...
9. Local integrated framework
Primary prevention in the
community (untargeted
interventions) 65+
Identification
& Assessme...
10. Measuring the effectiveness of falls
prevention approaches
Public Health Outcomes Framework
• Injuries due to falls
• ...
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Falls prevention slideset for training use - March 2016

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Falls Prevention Slideset

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Falls prevention slideset for training use - March 2016

  1. 1. Injurious falls in Cambridgeshire Falls Prevention Slideset March 2016 Public Health, Cambridgeshire County Council
  2. 2. Slideset Notes • This slideset has been developed by Public Health at Cambridgeshire County Council for use in training and awareness raising activities for falls prevention • Feel free to adapt and tailor appropriately for particular events and audiences • Please ensure technical notes and references related to the quantitative data provided remain in place • There are explanatory notes in the notes pane • For further information on any of the content in this slideset please contact: Jill.Eastment@cambridgeshire.gov.uk or Helen.Johnston2@cambridgeshire.gov.uk
  3. 3. Contents 1. Background and definitions of falls 2. Quick facts 3. Risk factors 4. Consequences of falls including fear of falling 5. Data on falls 6. Impact of falls on the health and care system 7. Guidance on measures for falls prevention 8. Evidence for the effectiveness of key interventions 9. Local falls prevention integrated framework 10. Measuring the effectiveness of falls prevention approaches
  4. 4. 1. Background & Definitions Falls are a major health problem in older adults • At least 30% of persons aged over 65 years experience one or more falls each year • This proportion increases to 40% after age of 75 • Both the frequency of falls and the severity of complications increase with age, level of disability, and extent of functional impairment Definitions • Falls: A fall is defined as an unplanned descent to the floor with or without injury to the patient1 • ‘Injurious falls’ and ‘serious falls’ are used variously2 where there is an injury or the person uses health services due to a fall 1. National Database of Nursing Quality Indicators (2011). 2. Differing definitions depending on source, different research study methodologies etc.
  5. 5. 2. Quick facts • Falls are a major cause of disability and the leading cause of mortality due to injury in older people aged over 75 in the UK. • Falls are the leading cause of injury-related hospitalisation in older people and are a common reason for older people requiring long-term care in their home or a residential facility. • Up to 90% of older patients who fracture their hip fail to recover their previous level of mobility or independence – Only 46% of older people with a fractured hip return to their usual residence on discharge from hospital.
  6. 6. 3. Risk factors for falls Intrinsic risk factors Extrinsic risk factors A history of falls Environmental hazards (poor lighting, slippery floors, uneven surfaces, etc.) Age Footwear and clothing Gender Inappropriate walking aids/ assistive devices Medicines including benzodiazepine, psychotropics, class 1a anti-arrhythmic medications, digoxin, diuretics, and sedatives and polypharmacy Medical conditions including circulatory disease, chronic obstructive pulmonary disease, depression, arthritis, incontinence Impaired mobility and gait Visual or cognitive impairment Foot problems Malnutrition, vitamin D deficiency Psychological status – fear of falling Established risk factors for falls Source: Adapted from 2004 Health Evidence Network Paper for the World Health Organisation
  7. 7. 4. Consequences of falls • Injuries due to the fall 1. Fractures • Wrist, spine, and other fractures • Hip fractures 2. Other injuries • cuts and lacerations • pain and distress • Fear of falling and wider psychological impacts Loss of confidence may result in future activity avoidance, limiting social opportunities, independence, and ability to get out and about • Reduced independence and increased reliance on formal and informal carers • Anxiety for family and friends and carers • Increased requirement from support by health and social care services
  8. 8. 5. Data on falls in Cambridgeshire • Overarching indicators – hospital admissions due to falls  Injuries due to falls in people aged 65 years and over  Hip fractures in people aged 65 years and over • Comparison with other areas • Trends over time • Where do people fall? - location • When do people fall? - seasonality • Limitations of the data
  9. 9. Overarching indicators: injuries due to falls http://www.phoutcomes.info/Public Health Outcomes Framework By Region By District
  10. 10. Overarching indicators: hip fractures http://www.phoutcomes.info/Public Health Outcomes Framework By Region By District
  11. 11. Injury due to falls in people aged 65 and over Source: Public Health England (PHE). Primary diagnosis code for Injury (ICD 10 S00-T19) with falls code (WOO-W19) anywhere in diagnostic string. Where the primary diagnosis (main reason for hospital admission) is an Injury code and a falls code has been included in diagnoses 1-12
  12. 12. • Around 2,450 admissions per year in Cambridgeshire • Around 660 admissions per year in Peterborough • 71% in over 80s • 70% in women Key data on injuries due to falls 2014/15
  13. 13. Rate of hip fractures in people aged 65 and over Source: Public Health England (PHE) Primary diagnosis ICD 10 S72.0, S72.1, S72.2.
  14. 14. Key data on hip fractures 2014/15 • Around 630 hospital admissions per year in Cambridgeshire • Around 190 hospital admissions per year in Peterborough • 72% in over 80s • 73% in women • More than 93% are coded as having experienced a fall
  15. 15. Type of fall and place of fall (ICD 10) How do older people fall? • Slips and trips: 53% in 65-79 and 40% in over 80s • Falls on same level 13% in 65-79; 22% in over 80s Where? Majority of older people fall at home
  16. 16. 0 50 100 150 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Cambridge 0 50 100 150 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar East Cambridgeshire 0 50 100 150 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Fenland 0 50 100 150 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Huntingdon 0 50 100 150 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar South Cambridgeshire 65+ Emergency admissions for injury due to falls in people aged 65+ Number of admissions 2012/13 and 2013/14 pooled 0 100 200 300 400 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Cambridgeshire Time of year of falls: seasonality There is little evidence of a seasonal pattern to falls
  17. 17. Limitations of data on falls • Falls: coding is known to be variable between hospital trusts, although this is thought to have improved. Some artefact of coding is likely nationally. • Hip fracture: fractures are coded but there is little further detail in the data (such as the place, ‘cause’ of the falls) • Considered an important proxy metric for serious falls. • Note relatively small numbers when broken down further eg. by place.
  18. 18. 6. Impact of falls on health and care • In 2013, results were published from a Scottish study which aimed to estimate the costs to health and social care services in managing older people who fall in the community • The study demonstrated that 34% of people aged 65 years and over living in the community fall at least once a year, of which 20% contacted a medical service for assistance. • Applying these results to local population figures for Cambridgeshire & Peterborough CCG, it is estimated that falls in in 2016 will result in over: 5,500 GP attendances 8,700 ambulance call outs 6,300 A&E attendances 3,000 inpatient admissions • The associated costs are high and estimated to be over £83 million. • Costs at discharge are predominantly associated with social care (but not from the funder perspective) Source: Local analysis based on Craig J, Murray A, Mitchell S et al. The high cost to health and social care of managing falls in older adults living in the community in Scotland. Scottish Medical Journal 2013;58(4):198-203
  19. 19. 7. Guidance on measures for falls prevention • NICE 2004 Clinical Guideline (CG 21) replaced by an extended Clinical Guideline in June 2013 (CG161) Falls: assessment and prevention of falls in older people. • The key recommendations from NICE comprise: Preventing falls in older people  Case or risk identification  Multifactorial risk assessment  Multifactorial intervention programmes:  Information and education:  Professional education Preventing falls in older people during a hospital stay  Predicting patients’ risk of falling in hospital  Assessment and interventions  Information and support National Institute for Health and Clinical Excellence (NICE): Clinical Guideline (CG161) Falls: assessment and prevention of falls in older people. 2013. Available at: https://www.nice.org.uk/guidance/CG161
  20. 20. NICE: Falls in older people pathway
  21. 21. 8. Evidence for the effectiveness of key interventions Cochrane Review: preventing falls in older people living in the community Effectiveness • Group and home-based exercise programmes, and home safety interventions reduce rate of falls and risk of falling. • Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling • Tai Chi reduces risk of falling Economic evidence Three interventions for preventing falls in community-living older people have indicated cost savings: • home-based strength and balance exercise (the Otago Exercise Programme) in over 80-year-olds • home safety assessment and modification in those with a previous fall • specific multi-factorial programmes Gillespie et al. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 9.
  22. 22. 9. Local integrated framework Primary prevention in the community (untargeted interventions) 65+ Identification & Assessment Targeted interventions At risk/frail or post-fragility fracture/75+ Preventing falls in hospitals & LTCF Post-discharge (towards independence) P.1 Exercise  Focused on gait, strength, balance, or functional training  Otago  Tai Chi IA.1 Older people routinely asked whether they have fallen in the past year TI.1 Multidisciplinary assessment PS.1 Regard at risk of falling in hospital: • All patients aged 65+ • Patients aged 50 to 64 years who are judged by a clinician to be at higher risk PD.1 Home hazard assessment and safety intervention/ modifications by a suitably trained healthcare professional. P.2 Vitamin D supplementation (+ Calcium) IA.2 Older people reporting a fall or at risk of falling observed for balance and gait deficits and considered for interventions to improve strength and balance. TI.2 Considered for an individualised multifactorial intervention PS.2 Multifactorial assessment PD.2 Specific exercise programmes (eg Otago) IA.3 Healthcare professionals’ professional competence in falls assessment and prevention. TI.3 Strength and balance training is recommended - individually prescribed and monitored. PS.3 Multifactorial interventions (include individual risk assessment and tailored interventions) IA.4 Multifactorial falls risk assessment TI.4 Psychotropic medications reviewed, and discontinued if possible. PS.4 Multifactorial interventions with an exercise component in extended care settings. IA.5 Strength and balance training. TI.5 Cardiac pacing considered for older people with cardioinhibitory carotid sinus hypersensitivity. PS.5 Vitamin D supplementation TI.6 Falls prevention programmes (includes behaviour change & addressing barriers) PS.6 Early anticipation of discharge needs TI.7 Education & information. PS.7 Information & support PS.8 Ensure that relevant information is shared across services. PS.9 Medication reviews for residents in LTCFs Lifecourse approach L.1 Physical activity for bone and muscle strength: children and young people (5-18 years) vigorous intensity activities, at least three days a week; adults (19-64 years) activity to improve muscle strength at least two days a week
  23. 23. 10. Measuring the effectiveness of falls prevention approaches Public Health Outcomes Framework • Injuries due to falls • Hip Fractures Service indicators: • Incidence of hip and fragility fractures in people aged 65 and over • Percentage of individuals aged 65 and over who have experienced a fall who experience another fall which results in injury within six months • Measurement of confidence and level of fear for an individual after a fall in people aged 65 and over Tools: • Tinnetti confidence index • Patient reported outcome measures • Validated quality of life scales: EQ-5D; SF-6; SF-12; SF-32; WEMWBS etc.

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