This document summarizes the results of a falls prevention and bone health initiative pilot project in Dublin North City primary care teams. It found that 40-58% of older patients screened required further assessment, and 40-60% of those screened were at risk of falls, with over half requiring intervention. Referral rates to specialists were low. The screening documentation was found to be clear but time-consuming. The next steps outlined continuing the initiative, further streamlining processes, and providing more education.

1. Dublin North City
Primary Care Teams
Falls Prevention and Bone Health
Initiative
Phase 2 Results
Millmount PCT and Network 1
Laura Binions
30th
September 2015

2. National Background
• Estimated one in every three people over 65 yrs and one
in every two over 80 yrs fall every year.
• In 2008 the “Strategy to Prevent Falls and Fractures in
Ireland’s Ageing Population” was published to ensure
development of integrated falls and fractures programme
to meet the need of the growing older population.
• Under the Care of the Elderly in Primary Care
programme a working group was set up and a draft
document was published “A Guide to Falls Screening
and Multi-factorial Falls Risk Assessment in Primary
Care” updated January 2013

3. The Stats
• 30% of the older population or 130,000 of 65 and over
fall annually in Ireland.
• Estimated 300,000 people over 50 yrs may have
osteoporosis.
• Yearly cost of falls and fractures €404 million.
• Hip fractures account for 2,800 approx hospital
admissions per year.
• By 2031 approx 1 million people will be over 65 living in
Ireland.

4. Local Background
• Ballymun Primary Care Team ran a pilot project: “Falls
and Fractures Prevention in Primary Care setting” in 2007.
• Several Exercise groups (FaME) have been run in the
area by Physiotherapist Services.
• Information days have been held in local areas.
• Occupational Therapy, Physiotherapy and Nursing have
implemented falls screen tools to their initial assessments.
• Falls Prevention and Bone Health Management Group
set up in DNC to promote more efficient and effective
protocols along with integrated pathways between hospital
and community services.
• Falls Prevention on Bone Health Coordinator started in
September 2014 on 6 month pilot project.

5. Objective
• Experience and findings
• Documentation revision
• Feedback
• Next steps
5

6. Role of Coordinator
• Development and
adaptation of Screens
and Assessments.
• Linking with all
stakeholders involved.
• Training and support for
PCT members in role out
of new Screen and
Assessment process.
• Data collection of all
clients who have been
through pathway and
onward referrals.
• Analysis of data gathered
in relation to numbers
referred, screened,
referrals both PCT and
others.
• Use data to highlight
those most at risk and
where education
programmes would be
most beneficial.
• Use data to confirm need
for specialist service in
falls prevention and bone
health.

8. 8
What we were doing

9. 9
Client over 65 years
PCT Referral
Level 1 Screen
Completed
No further
Intervention required
Recorded on data base
Require further Ax
Level 2 Multi-Factorial Screen
Completed
Onward Referrals
PCT referrals GP referral
Specialist service as
appropriate,
St Marys, DEXA etc
All onward referrals recorded on database
Coordinator reviews all referrals as
appropriate at PCT meeting
Pilot Aim

10. Millmount PCCT
10
Pilot began
28/10/2014
- 7 months

11. Millmount PCT
by age group
11

12. Impact of fall on the older Person
12
Injurious or falls requiring intervention were more common in
women and those who were 80+.

13. The Irish Longitudinal Study on Ageing
(TILDA)
Falls Injurious falls
52-64 yo 18.4% 7.3%
75+ 29.8% 9.9%

14. Self reported injuries
46 fallers
14
1:4 reporting injuries or further intervention sustained a
fracture following a fall

15. 15
37 (42%) had Onward Referrals

16. Bone Health – DXA
Level 2 only
16
Of those at risk, 1:6 were not asked about bone health.
Of those at risk, 17 (34%) were not referred for DXA.

17. Screening and Intervention
17

18. Network 1
18
Screened 16/3-
31/5/2015

19. 19
Findings
Male Results
• 17% of 70-79 had a fall and 100% fallers required further intervention
/injury.
• 30% of 80-89 had a fall and 67% fallers required further intervention /injury.
• 1 person under 65 had multiple falls
Female Results
• 52% of 70-79 had a fall and 33% fallers required further
intervention/injury.
• 39% of 80-89 had a fall and 60% fallers required further intervention/ injury
• 33% of 90+ had a fall 100% fallers required further intervention/injury.
Falls rate vary between 17% to 39%;
injuries/intervention from 1:3 to 100% across the
age groups.

20. DXA – Network 1
20
14 (54%) of those with falls risk WERE NOT referred for DXA.

21. THE EXPERIENCE &
LEARNING
21

22. Summary and Findings
• Age profile similar in Millmount and Network 1 for 70-89 women 80-
89 men
• 40-58% of older persons require more assessment (Level 2)
• Our experience showed that between 40-60% of those screened
were at risk of falls and more than half of them require further
intervention.
• The referrals to DXA , falls clinic and some profession (nursing)
remain low. More information sessions required.
• Referral rates to GPs for bone health has increased following
education sessions on bone health and St Marys services. Staff
reported knowing more about services available after attending
education day.
22

23. Success & Challenges
GP involvement
• Coordinator continuing to link with GPs regarding the Initiative and
their role in same.
• 1 Practice now requests all screens and level 2 Assessment
completed on their clients at 2-monthly client review.
Administration and Organisational Analysis
• Very limited computer base forms completed by Network 1 staff,
using post therefore some delay on input of client data on database.
• Millmount almost 100% are computer completed and utilise email
and new scanner facility.
• Excellent compliance with using CRO
23

24. Modification to practice
Revised Documentation
• Addition of not applicable criteria to Screen receiving
excellent feedback
• Combined Level 2 with Referral form reducing
completion time and streamlining the process
• Staff still report increased time in completing Level 2
form
• CRO working well for distribution of all documentation
• A focus group would be beneficial to identify clearly with
staff what to change in the documentation and to further
streamline the process.
24

25. 25
Documentation Evaluation
• All documentation is reported as being clear and largely
easy to complete. Some issue with Level 2.
• Most Staff felt it was MDT appropriate and relevant to
practice.
• Staff’s main concern was time taken to complete in
particular Level 2 with 64% recording 5-20 minutes and
29% reporting 20-30 minutes.
• Staff still remain concerned with time taken to complete
level 2 and own initial assessments.
• Found combination of Referral and Level 2 very useful
and time efficient, however some felt required more info
on Level 2, to effectively prioritise referrals.

26. 26
“ very detailed and time consuming to
complete”
“I feel this could be reviewed to make it
more relevant to practice”
“ Duplication of OT assessment takes a
lot of time”
“Needs to be shorter and less questions
for client when is being done along with
an assessment for ones own discipline”
“Time efficient as OTs were doing similar
assessment”
Further education
around MDT aspect
of forms not
profession specific
required

27. Overall Results of Phase 2
Survey
• Overall positive feedback about the initiative and
its concept.
• Training and support vital
• Excellent feedback regarding practical education
sessions
• Need for continued support and buy in from all
professions in PCT team.
• Essential that the process is as time efficient as
possible
27

28. 28
Where to Next?
• Continue to link with management to reinforce importance of Initiate
with all staff.
• Set up focus group to further review documentation and increase
compliance
• Continue to audit client data and staff feedback of process.
• Organise further information sessions on topics relating to healthy
aging.
• Continue links with Affinity project.
• Link with older persons services re mapping of area services and
current falls prevention programmes running in day centres

29. References
• Strategy to Prevent Falls and Fractures in Irelands
Ageing Population. June 2008
• A guide to Falls Screening and Multi-Factorial Falls Risk
assessment in Primary Care 2011-2013
• Gannon B, O’Shea E, Hudson E, 2008. ‘Economic
Consequences of Falls and Fractures Among Older
People’. Irish Medical Journal. 101(6): 170-3.

30. Acknowledgements
• DNC Falls prevention and bone health
management group
• Donal Cassidy DNC Primary Care development
officer
• Daragh Rodger ANP St Marys Hospital
• Dr. Chei Wei Fan St Marys Hospital
• Management and Staff Dublin North City Pilot
Sites
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31. Thank you for listening
Any questions?