Why it gets harder to prevent falls when older people leave hospital

Chiara Naseri is a physiotherapist and is currently completing her PhD at Western Australia’s Curtin University School of Physiotherapy and Exercise Science. She has recently published a review in Age and Ageing entitled “Reducing falls in older adults recently discharged from hospital: A systematic review and meta-analysis.”

The paper reveals the complexity of the discharge process for older people and that more support is required than is currently widely recognised. Her team found that falls prevention strategies, known to reduce falls for older people in general, were not as effective for older people following hospital discharge.

Evidence has shown 30% of the population of older people who live in the community fall at least once per year, 10% of these falls result in a serious injury. Whereas 40% of the population of older people who have recently been discharged home from hospital fall within 6 months of discharge, most of these falls occur in the first month and 54% result in a serious injury, particularly hip fractures.

The Other “F” Word: Is upstream prevention the way forward for falls?

Steve Parry works in acute medicine and older people’s medicine. He has a special interest in investigation and treatment of falls and blackouts in adult patients of all ages. He is BGS Vice President – Academic and Research.

Since those heady days in the late 90s when our local falls service was started by Rose Anne Kenny, falls services have moved from novelty to mainstream in the UK’s care of older people landscape. But has this service ubiquity made a difference?

Probably. Possibly. Or perhaps not. It’s almost impossible to say. Falls are notoriously poorly recorded and coded, though falls surrogates like hip fracture, the tip of the falls iceberg, provide at least a hard outcome measure universally recorded. Here, however, despite a decade and a half of falls and bone health services, the news is not good.

Time to Up our Game (TUG) in the management of falls!

Debra Eagles is a Resident in Emergency Medicine at The Ottawa Hospital in Canada. Here she discusses her recent Age & Ageing paper.

Your medical student reviews a case with you.  It is a 78 year old woman who presents with right knee pain subsequent to a recent fall.  The student has taken a comprehensive falls history and physical examination.  After reviewing the knee x-ray, the student summarizes the case by stating the patient suffered a mechanical fall, luckily without evidence of fracture and can be discharged home.  But wait, you say, can she safely mobilize?  The medical student smiles triumphantly, yes, she was able to use her walker to ambulate a short distance.  Excellent, you say, she can be discharged home.  But you wonder, is there anything further you can do to determine what her risk of negative outcomes associated with falling is.

The steps we are taking to reduce inpatient falls

Prof Finbarr Martin is a Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Medical Gerontology at King’s College London. He is a former President of the British Geriatrics Society.

How good is your department and hospital at preventing your patients falling? About 600 inpatients fall every day. As clinicians, we are fully aware of the injuries that can result from older people falling in hospital and the serious effect a fall can have on their recovery. So what can we do to prevent this happening? NICE guidance suggests we can reduce the number of falls by up to a third. The issue is high on the national patient safety agenda, but we need to be able to gather reliable data to ascertain if greater awareness is leading to the falls rate reducing.

Last year, the London Royal College of Physicians carried out an audit of hospital policies and practice in falls prevention, producing a national picture and a report on each hospital in England and Wales. The audit items were based on guidance from NICE and NPSA. You can access the national report here. Please find the time to take a look at your hospital’s data.

Open (Nearly) All Hours

This year Heart of England NHS Foundation Trust became one of the first to introduce open visiting.  Dr Helen Chamberlain, a Consultant Geriatrician at Good Hope Hospital (one of the three sites run by the Trust), shares her experience of this innovation.

One of the drivers for our recent change in visiting hours was John’s Campaign.  This was started by Observer journalist Nicci Gerrard in November 2014 after death of her father Dr John Gerrard.  He had dementia, but during his admission for infected leg ulcers declined badly.  Nicci felt that had his family been allowed to visit as often as they wished, he would have been less distressed.

July issue of Age and Ageing journal out now

The July 2014 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

• Medical education and ageing
• Organisation of acute hospital care for frail older people
• Falls prevention in secondary care
• Screening for delirium
• Management of acute coronary syndrome

The Editor’s View can be read here.

This issue’s free access papers are:

• Equipping tomorrow’s doctors for the patients of today
• Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people
• Preparation to care for confused older patients in general hospitals: a study of UK health professionals

Research studies test if a new guide does reduce falls in care homes?

Gemma Walker is a Research Assistant at Nottingham University. She recently described the Falls in Care Homes study on the ENRICH website:

Falls in care home residents occur 5 times more frequently than those in older adults living in the community. Many of these people suffer injury and there are high associated costs to the NHS. A falls management programme that can reduce falls as well as current community programmes has yet to be established in care homes; possibly because current programmes are not tailored to the care home population, known to experience high levels of cognitive impairment.

What can older people tell us about their experiences of therapeutic exercise as part of a falls prevention service?

Janet Husk is a Patient Safety and Quality Improvement Manager at the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians

The answer is a great deal as you can see in this article on ‘older people’s experiences of therapeutic exercise’ – available online in Age and Ageing. Don’t think it was just  younger people (55 to 74 years) that responded; some people that completed a questionnaire were over 95 years of age which just goes to show that people of all ages were exercising and  were able to give important feedback about their experiences of NHS run therapeutic exercise programmes to reduce falls.