Reducing risk when older people fall

What was the issue you were addressing or working on?

It is important to look for underlying reasons why people fall and if these are preventable. We know that falls record the highest total length of stay for all admissions and can result in a fracture with the associated loss of confidence and lengthy rehabilitation. Many older people have a ‘community alarm’ and use this to call for help when they have fallen with immediate support provided through the Social Care Response Service (SCRS). Information relating to the call out is gathered by the service and logged, however the information is not shared and other than GP/Emergency service referrals, there is no pathway from the service to falls clinics, etc.

What you did?

A pilot was set up to look at the use of the Dundee City council, SWD Social Care Response Service to gather and evaluate information relating to falls. The pilot allowed the cross referencing of patient/service user information and used this information to map out the sources of information, the lack of connectivity between services/agencies and the points at which preventative actions should be taken.

For one month information was gathered on older people whose primary reason for calling out the SCRS was a fall.  This information was analysed by the Fall Lead who is a Physiotherapist from the Community Rehabilitation Team (CRT) and a SWD Resource Manager. Names were cross referenced against a data bases for District Nurses, CRT and Medicine for the Elderly clinics and identified those older people who were known to other services.

What were the outcomes - benefits or otherwise?

In a one month period the pilot recorded 178 older people who accessed the SCRS where the primary response for the call was a fall at home. This averaged at 6 calls per day to the service within a range of 2-15. The total number of fallers was 133 with 29 people falling more than once. Of those who fell 14% were recorded as “hurt” and 86% as “un hurt”. When cross referenced against NHS data base 77% of older people were known to a health service. Of these 49% were known to district nurses and 34% to CRT/Physiotherapy. 22 % of fallers were not known to NHS and were therefore telephone triaged by the falls co-ordinator. This resulted in referrals to physiotherapy, occupational therapy, locality (practice) pharmacy for medication reviews and on to ‘Early Intervention’ for a full MDT Review.

The results of this one month pilot highlighted the lack of connection and information sharing that existed between health and social work and therefore missed opportunities for falls prevention and for wider assessment of an older persons needs.

In the future, if a person falls, presses their alarm and has active DN or CRT involvement then this service is informed of the fall and the NHS member of staff is requested to complete a falls screening assessment. If this tool highlights a falls risk, it is sent to the falls co-ordinator who will then telephone triage the patient and refer the patient into the appropriate service as indicated by the information gathered. If the person is known to a Medicine for the Elderly clinic, a member of staff from the day hospital will contact the patient to conduct a telephone review of the fall and organise follow-up as required.

Contacts - to find out more

Gail Young, Clinical Development Manager, 01382 436318