Looking after yourself to prevent falls

Our clinicians are sharing important advice and guidance on how to help prevent a fall at home.

New developments are also happening in Somerset in the form of a trial to bring together home care and hospital care, so patients can get the support they need quicker.

Ann Mann, our falls prevention lead, has seen first-hand how the effects of a fall can be long lived and detrimental to a person’s health and quality of life.

Once a person has had a fall, the chance of falling again increases. Ann works with patients in Somerset to try to prevent a fall and is encouraging friends and family to think of how they can help frail neighbours, friends and loved ones too.

She advises: “One of the first things to ask after a fall, is whether the person’s pain is under control. If it’s not, it can really affect movement, for example if it hurts to walk a person may they find themselves shuffling instead and trip.

“I’d encourage people to make sure they have had a medication review at their GP surgery if they have been on medication for some time, as we’ve found many people are taking medications which could have side effects and are actually no longer needed. But don’t stop any medications without talking to your doctor or pharmacist.

“Then we look at whether they are using the right mobility aids for them. If their fall has resulted in a hospital stay, we ask that loved ones bring in their usual walking aids to hospital, to help prevent additional falls as they are familiar with their own frame/stick/walker etc.

“Many families want to know why a fall has happened and there are a variety of factors which could contribute, such as eyesight, balance, medical conditions and if you have a history of falls.

“But there are also things we can control, such as making sure the environment is as easy to navigate as possible. Check the floor isn’t uneven with rugs, and whether a night light could help avoid tripping in the dark.

“Footwear is also important. Shoes and slippers that fit well and are in good condition can help provide grip and stability, especially if you need to stay in an unfamiliar environment like in hospital.

“We are asking families to bring in well-fitting slippers, as well as day and night clothes for a hospital stay, as staying mobile and active is also a key factor in avoiding muscle weakness too. Some simple leg exercises before getting up from bed or a chair can help increase your circulation which helps, as well as drinking and eating regularly to combat dizziness and dehydration which could cause a fall.”

Despite popular belief, falls are not an expected consequence of getting older, they can be an indicator of worsening frailty. As falls are one of the leading causes of emergency hospital admissions for older people, more focus within the NHS is being directed towards proactive, preventative care.

Lily Humby is a trainee advanced nurse practitioner in our Hospital at Home team, which supports patients to recover in the comfort of their own home rather than be admitted to hospital.

This team provides the same level of care patients would receive in hospital and is made up of doctors, advanced clinical practitioners, pharmacists, nurses, and therapists who visit the patient as they recover.

As part of her role, Lily sees many patients who come under her care after a fall. She is able to support them with a comprehensive frailty assessment considering the whole person. The term frailty is defined as a health state related to the ageing process that gradually weakens different body systems, meaning that there is overall less health resilience.

In practice it means that a relatively ‘minor’ infection could have a severe impact due to impaired recovery. Frailty is often characterised by issues such as reduced muscle strength, fatigue, and poor mobility. Frailty is not the same as living with multiple long-term health conditions, although there is often an overlap.

New initiative between home care and NHS to help prevent falls

Lily has been working with home care service, Home Instead, to start a trial in Somerset, which provides a direct link between their carers and the Hospital at Home frailty team, when they start to notice that their client is beginning to experience falls.

Lily explains: “We’re hoping that this pilot will mean that support can be put in place much more quickly. Currently, a carer would need to request a GP review for their client, who can then refer to into the falls service which may take between eight and ten weeks, and then if further medical intervention is needed there would be another two to four week wait.

“This could be a delay in over three months, during which time they could fall again and need hospital care. The trial will involve Home Instead carers, directly paid for by patients, being empowered to raise the alarm about someone they support on a regular basis, with the aim of our Hospital at Home frailty team seeing them within a week, which is a huge difference.”

“A recent example is a lady who employs Home Instead care who had started having falls and so her carer contacted the team. She has Parkinsons and had lost her confidence moving around the home, even considering whether she should go into a nursing home.

We were able to visit the next day to assess her needs and had equipment delivered two days after that to help her to stand. We were able to refer her for further reviews. A physiotherapist was able to help her get the right equipment to be able to have showers again, a neurologist will review her Parkinson’s medication, and the pharmacy team provided equipment to help reminder her that her medication is due, to reduce the chance of the missing the medication making her freeze up.

As a result, she now feels safe to continue living in her own home which really shows the difference this support can make to people’s lives.”

Home Instead Director Dr Mark Hunt adds, “We have trained carers to use the Clinical Frailty Scale (CFS) that is widely utilised in the NHS, and which uses falls as one of the key indicators. I know from my own experience as a GP, what an important tool it is to aid decision making around health and wellbeing. The fact that our clients have care needs, is indicative of the vulnerable population that we support.

“The system we now have in place means that our team recognise that a CFS of moderate frailty equates to an increased risk of hospital admission, and this triggers the referral process. We support around 200 clients in our community, and I hope this trial alongside our closer working can really help our clients to continue living well for as long as possible. The goal is to set a new benchmark for what it is possible to achieve within community care.”

The pilot will be run over two months and has already seen four clients within the first two weeks.