The 10 Topics are a set of learning activities, launched mid-2013 and integrated with falls prevention initiatives in the national patient safety campaign Open for better care . Anyone involved in the care of older people at risk of falling – or interested in how older people can ’keep on their feet’ – will find the topics useful as up-to-date information.
The topics bring together evidence, clinical guidelines and recommendations for best practice with resources to support your falls prevention improvement projects. The topics provide an update and can be used in team meetings, and in group or self-directed study.
Topic 1 is an overview useful to anyone involved in the care of older people, as it explains why the national programme, Reducing Harm from Falls, is focussing on falls in older people, and covers the causes and impact of falls in this age group. Topics 2, 3, and 4 are particularly relevant to those in care settings (whether hospital, age-related residential care or care at home) and primary care. These topics review screening, assessment and interventions for falls risk, including essential elements for safe environments and safe care that apply universally for all in our care, regardless of their falls risk.
Topics 6, 7, 8 focus on issues relevant to care of older people in any setting (and especially frailer older people) – hip fracture, vitamin D deficiency and the interaction between medicines and falls risk. Topic 9 examines exercise programmes for improving balance and strength to prevent falls, and Topic 10 reviews approaches to preventing falls and reducing harm from falls in relation to setting priorities and practical action.
The 10 Topics follow on from the first national annual April Falls Quiz run in 2013. Nationally, the results showed that we have a great base of knowledge and commitment to build on: 96 percent agree (62 percent strongly agree; 34 percent agree) that a significant proportion of falls in older people can be prevented, and over 90 percent understand what a fall can mean for an older person and think it’s true that older people are more likely to fall and come to harm when they fall.
In the second national annual April Falls Quiz, running 10-29 April 2014, some of the questions have a link to the relevant topic.
The writing team includes subject matter experts, and peer review is sought from both academics (to ensure a good base in the literature) and clinicians (to ensure a connection with practice). The topic material is offered as a downloadable interactive PDF which includes 10 questions, making it a learning activity equivalent to 60 minutes of professional development.
An outline of the 10 Topics is provided below. You can also subscribe to receive alerts about the 10 Topics and the falls quarterly newsletter here.
This overview gives brief descriptions for each of the topics. Download the overview.
Falls in older people: the impact
An overview suitable for everyone involved in the care of older people, whether you are new to falls prevention or quite familiar with this area. Topic 1 introduces you to some of the key resources for the national falls programme and national patient safety campaign: videos, factsheet and patient information. A patient story and staff perspectives help explain what is meant by ‘a duty of care’.
Which older person is at risk of falling? Ask, assess, act
In Topic 2 we cover a few simple screening questions which can identify those older people most at risk of falling to target for a fuller assessment. Since many risk factors can be modified or managed, you can talk with the person and their family about which interventions and supports will work best to reduce their risks and help keep them safe. Ask, assess, act resources were trialled in 2013 with providers across several settings, and an updated and improved version will be available from April 2014.
Falls risk assessment and care planning: what really matters?
Topic 3 follows up on recent audits of falls-related Quality and Safety Markers to look at what’s important in the hospital setting for risk assessment and care planning for older people at risk of falling. But the principles of attention to the individual, critical thinking and clinical judgement apply in all settings. Topic 3 makes the case for systematic assessment of risk factors and individualised interventions to prevent falls for older people at risk.
Safe environment and safe care: essential in preventing falls
Many falls are caused by an interaction between an older person’s specific risk factors and the physical environment, and in Topic 4, the emphasis is on the environment and care side of the equation. In care settings, patient and residents have a right to safe environments where hazards that could cause a fall are minimized; and a right to safe care, which includes timely attention from staff. We revisit the Topic 1 patient story to see how staff have put their learning into action.
After a fall: what should happen?
A fall in an older person – whether at home, in residential care or in hospital – requires prompt clinical assessment and intervention, not least because a fall can signal deterioration in an underlying condition. Topic 5 reviews what should be covered in clinical assessment and post-fall protocols. In care settings, the point of reporting falls is to analyse an individual’s fall or pattern of falling in order to reduce their risk of falling and improve their care. At a team and organisation-level, the point of reviewing falls is to find out what happened, why it happened and what we can do to prevent it happening again. Topic 5 also looks at how best to learn from analysing falls.
Why hip fracture prevention and care matters
One half of hip fracture patients give us advance notice by having broken another bone prior to breaking their hip – the first fracture presents an opportunity to assess fracture risk and treat osteoporosis. Hip fracture care holds scope for improvement – 27 percent of those who fracture their hip will die within a year of their hip fracture, and of these, just under two-thirds would not have died if they had not fractured their hip. Topic 6 is timely given the requirement for DHBs to provide Fracture Liaison Services from 2014. We also present the numbers to make the case for treating osteoporosis in a group particularly prone to falls and fractures – older people living with dementia.
Vitamin D and falls: what you need to know
The benefits of vitamin D supplementation are discussed and debated in the media and popular scientific magazines. While most people get sufficient vitamin D from sun exposure and dietary sources, the question we raise in Topic 7 is this: What benefit (or risk) is there in vitamin D supplementation for people at risk of vitamin D deficiency and also at higher risk of falling?
Medicines: balancing benefits and falls risks
Older people are at higher risk of adverse drug events, including falls, leading to increased hospitalisation, morbidity and mortality in this group. In Topic 8 we look at how medicines can increase the risk of falls by affecting blood pressure, gait and movement, cognition and toileting requirements, and why certain medicine classes should ring ‘alarm bells’ when assessing falls risk and the potential for fall-related injury in older people. Polypharmacy increases risks (and we look at the Commission’s atlas of healthcare variation of polypharmacy in older people) whereas medicines review may reduce falls risks associated with medicine use.
Improving balance and strength to prevent falls
As falls prevention guidelines recommend exercise to prevent falls in older people, Topic 9 summarises what we know about the types and ‘dose’ of exercise that work to prevent falls and harm from falls, and who benefits most from each type of exercise programme. We also need to know how to deliver effective programmes and the common barriers encountered, whether these programmes give good value for money, and ways to encourage the older person to keep exercising.
Falling into place: making sense of what you can do to reduce harm from falls
In Topic 10 we look at approaches to falls prevention and reducing harm from falls to help you focus on what you can do in your role or service. Should we use interventions that focus on a single risk factor or interventions that have many components? (Hint: it depends on the setting – hospital, residential or community). How do we balance evidence, experience and common-sense? How do we sustain the focus, join up our efforts across sectors and share our learning?