Sep 26, 2016

Falls prevention – How Can We Make It Work?

I’ve spoken previously about the unacceptable number of falls suffered by elderly Australians. Studies at home and overseas have shown that as many as one in three people over the age of sixty–five in the community fall very year. One in ten of these fall multiple times and nearly a third of the falls are injurious and need hospital attention. The figures are even higher in residential facilities, with research suggesting the incidence could be nearly six times as high as the rate of falls in the home.

The real cost of falls

The sad truth is that falls are expensive. There’s a huge emotional and physical cost to the individual with the need for hospitalization, impaired mobility, and a real drop in function and quality of life. But there’s also a financial cost to the government in treating, monitoring and rehabilitating people who have been injured. Back in 2001, falls were setting us back 500 million ASD a year.

A staggering one in every 10 days spent in hospital by a person aged 65 can be directly attributable to an injurious fall. That money is better spent on decreasing frailty, improving mobility and preventing falls.

Falling is not normal

I think that too often falls are accepted as an inevitable part of getting older. But research has shown that we can make a difference. Many falls can be predicted and prevented, by using the right interventions we can stop avoidable injuries and improve wellbeing.

We’ve seen with the changes to the ACFI that financial cutbacks are having to be made and that at the moment the figures don’t stack up. Could an effective falls prevention program be the strategy to help balance the books; a way to save money and improve the care we offer elderly Australians?

The way ahead?

I started researching this blog hoping to calculate the financial costs and savings of falls interventions. Unfortunately, the evidence shows that despite targets, interventions and national plans we’re still not getting it right. There is a national trend of increasing fall related hospitalisations. I think we need to adopt an evidence based approach to see the numbers fall. The problem is, the research is patchy, often contradictory and we have many more studies from the community than from residential care.

What does work? Examining the evidence

Dr. Frances Batchelor, deputy director of health promotions and stream leader for falls and balance at the National Ageing Research Institute said that when it comes to falls “Complex problems require complex solutions and this also applies to residential aged care where there is no silver bullet for preventing falls. In order to implement effective interventions, we first need to understand how and why people fall. This is particularly challenging in residential aged care as most falls are unwitnessed and residents may not always be able to accurately describe a fall.”

Groundbreaking research has started in Canada videoing the public spaces in residential facilities to observe why falls happen. If you work in residential care, then you probably won’t be surprised to hear that tripping over clutter, trying to sit in unstable seating or unlocked wheelchairs and poor balance and mobility were key causes. So what can we do?

Cochrane reviews have found that vitamin D supplementation, medication review and a multifactorial approach to prevent falls together with much better staff education, can decrease falls.
Exercise can improve balance, core strength and mobility and may be effective in fall prevention in residential care. The evidence is mixed as to the best approach, although Tai Chi has been consistently shown to be beneficial.
In the community the benefits of exercise have been better researched and the evidence is a little clearer. Challenging balance exercise for 2 or more hours per week on an ongoing basis can help reduce the falls risk in older adults. Vitamin D, medication review and falls education is important in home and the community.

It seems that there isn’t a single answer and we need to attack the problem from many angles to get the best results.

Reablement and falls

The Commonwealth Home Support Programmehas advocated a reablement care approach to aged care. Gill Lewin has researched the effects of restorative care extensively in Australia. Her studies show benefits in terms of activities of daily living and mobility. Looking at final outcomes there were greater improvements in physical functioning in the reablement group compared with the control group. Although we don’t have the specific falls figures, the physical improvement is promising.

The improvements translated into cold hard cash. There was a decreased need for home care provision and fewer hours of ongoing support adding up to median cost savings per person of approximately AU $12,500 over nearly 5 years.

As a physio in aged care, the research into specific exercise programs always catches my eye. A study looking at reablement programs found that participating in a lifestyle exercise program can be just as effective, if not more so, as undertaking a structured exercise program. Those using the LiFE program did significantly better on 40% of the outcome measures. This could be both time and cost effective for providers and may also improve patient compliance.

In aged care we’re all committed to caring for and helping the elderly live active, enjoyable healthy lives. Seeing the falls incidence continue to climb is frustrating but it’s only by researching further, finding what works and following all the fall prevention guidance that we can finally start to get the figures falling.

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