Download IMPLEMENT INTERVENTIONS WITH OLDER

IMPLEMENT INTERVENTIONS
WITH OLDER PEOPLE AT RISK OF
FALLS
UNIT: CHCAC17A
Certificate IV in aged care 2012
Element 1
PREPARE FOR AN ASSESSMENT OF THE RISK OF FALLS
1.1Confirm assessment requirements with supervisor or relevant health
professional
1.2Identify assessment requirements outside scope of roles and
responsibilities and report to supervisor or relevant health professionals
1.3Work with the older person and their carer to establish their involvement
in the assessment and further actions
1.4Provide information to clarify own role, responsibilities and accountability
1.5Provide information to clarify the assessment process, information that
will be obtained and stored
1.6Provide information to clarify relevant others who might see the
assessment results
1.7Communication in a supportive and encouraging manner that is respectful
of the older person and their carer’s level of understanding and cultural
background.
1.8Obtain the older person’s informed consent to the assessment process
What would you
consider a fall?
TO DO
1. Spend a few minutes to think about the word
“Fall”
2. Think about your own meaning(definition) of the
word “fall”.
3. Write this definition down and it is compulsory that
you then share your own definition on the moodle
forum.
4. Click here to go to certificate IV moodle And then
scroll to the falls definition forum under the falls
unit.
The world Health organisation (WHO) defines a
fall as:
“ A FALL IS AN EVENT WHICH RESULTS IN A
PERSON COMING TO REST
INADVERTENTLY ON THE GROUND OR
FLOOR OR LOWER LEVEL”
Who is involved in falls management within residential
aged care facilities? And community settings?
What Health professionals need
To be included?
Before moving to the next slide make a
List, see how many you have correct
And then check who you forgot.
• Everyone is responsible for falls management
And health care professionals would include the
– Nurses: RN, AIN,PC,EN,EEN
– Doctors
– Physiotherapist
– Recreational officer
– Divisional / Occupational therapist
Review of the literature
When you review the literature many things can
predispose one to a fall and is not limited to
the over 65.
Why people fall
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Incontinence
Cluttered environments
Slips , trip
Poor vision
Poor lighting
Incorrect fitting footwear
Incorrect fitting clothing
Disability
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Poor nutrition
Alcohol and or drugs
Medication side effects
Uneven surfaces
Mats
………………………….
Risk factors
Lifestyle factors
How do we MANAGE
• As health care professionals we can manage
falls in many ways:
– Gather a client history include things like vision,
mobility.
– Identify what the client can and can’t do for
themselves
– Identify risky behaviours
– Review the environment , remove any clutter
– Do they wear correct fitting shoes and are they in
“good order”, no holes, laces done up
– Do there clothes fit correctly, not too big or too
small
– Be aware of the client’s continence , are they able
to get to the toilet , do they need help
– Be aware of the medications the client is taking
– Are they eating a well balanced diet
– Are they well hydrated
Prepare for an assessment of the
risk of falls
FRAT
“Falls Risk Assessment”
• Click here for the FRAT form
Once you have downloaded the FRAT you now
need to complete the activity Below:
• Click here for the ACTIVITY
Much like the care planning process as with falls
management, we must
Plan
Implement and
Evaluate within a process of continuous
improvement.
It is identifiable falls are an issue for older
people. We as a community and society at
large are actively recognising this and
implementing strategies for prevention or
management.
WHY FOCUS
ON FALLS
Falls Facts
You will be able to identify on completion of this
unit that Falls are a leading cause of:
• loss of independence
• Hospitalisation
• And even death
• Change in mobility status post a fall
FALLS ASSESSMENT
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The role of the care plan
Involvement of family
Confidentiality
Consent
Role of assessment
Communication
referral
The facts the facts the facts the facts
the facts the facts
the facts the facts
Ageing population
People aged over 65 years are at greatest risk of
sustaining an injury from a fall.
Australian and overseas studies of community dwelling
older people have identified that approximately one in
three people aged 65 years and over fall each year, with
10% having multiple falls and over 30% experiencing
injuries requiring medical attention.
• The rate of falls and associated injuries is even
higher for older people in residential aged
care and acute care settings (NARI, 2004).
• During the next 50 years, Australia will
experience a significant increase in the
proportion of the population that is aged 65
years and over. By 2042, the projected life
expectancy at birth will be 83.9 years for men
and 88.5 years for women (Intergenerational
Report: 2002:75).
• From 2001 to 2051 the proportion of the
population that is aged over 65 will double in
all jurisdictions except the Australian Capital
Territory, where a two and a half fold increase
is predicted; and in the Northern Territory,
where a three fold increase is predicted
(Moller 2003).
• Older people who have more opportunities to
remain in the workforce are more likely to
have higher health status and reduced risk of
falls and fall related injury as a result of being
more physically active and less likely to be
socially isolated
• (Moller ,J.(2003)Projected costs For fall
related injury to older clients due
demographics changes in Australia. Prepared
for the Commonwealth department of Health
and Ageing Canberra ACT Feb 2005 at
• http://www.health.gov.au/internet/main/publ
ishing.nsf/Content/8F331513D9F8A95BCA257
553007FF335/$File/slips-and-falls-prev.pdf
• ( the file should open in another window/
browser), otherwise type above link in google.
Costs of falls
• In general, health spending on older people is growing
faster than for the total population. Australian
Government spending on aged care is projected to
more than double by 2042 (Intergenerational Report,
2002:38).
• Data suggest that care and services associated with fall
related injury will contribute to a significant proportion
of this expenditure unless effective preventive
strategies are put in place.
• It is projected, that if appropriate action is not taken
the major impacts of the ageing population on the cost
of fall related injury in Australia by 2051 will be:
(Moller,J.(2003)
• There will be 1,174,500 additional hospital bed days
per year – the equivalent of 3,300 additional beds
permanently allocated to fall related injury treatment;
and
• 4,630 additional nursing home places will be required1
• These cost estimates relate solely to direct and allied
health costs. They do not estimate costs associated
with insurance liability, the loss to the workforce of
having carers support disabled people or the cost of
caring for people with ongoing disability. These
estimates are based on current care requirements and
do not take into consideration future advances in
health care technology
(Moller,J.(2003)
Evidence needs
• While there is a growing body of evidence that
falls and fall related injury interventions are
effective, transferring this evidence and that
from other areas, into practice remains a
challenge. It is imperative that Australia
continues to research, develop and
disseminate local evidence based findings.
• • How specific risk factors have in contributing to falls and fall
related injuries, such as multiple medication use;
• • Development of effective strategies for older people with
cognitive impairment;
• • Identification of exercise options that provide the best
outcomes for preventing falls and fall related injuries;
• • Older peoples’ perception of falls prevention messages and
how to best present messages;
• • Development of cost utility and effectiveness measures on
current and emerging strategies; and
• (Moller,J.(2003)
Residential aged care
• Older people in residential care are at high risk
of falling in large part because of their age and
frailty. The Australian Government
predominantly funds, plans and regulates
residential aged care facilities through an
accreditation based quality assurance system
that is overseen by the Aged Care Standards
and Accreditation Agency Ltd.
• Working in aged care we must comply with
the STANDARDS.
• The quality assurance system prescribes four
agreed accreditation standards that include
Health and Personal Care and Physical
Environment and Safe Systems. These provide
a framework in which care providers work to
address the prevention of falls and fall related
injuries among older people in residential
aged care services.
• The accreditation and quality assurance
mechanisms can be used to bring attention to
monitoring and reviewing medication use,
nutrition, vitamin D supplementation,
provision of opportunities for regular
individual or group exercise, protective
garments for high risk residents, staff training,
relocation policies (from or to other settings)
and management of risk factors within the
environment are cornerstones to falls and fall
related injury prevention strategies within
residential aged care settings.
FALLS
As previously stated not unlike care planning to prevent
falls we need to
 PLAN
 IMPLEMENT
 EVALUATE
FALLS IS NOT A NORMAL PART
OF AGEING.
Best Practice
Best practice strategies in
Falls management suggest
“four key components”:
Fall prevention strategies
Identify at risk people
Falls prevention
Injury prevention for those who do fall
ASSESSMENT TOOLS
When assessing for falls this needs to include:
• Mobility
• Falls risk-actual / potential
• Medication
• Incontinence
• Psychological
• Nutritional
• Pain
• Environment- include hazard identification
ACTIVITY
Do a draft of a FALLS ASSESSMENT tool that would
be relevant to your area of work, can be
residential or community based.
Utilise the current information you have just
learned about falls assessment, including criteria.
At the end of your draft assessment tool -State why
you have included the information / questions
you have. (Its relevance to the task at hand)
Assessment tools- TO DO
• Now as you are working in the workplace get
a copy or have a look at the falls assessment
tool your workplace using to assess a resident
for falls.
• Compare your draft to the actual assessment
used in your workplace.
ACTIVITY- PRE ASSESSMENT DECIDING ON THE
BEST ASSESSMENT FORMAT/ TOOL
Before we review current assessment tools complete the following :
On a piece of paper present the following:
1.What sort information would you want
to be able to get from a falls assessment
and why.
Be specific in your answers.
Identify who else may need to involved in the
assessment process other than your direct
team?
State at least three others:
1._______________________
2._______________________
3._______________________
• When looking at assessment of falls
environmental issues are important why / why
not?
_____________________________________
_____________________________________
_____________________________________
And how can we assess the environment?
_______________________________________
_____________________________________
_____________________________________
Tools cont.
Things needed in a falls assessment should include:
• CLIENT DETAILS
• DATE OF DEVELOPMENT
• DATE ASSESSMENT ATTENDED
• RISK FACTORS
• ADHERES TO POLICY AND PROCEDURE
• PROFESSIONAL FORMAT
• INTERPRET RESULTS
• AREA TO RECORD FINDINGS / COMMENTS
• WHO CAN CONDUCT ASSESSMENT
• What to do now-results / findings
WHAT IS FALLS PREVENTION ALL
ABOUT?
_______________________________________
Have you heard of the saying “PREVENTION IS
BETTER THAN CURE”
Levels of prevention:
1.Primary
2.Secondary
3.Tertiary
INVOLVING THE PATIENT , RESIDENT
AND THEIR CARER
HOW CAN WE DO THIS?
THE WORKERS ROLE
• In the assessment will depend on the
qualifications and experience of the worker,
and on their role description in the
organisation. Some workers are trained to
conduct quick and simple assessments or
parts of.
• The purpose assessment being to assess the
level f risk of the client falling, so strategies
can be put in place to reduce that risk.
Three simple screening questions
• Have you had a fall in the last six months?
• Do you have difficulty with balance/ unsteady
gait/ mobility aid?
• Are you taking four or more medication?
If the client answers no to all these questions
does screening need to occur?
If they answer yes to one or more further
assessment
The client and carer need to understand that
most, of the information collected in the
assessment will be stored on a computer/
paper base and kept in the client records and
may also be used by other health
professionals in meeting the needs of the
client.
communication
As we all we do the process of communication is
important in the delivery of assessment tools.
We therefore need to ensure staff know how to conduct
assessment, build rapport, gain and ensure client
consent be respectful to its delivery, mindful and aware
of residential rights, organisational documentation
procedures including reporting and recording methods,
professional application of completing forms, as a legal
document. What to do when unable to meet the needs
of the client.
Be client centered in delivery – holistic care, culturally
aware
General points to consider
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Your job roles and responsibilities
Each person should be treated as an individual
Organisations will have their own rules- guidelines
In everything we do safety is a key factor
Just think when you use a piece of equipment that you
have never used before you seek training or are shown how
to use the equipment. Assessment tools are no different as
if not carried out correctly this may give bias and incorrect
results which will then impact on the client
• The process of communication is of importance as if
misunderstood may reflect in the assessment tool and give
inaccuracy / bias / not a true account of the results /
findings and therefore impact on the client
• In order to ensure service delivery you use
written documentation to support this.
Assessment tools form part of the service
delivery and client records. Factual, objective,
clear, written in pen, date , time, client details
and once recorded appropriate action /
evaluation and safe storage systems.
Falls
For a care worker you need to establish what are the
role responsibilities and accountabilities re falls
prevention and this might include:
 Implement and review a exercise program
 Encourage clients to attend exercise class
 Individual therapy
 Participate in case management meetings
 Residents rights
 Ensure easy access to programs
Comply with policy and procedures
Report all client activities in accordance with
policy
Assist in mobilisation as required
Report any changes in client status
Apply falls risk assessment tools
• As the nurse you should have the training to perform
you job
• Ensure mandatory clinical competencies are
maintained
• Comply with infection control, manual handling,
OH&S
• Staff should maintain an environment of quality
continuous improvement
• Aged care workers are often involved in collecting
some of the data for assessments, but the
assessments are usually monitored by medical
professionals, RN, senior nursing staff
Communication
• As with any care the care worker must have
effective communication skills,
communication is a key element and should
be respectful and maintain residents rights as
well as being culturally respectful and obtain
client consent.
• Information should be appropriate, clear and
logical