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Falls Awareness Falls are often viewed as accidents, however, there are many ways we can reduce the risk of falls. What is the role and responsibilities of an agency worker to prevent falls? Agency workers should always be vigilant and assess a service user/patient and their home or hospital for risks to falls. Any concerns must be reported and addressed as quickly as possible to minimise the risk of falling. What are the legal requirements of an agency worker to prevent falls? Always follow your Health and Safety Policy and the risk assessments. You must report any concerns, incidents or near misses as soon as possible to avoid future accidents. You have a duty of care to your service user/patients, if you think they need a specialist to assess them or give advice you must highlight this to your manager. What are the main aims of an agency worker to prevent falls? To constantly check for risks within the environment in which you work Monitor the service user/patient and report any identified risks Follow any risk assessments already completed Eye sight Poor eye sight is a huge factor in falls. Service user/patients may not see items or spillages on the floor and could easily trip, slip or fall. It is important that if you see a hazard you remove it and warn the service user/patient. If this is in their own home remember you need consent to remove items. Also consider if their eye sight is poor, they will need to know where the item is, they may be happy with it where it is. Check the service user/patients glasses. Are they clean? If not, prompt them to clean them or offer to clean them if they are unable. Ask when they last had an eye test and had new glasses, they may need new ones. It is recommended we have an eye test every two years, and once you reach 70 this should be every year. Always encourage a service user/patient who has fallen to see an optician. Remember opticians also do home visits for those who cannot go in. Make sure areas that the service user/patient is in or will walk through are well lit. Poor lighting as well as eye sight problems could be disastrous. Medication Medication can also have an effect on our mobility. If a service user/patient is on four different types of medication or more they should have their medication reviewed every 6 months. Older people who are at risk, or have recently fallen should have their medication reviewed. Continence Urge continence – A service user/patient may suddenly need the toilet and rush to get there, putting them at a higher risk of falling. They could be especially at risk if they take medication such as diuretics as they may cause this. Nocturia – getting up in the night, may put a service user/patient at higher risk due to the lack of adequate lighting, effects of any medication e.g. sedatives, and not being fully conscious. 1 Neurological Conditions Conditions such as stroke, Parkinson’s, cognitive impairment (Dementia) may also be a risk factor for falling. Often service user/patients with Dementia will have perceptual problems, the inability to see objects of a similar colour and spatial awareness, memory loss, or they may think they are living in a different place and expect it to be flat or have steps. Additionally medication for the specific condition may affect movement and walking. Diabetes can cause peripheral impairment which is a lessened sensation of the hands and feet, causing an increased risk of falling. Balance and Mobility Mobility disorders are a significant indicator of future falls. Muscle deteriorates with age so exercise is important. To combat falls the service user/patient would need to do specific exercises. Physical activity will help the Service user/patient with not only their balance, but will help their self esteem and well being, confidence, fitness, cardiovascular fitness and function, weight control, muscle strength and joint mobility. Walking aids should be assessed and fitted correctly and checked regularly for damage and that they still meet the needs of your service user/patient. Wheels and brakes should be checked regularly. The service user/patient should also use it properly. Footwear and Foot care Always check your service user/patient’s footwear, and encourage them to wear appropriate footwear. Make sure they are done up properly and not loose and slack. Toe nails should be cut regularly and any hard skin or corns removed. If your service user/patient can no longer cut their own toe nails this is another indicator of risk of falling. Home environment Rugs, trailing wires, slippery floors, poor lighting, clutter, pets, raised door sills, low/high chairs, unstable furniture, lack of grab rails, toilet too low, steep stairs, lack of handrail on stairs, loose/worn carpets are all hazards within someone’s own home. Be aware though it is the service user/patients own home and they may not welcome your comments on the hazards. If you have any concerns report them. Alcohol Alcohol affects our mobility and judgment, so increases our risk of falling. Government guidelines recommend that to stay healthy: Men do not consume more than 1-2 units of alcohol per day which is equivalent to half to one pint of beer per day. Women do not consume more than 1-2 units of alcohol per day which is equivalent to half to one pint of beer per day. One measure of spirit – one unit One pint of beer – two units Wine depends on the size glass you have, starts at 2.3 units for a 175ml glass at 13% 2 Smoking Reduces absorption of calcium in the body and reduces osteoblast – bone building activity. Smoking has a negative effect on bone thus increasing the risk of fractures. Reporting & Recording Always follow your Thornbury Nursing Services policy and report any fall, near miss or trip hazard immediately. Osteoporosis Osteoporosis is a condition that weakens the bones which heightens the likelihood of fractures occurring. The fractures/breaks are most common in the wrist, hips and spine, however, other areas can be affected too. Losing bone density as you get older is normal, and this starts from around the age of 35, for some this will lead to osteoporosis. The risk is increased if there is a family history, you have an overactive thyroid gland, you are a heavy smoker or drinker and some medications will put you at a higher risk. It is important that you understand someone with osteoporosis is more likely to fracture/break a bone. Therefore you need to be more aware of any potential hazards they could slip, trip, fall or knock into. Fear of Falling Some of your service user/patients may be scared of falling, they may then reduce their activity levels believing this will reduce the risk of falling. This is untrue; it will in fact increase their risk of falling. Encourage your service user/patient to be as active as possible. If you have concerns that one of your service user/patients is worried and anxious about falling it is important that you report this, so they can get the support they need to regain their confidence and then reduce the risk of falling. Healthy Eating Calcium and vitamin D are essential for good healthy bones – healthy bones mean less risk of fractures. Often service user/patients do not get enough vitamin D as they do not go outside, the body needs vitamin D from the sun to help with the absorption of calcium. Cataract Cataracts cause blurred or misty vision, they are cloudy patches on the eye, they develop over a period of years and are often not noticed at first. Cataracts generally develop in both eyes, not always at the same rate. Cataracts become worse over time, they can be removed by surgery that removes and replaces the affected lens. Cataracts are not painful and don't make your eyes red or irritated. Glaucoma 3 Glaucoma affects both eyes in varying degrees and is a group of conditions that affect vision. Fluid cannot drain away from the eye due to blocked drainage tubes, which causes pressure to build up in the eye. It can be painful and cause nausea, blurred vision and redness of the eye. Macular Degeneration Macular degeneration affects the central line of vision, it usually affects both eyes, how it progresses in each though can be different. It does not affect your outer vision only the central vision directly in front of you. Bi-focals Be aware that bi-focals can cause problems on uneven surfaces especially stairs as they impair depth perception. VIDEOS Reablement: maintaining independence: http://www.scie.org.uk/socialcaretv/videoplayer.asp?guid=7f99fdd1-0e82-47c9-adb9-b939284397fc Avoiding unnecessary hospital admissions among older people: residential care homes: http://www.scie.org.uk/socialcaretv/video-player.asp?v=avoidunhospadmiresidential Reablement: maintaining independence: http://www.scie.org.uk/socialcaretv/videoplayer.asp?guid=7f99fdd1-0e82-47c9-adb9-b939284397fc Osteoporosis: http://www.nhs.uk/conditions/Osteoporosis/Pages/Introduction.aspx What is one unit of alcohol? https://www.drinkaware.co.uk/check-the-facts/what-isalcohol/alcohol-unit-guidelines/ Glaucoma: http://www.nhs.uk/conditions/glaucoma/pages/introduction.aspx NHS Choices falls awareness: http://www.nhs.uk/Conditions/Falls/Pages/Prevention.aspx USEFUL WEBSITES Osteoporosis: http://www.nhs.uk/conditions/Osteoporosis/Pages/Introduction.aspx Glaucoma: http://www.nhs.uk/conditions/glaucoma/pages/introduction.aspx Age related cataracts: http://www.nhs.uk/conditions/Cataracts-age-related/Pages/Introduction.aspx Macular Degeneration: http://www.nhs.uk/conditions/maculardegeneration/pages/introduction.aspx NHS Choices falls awareness: http://www.nhs.uk/Conditions/Falls/Pages/Prevention.aspx Falls NICE guidelines: http://guidance.nice.org.uk/CG161 REFERENCES Aware, D. (n.d.). How much alcohol is too much? Retrieved June 19, 2014, from Drink Aware: https://www.drinkaware.co.uk/check-the-facts/what-is-alcohol/how-much-is-toomuch?gclid=CKbPnfmwhr8CFQXnwgod4ZIAKA 4 Choices, N. (n.d.). Age related cataract. Retrieved June 19, 2014, from NHS Choices: http://www.nhs.uk/conditions/Cataracts-age-related/Pages/Introduction.aspx Choices, N. (n.d.). Falls Awareness. Retrieved June 19, 2014, from NHS Choices: http://www.nhs.uk/Conditions/Falls/Pages/Prevention.aspx Choices, N. (n.d.). Glaucoma. Retrieved June 19, 2014, from NHS Choices: Glaucoma: http://www.nhs.uk/conditions/glaucoma/pages/introduction.aspx Choices, N. (n.d.). How often can I have a free eye test? Retrieved June 19, 2014, from NHS Choices: http://www.nhs.uk/chq/Pages/1093.aspx?CategoryID=68&SubCategoryID=157 Choices, N. (n.d.). Macular degeneration. Retrieved June 19, 2014, from NHS Choices: http://www.nhs.uk/conditions/macular-degeneration/pages/introduction.aspx Choices, N. (n.d.). Osteoporosis. Retrieved June 19, 2014, from NHS Choices: Osteoporosis: http://www.nhs.uk/conditions/Osteoporosis/Pages/Introduction.aspx NICE. (n.d.). Falls NICE guidelines. Retrieved June 19, 2014, from NICE: http://guidance.nice.org.uk/CG161 patient.co.uk. (n.d.). Prevention of falls in the elderly. Retrieved June 19, 2014, from patient.co,uk: http://www.patient.co.uk/doctor/prevention-of-falls-in-the-elderly-pro 5