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Guidance for completing RiO Falls Assessment Forms Question Has the client had any falls in the past year When did these falls usually occur Where did these falls usually occur? Details of last fall Date of last fall? Has the cause of your last fall been investigated and have you received treatment for it? Did you black out when you fell? (unable to recall hitting the floor) Where did the fall occur? Did you feel dizzy before or during your fall? (but did not black out) Do you think you fell because of a problem with your balance, strength or walking? Do you take four or more types of medication? Did your last fall cause a fracture? Have you been given medication for bone protection? Do you have a problem with your eyesight? Has it been treated by an optician? Do you have pain or problems with your feet? Details of events just before the fall Can the client remember what happened? What was the client doing? Did the client experience any of these symptoms: Fitting Chest pain Light – headedness Palpitations Blackout / faint Headache Visual Disturbance Legs giving way SHFT Falls Prevention Team, July 2013 Guidance Specify time of day e.g. first thing in the morning, getting out of bed Narrow down the place to where the person falls, e.g. in the bedroom, bathroom Have they seen GP / consultant? If yes – refer to GP for assessment (unless GP was the one referring patient ) to do cardiac/ neuro exam/ medication review Referral option – falls clinic via GP letter What starts it, how long does it last? Is it prompted by head/ neck movements / change in positions? Is hearing affected? check ears for wax, refer to GP Refer to physio for balance or gait assessment. Check walking aids Offer advice dependent on own professional skills/ knowledge Identify medications that may cause sedation or postural hypotension e.g. Bisphosphonates such as Alendronic Acid plus calcium and vitamin D Ask when they last had their eyes tested? Advise eye test if more than a year since tested. Check if bifocals/varifocals Give advice on risk of falls when wearing bifocals Consider referral to Sensory Impairment team Check if they can cut their toenails? Consider referral to podiatrist or nail cutting clinics Advise about suitable low –heeled supportive footwear Consider if the person was using a walking aid, bending down turning round Had they taken their medication that day? Had they eaten and drunk adequately? What was the weather like? Were they wearing shoes? Any infections? UTI / Chest infections? Is the person epileptic? Are they taking their medication? Refer to GP if chest pain or black out /faints Check lying and standing BP Check pulse, record rate and rhythm Had they eaten, drunk well Other Was anyone else present at the time? Observed signs and symptoms from above list How many times has the client almost fallen in the last year? Is the client frightened of falling? Afraid of injury Not being able to get up Not being able to get help If the answer to the above question was yes, please select reasons Is there any evidence of environmental Hazards? Medication Review Does the client take 4 or more different types of medicines per day? (including those brought over the counter and herbal remedies) Has there been a recent change in medication? Does the client have any problems getting or taking their medication? Does the client experience or suffer from any of the following? Dizziness, depression, confusion, memory loss, pain, diabetes, osteoporosis, heart conditions, neurological conditions If Osteoporosis selected please tick risk factors Family history of hip fracture Early Menopause (before 45 years old) Hysterectomy (untreated with HRT) Lack of exercise / immobility Smoking and high alcohol intake Lack of vitamin D Planned or current long term steroid use Gastrointestinal conditions, e.g. Crohn’s, Coeliac Hypothyroidism Liver disease Rheumatoid Arthritis Low body weight History of fragility fracture (fall from standing height) Conclusion Record in comment boxes Record in the comment boxes Action Plan Name & Signature SHFT Falls Prevention Team, July 2013 Advice as above Did they have any near falls? What time of day is it? Consider using FESI as an outcome measure Refer OT / PT for fear of falling Consider referral for lifeline / call system Has the HOMEFAST Tool been completed? Does a referral to Occupational Therapist need to be made? Discuss ways of reducing risks of falls Consider homecheck / handyman services for small repairs and safety checks 4 or more medications is termed polypharmacy. It increases risk of falls. Are any of them culprit drugs e.g. sedatives, antidepressants (refer to medicines handout) Has medication been reviewed in last 6 months This could include not taking prescribed medication Consider medication compliance. Are they able to swallow? Do they need a Nomad? Is the pain well controlled, what analgesia do they take? Is there a diagnosis of dementia / Alzheimer’s? If diabetic, do they check their blood sugars? Do they see practice nurse for diabetic review? If not already on medication for bones, refer to GP If on bone medication check taking correctly e.g. Alendronic acid, should be taken on an empty stomach with a glass of water and the person needs to sit upright for half an hour following If low body weight, check body weight (BMI) and medical conditions Provide literature on bone health Ensure aware of National Osteoporosis Society Verbal advice given to client / carer Written advice given to client / carer Staying Steady leaflet from Age UK. ‘Better Balance’ exercise leaflet ‘Are you worried about Osteoporosis’ NOS ‘Cosyfeet’ or ‘DB Shoes’ footwear Pendant alarms Include key points and what action is required e.g. referral to OT, physiotherapy, podiatry Text can be copied into progress notes/ care plan Date & time SHFT Falls Prevention Team, July 2013