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Preventing and managing falls to improve quality of life

Falls can be devastating - for the individual who has fallen, their families, their carers and NHS and social care services. Falls can lead to death, fractures, pain, loss of independence, social isolation, increased hospital admissions, fear of falling, poorer quality of life. They are expensive to the faller, their family and to health and social services.

Fall prevention is a key priority at all levels of care – from public health and private care services and to transport services and in the home. But what are the best fall prevention strategies? And how do we best implement these strategies successfully over such a large range of differing environments?

Professor Pip Logan from the Centre for Rehabilitation and Ageing Research in the School of Medicine has led a number of studies investigating the reasons behind falls, the most effective methods to prevent them, and how to adapt those methods to different settings.

This includes the largest study of care homes in the UK, published in the British Medical Journal in December 2021. The study found that a co-ordinated approach to fall prevention in care homes significantly reduced the number of times residents fall.

The study found that the programme reduced the rate of falls by more than 43% compared with residents who did not receive the intervention. There was no adverse effect on residents’ mobility or independence and the treatment was found to be cost effective and fell well within the cost-thresholds set by the National Institute for Health and Care Excellence for treatments to be funded through the NHS.

This approach built on previous studies led by Professor Logan, which developed interventions including staff training programmes, resources and implementation guides. They have been modelled using rigorous research methods, evaluated in the real world and implemented by commercial organisations.

The ‘Falls in Care Homes study’ (FinCH), led by Professor Logan and colleagues from the Centre for Rehabilitation and Health Care Research, tested a new approach previously called the ‘Guide to Action to prevent Falls in Care Home’ (GtACH) programme, now called ‘Action Falls’ which was designed by a collaborative group including care home staff, and families. The group developed and tested a 33 point checklist with a list of 33 associated actions that care home staff can use to reduce the risk of falls among their residents.

The programme includes one hour of training for all care home staff (including gardeners, caretakers, cooks, cleaners, managers) in small groups, delivered by a falls specialist, a mobile APP and web based case studies . Once trained, staff are expected to use the Action Falls risk assessment and guide to action checklist with all residents.

For example, the assessment might highlight that a resident is dehydrated and the recommended action is to increase fluids. The manual and training help the care home staff take action and have confidence in their response - such as introducing smoothies, having more fruit juice on offer, providing appropriate crockery, making soups, and making an event of coffee time. The App can be used on any phone free of charge and provides hints and tips. Overall, the training and resources increase both awareness and knowledge about the management of falls.

Professor Logan and her team have also worked with services across the care journey to ensure that those who have fallen in their own homes receive the right care and are directed to the right support services.

“Our research has shown that not all people who fall need to go to hospital, and that falls rates can be halved and money saved if these people are referred to falls prevention services,” she said. “This led to a collaboration with the University of Swansea where we explored if a computer programme could help ambulance crews make decisions about which patients to take to hospital.

"Our research has shown that not all people who fall need to go to hospital, and that falls rates can be halved and money saved if these people are referred to falls prevention services."
Professor Pip Logan

“Poor eyesight is a risk factor for falls. We have shown the positive impact of first and second eye cataract surgery on reducing falls and fractures in older people. This evidence is cited in NICE cataract guidelines and has changed the NHS priority of older people needing second eye cataract surgery. “

She has also focused on providing clear, helpful guidelines to exercises that help those at risk of falls, and their families, to take significant action in implementing falls prevention in the home.

“The NHS, public health, charities and local authorities provide falls prevention exercise programmes, but older people and those who have dementia many find it hard to engage with these exercise programmes.

“In addition, providers do not know how to best implement exercise programmes for people with long term health needs,” Professor Logan said. “To guide exercise providers, we have produced a definition of a physical activity programme, which we have tested in both a feasibility and definitive randomised controlled trial.

“The PRAISED activity programme has been tested in four NHS locations for people with early stage dementia and the Fame exercise programme is now being rolled put across the UK. Changing older people’s behaviours so that they can self-manage their long-term health conditions is a priority for the people themselves, the NHS and social care providers.”

Professor Pip Logan

Professor Pip Logan, Professor of Rehabilitation Research, Centre for Rehabilitation and HealthCare Research, School of Medicine.

Further reading:

British Medical Journal 2010: Logan PA,Coupland CAC,Gladman JRF, et al. Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial.

Age and Ageing 2021 Orton E, Audsley S, Coupland C, Gladman JRF, Iliffe S, Lafond N, Logan P, Masud T, Skelton DA, TimblinC, Timmons S, Derek W, Kendrick D ‘Real world’ effectiveness of the Falls Management Exercise (FaME) programme: an implementation study. Age and Ageing.2021;

Clinical Rehabilitation 2018: Booth V, Harwood RH, Hood-Moore V,Bramley T,Hancox JE,Robertson K, Halls J, Van Der Wardt V, Logan PA. Promoting activity, independence and stability in early dementia and mild cognitive impairment (PrAISED): development of an intervention for people with mild cognitive impairment and dementia

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