Oxford Health NHS Foundation Trust

The underlying principles are:

• To treat all our patients with compassion and respect
• Provide services in the community close to home in a safe and secure environment
• Provide accessible high quality, personalised, safe and appropriate health care, were we listen to our patients and strive to provide the best service and aim to continually improve
• To maintain independence and improve the quality of life of those who fall or who are at risk of falling
• Reduce avoidable admissions to hospital
• Identify and treat common conditions
• Reduce the incidence of falls amongst older people
• Support our patients to remain living safe and independently at home
• Support carers/families and all clinicians in the early detection and management of risk factors that can increase the risk of falls through education, training

The fall’s prevention practitioner is in most cases a registered nurse, trained as an extended scope practitioner to carry out a comprehensive gerontology assessment and put in place a treatment plan to reduce the risk of further falls.

The Falls Specialist will ask the patient several questions about their falls and carry out a physical examination.

A patient treatment plan is discussed and implemented together with the individual and their carer as appropriate. Treatment recommendations and referrals to other services such as exercise classes are made and a copy of the plan is shared with the patient’s GP.

This is delivered via ‘The Otago Programme’ developed in New Zealand for individuals who are housebound.

Studies using the programme show a reduction in falls of between 30-46% and fewer injuries associated with falling. This programme was designed specifically to prevent falls and consists of a set of strength and balance retraining exercises and a walking plan.  The exercises are individually prescribed and increase in difficulty over a series of five home visits.  Last year a total of 89 patients undertook the programme.

Our physiotherapist visits patients at home and agrees with them a programme of exercise that aims to improve their balance and muscle strength.

Our advisor visits community groups, day centres and WI’s delivering health promotion advice on falls prevention and makes links with local seated exercise groups and services.

She also offers taster session of exercise to community centres, care homes, day centres and can link them with a tutor to encourage them to have regular sessions. (picture of group exercise)

She also supports our home based exercise physiotherapist with the Otago Programme and will visit patients at home.

• Reduced sensory input- this is believed to be the most significant.
• Medical conditions that commonly affect sensory input such as stroke and Parkinson’s disease.
• Medications. Antidepressants and sleeping tablets affect sensory input.  Older people also often take medications that affect the blood supply to the brain by causing a reduction in blood pressure which can result in a fall.
• Weakness to joints and muscles and pain from arthritis, damage to nerves will also increase the incidence of falls.
• Anxiety, depression and dementia can prevent a person from concentrating properly and they can fall as a result.
• An infection or any illness that makes a person feel unwell can increase their likelihood of falling. It is well recognised that falling can be a clear indicator of failing health.

• Cluttered environment,
• Rugs which are a trip hazard
• Equipment that is in a poor state
• Furniture such as the bed and chair at an inappropriate height.

A fall or injury can have a devastating effect on the older person’s life, leading to personal costs include, fear, isolation, pain, loss of independence, depression and death.   The estimated burden of falls in the over 65 population in Oxfordshire now and over the next 20 years will rise due to the increase in the population ‘at risk of falling’ as we are living longer.

It is well documented that effective fall prevention has the effect on reducing emergency department visits, hospitalisation, nursing home placements and functional decline.

The NICE ‘clinical guidelines 21’ on falls prevention were first published in 2004 and update in June 2013 as NICE 161.  The Oxfordshire falls prevention service works to these NICE guidelines

• Wear proper fitting foot wear.
• Have your eyes checked annually.
• Ask your GP to review your medications and ask about the side effects.
• To avoid giddiness, get out of bed or up from a chair in slow stages.
• Do not rush to answer the door or phone.
• Wear your pendant alarm. Consider purchasing one if you do not have one.
• Multifocal glasses can affect balance.
• Increase your daily intake of calcium & vitamin D (dairy produce, tinned boned fish & sunlight).
• Keep active.
• Try adding exercise to your daily routine as this helps to increase your bone strength, flexibility and balance.
• Consult your GP before undertaking any form of new physical activityor exercise

Most of our referrals are from the patients GP following a person visiting their practice due to being at risk of falls. On receipt of the referral we send out an appointment letter to invite the patient to a clinic. We aim to see all patients referred to the service within 12 weeks but our waiting time is often shorter than this. If patients are keen to be seen sooner than their allocated appointment and they are able to fill a last minute cancelation then we advise contacting the office.  If the patient is housebound we can organise to visit them at home.

If a patient falls at home and requires assistance to get up and they call 999 and the ambulance service visits. If the crew decide not to take the patient to hospital they will fax a referral to our service and we then arrange to visit the patient at home. We do not invite patients who call 999 to a clinic as we found that commonly they are very frail and we prefer to see them at home in their own environment.

If you have a fall and unfortunately have a fracture our colleagues at the hospital will with your permission refer you to our service.

Anyone can refer someone to the service and we also accept self-referrals as long as the patient meet our referral criteria.

We always call our patients to remind them of their appointment about a week or a few days before the appointment is scheduled.