west Kent falls service survey March 2018 [Type author here] [Type date here]

Transcription

1 west Kent falls service survey March 2018 [Type author here] [Type date here]

2 Document revision history Date Version Revision Comment Author Table of Contents... 1 Contents 1. Introduction 2 2. Methodology 3 3. Summary of responses 4 Respondents 5 Responses in detail..4 6 Discussion Appendices 3 Appendix A. falls survey

3 West Kent falls survey results Introduction The NHS, social care and partners in Kent and Medway are working together to plan how they will transform health and social care services to meet the changing needs of local people. In August 2016, the Community Falls Prevention Service Evaluation was presented to the Clinical Strategy Group (CSG). This evaluation found that following frequent contract monitoring meetings, revised service specification/kpis and recommendations from the West Kent Clinical Commissioning Group (WKCCG) and other stakeholders, the service continued to report low attendance and inefficiencies in the short and long-term management of patients who have fallen or were at risk of falling, alongside a clear increase hospital visits due to falls. Consequently, the CSG approved the recommendation to stop Community Falls Prevention Services provided by Kent Community Health NHS Foundation Trust (KCHFT), with a view to re-designing and commissioning a new falls prevention service in 2017/18. Getting the service right has taken time and the new pathway will aim to be commissioned in 2018/19. Historically, falling has been considered an inevitable and unavoidable part of aging, however there is now evidence-based research proving that this is not always true. Falling may often be preventable and some risk factors can be reduced or even removed with the correct intervention. The proactive support and case management of patients living in west Kent, who have fallen or at risk of falling is an opportunity for improvement, enhancement of care for local people and savings through efficiency. To support the development of the new falls pathway, West Kent CCG invited the views of local people through a patient survey. 3

4 2 Methodology A survey was designed to allow patients and the public to share some of their thoughts about a future falls services and their personal experiences. The survey had seventeen questions and was divided into two parts (see appendix A). Questions 3 to 8 asked respondents to give information about their experiences of having fallen and their thoughts. Questions 9 to 16 asked respondents to rate a range of factors relating or contributing to falls services. Question 17 was a free comment question allowing respondents to expand on their other answers or provide supplementary information. The link to the survey was shared with NHS West Kent clinical commissioning groups (CCGs) PPG Chairs group, all west Kent GP Practice Managers, WKCCG virtual Health Network and voluntary sector partners including. Kings Hill U3A, Royal British Legion, Age UK Tunbridge Wells, Sevenoaks and Maidstone, Age Concern Malling and Involve Kent. Paper copies of the survey were available on request, and Involve Kent distributed these at postural stability classes In addition paper copies of the survey where distributed at Maidstone Older Person s Forum and paper copies of surveys returned from Sevenoaks Hospital and the Good Neighbours (postural stability classes) All participating groups were encouraged to cascade the survey to their own social and professional networks. 4

5 3 Summary of responses Between Friday 16 January 2018 and Friday 16 March 2018, 249 survey responses were received, on-line and by paper copy. This represents a very good response rate for a survey that is aimed at a patient group with lower rates of internet use than the general population. Response rates were higher for questions three to five which explored the respondents fear or experience of falling, than for questions nine to sixteen that asked about the impact of falling or worrying about falling and the importance of parts of falls services.. Questions six to eight, asking about the impact of falling were not intended to be completed by all respondents as these asked for additional information depending on answers to previous questions. It should be noted that for questions three to five, which explored the respondents fear or experience falling, response rates averaged 98 percent. 75 percent of people (184) answering the question; are you ever worried or frightened about slipping, tripping or falling over?, replied that yes they were worried or frightened. Overall the survey shows that falling and preventing falling are a major concern for survey respondents 33 percent of those people reporting that they were injured did not seek care or treatment from a health service or professional. This has clear implications for the design of any falls prevention services that builds on early intervention for people at risk of falling and further injury. The high proportion of respondents reporting direct personal experience of falling allows the importance given to parts of falls services to be confidently considered as service user views.. 4 Respondents In addition to the questions about falls services, respondents were asked to provide demographic details. Ninety nine per cent of respondents provided details of their age and ninety eight per cent provided details of their gender. 5

6 It should be noted that the demographic section of comparable, health and social care related surveys is often skipped and that these are relatively very high completion rates. Respondents to the west Kent falls service survey are predominantly drawn from a group referred to as older elderly women: Age group Respondents Percentage Under Table 1 34 per cent of those providing details of their age were aged per cent of those providing details of their age were aged per cent of those providing details of gender were female Reading from the section of table {highlighted] shows that respondents aged provided make up over 70 percent of survey responses. In comparison, only 4 per cent of those providing details of their age were aged under 50. 6

7 This demographic is significantly older than the predominant membership of the majority of healthrelated, regular patient reference groups meeting in the west Kent CCG areas. This age profile has a considerable impact on potential service design and delivery as traditionally older adults services are offered to people aged 55 and above. 5 Responses in detail Questions 3 5 show that the majority of respondents, 70 percent of those providing information, had direct personal experience of falling Q3 Are you ever worried or frightened about slipping, tripping or falling over? Table 2 shows response detail Answer Respondents Percentage YES NO I don t know 6 2 Q4 Would you describe yourself as often unsteady on your feet or wobbly? Table 3 shows response detail 7

8 Answer Respondents Percentage YES NO I don t know 9 4 Q5 Have you slipped, tripped or fallen over within the last two years? Table 4 shows response detail Answer Respondents Percentage YES NO Questions six, seven and eight prompted those respondents who had fallen in the past two years, to develop their answers in greater detail Table five below illustrates the range of services respondents used as a result of falling. Table 5 below Action Respondents Percentage 8

9 I didn t have any treatment, or see a health professional I needed an ambulance to be called and I was taken to hospital I saw my GP I went to the hospital but I didn t need an ambulance to take me I needed an ambulance to be called but I didn t go to hospital 5 4 I went to a Minor Injury Unit (MIU) 3 2 I went to a pharmacy 2 2 Note that the two unlabelled chart segments, chosen by 3 and 3 people, correspond to the answers Yes, I went to a Minor Injury Unit and Yes, I went to a pharmacy. 9

10 Figure 1 shows healthcare seeking actions taken by respondents Q7 If you fell, what type of injury did you have? Table 6 shows response detail Answer Respondents Percentage Cuts and bruises Broken bone(s) Q8 If you had a broken bone or bones - fracture(s), which bone or bones did you break? Please note that this question was mistakenly completed by 15 people who having stated that they did break a bone then commented that they did not break a bone or bones. The table below shows reported broken bones. Table 7 shows reported broken bones grouped by body part Broken bones Respondents Percentage None Hip 6 13 Wrist

11 Ribs 5 11 Other 5 11 Nose or facial 4 9 Pelvis 3 7 Vertebrae 2 5 Please note that the Other response category included individual reports of breaks to elbow, hand, collarbone, skull and leg. The second part of the survey asked respondents what was important to them when thinking about falls services. This second part of the survey was completed by fewer respondents than the first part with 83 percent of respondents completing Q9 and Q10. Q9 Would you find it useful to discuss falling over or being worried about falling over useful? Table 8 shows response detail Answer Respondents Percentage YES NO I don t know

12 Q10 Have you ever considered having your home assessed for risks that may cause you to fall? Please think about whether there is anything that could make you fall e.g. uneven paving, poor lighting, loose rugs or flooring. Table 9 shows response detail Answer Respondents Percentage YES NO I don t know So half of respondents would welcome the opportunity to discuss their fear of falling, and sixty six per cent of responds hadn t considered having their home assessed for risks that might cause a fall. I don t know 11 6 Overall responses to questions 11 to 15 strongly suggest that those respondents who completed these questions were more likely to reply in order to select aspects of falls services that they thought to be of high importance. That is to say the responses show people highlighting what they found important rather than what they found unimportant Group sessions with a physiotherapist/therapy assistant to advise on strengthening and balancing exercises was the aspect of falls services most often chosen as being of high importance, there was also strong preference for working with individuals to build confidence to complete tasks important to individuals and to maximise your independence. 12

13 Detailed assessment of the reasons why a person might be falling over or worried about falling over was most often rated as an aspect of falls services of medium importance. Review of anything at home that may make a person more likely to fall (trip hazards, poor lighting) and an assessment to see if supplying equipment, such as hand rails may reduce the risk of falling was most often rated as of low importance, concurring with the low proportion of respondents who would consider an assessment of their home. Scores given on a 1 to 10 scale were allocated as showing high, medium or low importance to respondents, a breakdown for each question is shown below. Please rate from 1 10 (1 being least important 10 being most important) which main parts of a falls service you feel would be important: Q11 Detailed assessment of the reasons why you might be falling over or worried about falling over Rating Percentage High 52 Medium 34 Low 14 Over half of respondents rated detailed assessment of reasons why you might be falling over or worried about falling over as highly important. To some extent this is in contrast to more detailed responses around home and trip hazard assessment. Q12. Group sessions with a physiotherapist/therapy assistant to advise on strengthening and balancing exercises Rating Percentage 13

14 High 66 Medium 23 Low 17 More than 60 percent of respondents rated group sessions with a physiotherapist/therapy assistant to advise on strengthening and balancing exercises as highly important and this concurs with informal feedback at community groups for older adults. In community settings in Maidstone where the survey was distributed, engagement staff spoke with attendees who had direct personal experience of falls prevention classes and who spoke positively about group sessions, the social aspects of classes and confidence when classes were led by a professional. Q13. Review of anything at home that may make you more likely to fall (trip hazards, poor lighting) and an assessment to see if supplying equipment, such as handrails may reduce your risk of falling Rating Percentage High 43 Medium 28 Low 29 Review of hazards in the home was consistently less often rated as highly important and this echoes more detailed responses relating to this proposition or service area. 14

15 Q14. Falls prevention advice including a review of other factors that might increase your risk of falls for example your diet, footwear, eyesight and medication Rating Percentage High 49 Medium 33 Low 19 The importance rating give to review of diet, footwear, eyesight and medication and other alternative falls risk factors is closely aligned to review of home hazards and suggests support and a preference for active intervention and professional involvement with individuals rather than environmental factors Q15. Working with individuals to build confidence to complete tasks important to you and to maximise your independence. Rating Percentage High 56 Medium 28 Low 15 15

16 This implication of response patterns is reinforced where over half of respondents rated working with individuals to build confidence to complete tasks important to you and to maximise your independence as highly important. Q16 Can you think of anything that would stop you using falls prevention services? Table 10 shows response detail Answer Respondents Percentage YES NO Discussion points Comparing pairs of questions reveals information that prompts further discussion. For example, all respondents who said they worry about falling can then have their answers to all other questions in the survey compared to all those who said they were not worried about falling. This group of respondents could be seen as those who consider themselves at risk of falling. To further support this view, 74 percent of respondents worried about falling over would describe themselves as wobbly or unsteady on their feet. However, perhaps unexpectedly, 63 percent of respondents worried about falling over who gave an answer to Q10 have not considered having their home assessed for risks. Explanatory comments highlight that approximately a third of those who replied, No, had already had an assessment, had some aids or were living in adapted or supervised accommodation 1, 75 percent of people answering the question; are you ever worried or frightened about slipping, tripping or falling over, who replied, yes. Significantly, fewer than half of respondents who were worried about falling over would find it useful to discuss their worries. Alongside more detailed comments, this 16

17 reinforces support for direct, practical interventions. From this survey people want help to feel more confident moving around and by extension less worried about falling, rather support with their feeling of worry. Looking more closely at replies shared by people who are worried or frightened of falling shows that while, as may be anticipated 78 percent have fallen over in the last 2 years, 22 percent have not.. 70 percent of people answering the question; have you slipped, tripped or fallen over within the last two years replied yes. Significantly, fewer than half of respondents who had fallen in the last two years would find it useful to discuss their worries. Falling does not make these people more willing to talk about their worries about falling again.. This finding is all the more significant when taking into account that 84 percent of those people who had fallen in the last two years were worried about falling again. 70 percent of people who had fallen in the last two years described themselves as wobbly or unsteady on their feet, a similar proportion to those who were worried about falling who chose this description. Approximately half of respondents who had fallen would not consider having their home assessed. Explanatory comments highlight that approximately a third of those who replied, No, had already had an assessment, had some aids or were living in adapted or supervised accommodation. These comparisons between questions raise the question of whether or not, not finding discussing worries helpful may be connected to not wanting to talk about the risks of falling and become a barrier to accessing services. However, looking more closely at all 61 additional comments in response to Q16, only one remark suggests this barrier. I am independent, I always have been. It is hard to admit that you may need the help 17

18 7 Additional comments A high proportion of respondents gave additional comments in response to questions 4, 5, 7, 9, 10 and 16. The majority of respondents used the survey comment fields to expand on, explain or give detail or examples of personal experiences. At an NHS West Kent CCG PPG Chairs meeting discussion of the falls services and the survey elicited remarks and debate around the differentiated need of those people who fall who are living with dementia, and the need for adapted services. As well as the frequency with which urgent assistance, most often in the form of calls to the ambulance service, were the result not of injury but of an elderly person living either alone or with a frail spouse or family carer who were unable to get the person back on their feet. This specific point about the inability to get back up was echoed in the survey, with reference to falling in the street or garden and not being able to get up again. Overall Themes and trends A number of themes emerge from additional comments provided and free responses to Q17 - Please tell us if there is anything else you feel is important for us to think about when designing a new falls prevention service Alongside additional comment provided to earlier questions 51 percent of respondents gave further as free responses to Q17. 18

19 A clear theme is that of the value and benefit found in classes, for those respondents who are currently or have previously attended sessions. Over a quarter of free responses specifically referred to positive reaction to or the benefits of specialist falls classes. A regular class helps maintain one s own commitment. The benefits of such group activity go beyond preventing falls, to building confidence, sharing ideas & helping with other problems - including poor sleep habits Currently attending 36 week PSC - ran really well and I have benefitted from it I wouldn't do without my postural stability class. They are vital for me, for exercise and companionship This theme is qualified and expanded by additional comments including those referring to barriers to accessing a falls service that refer to the cost Transport as in getting it and cost if it became too expensive for me. As well as paying for the class, I also have to pay for a taxi there and back many pensioners would find it difficult to pay much for weekly, or more frequent sessions 19

20 A second theme brought together concerns around the expense of travelling to classes, sessions or services and difficulties with travel and mobility. It would be helpful if any meeting place for talks did not involve much walking Accessibility to venue. Maybe someone to accompany individuals if they are unsteady on their feet. It would need to be within easy reach of home and not for too long Having a reasonably local venue for the meetings/training sessions. Making it accessible to people with limited ability to get to surgeries A number of explanatory personal comments described individuals experiences of falling and a linking theme of worry and experience of falling outside the home and in public spaces can be drawn out. Having someone to walk you up a street to give you confidence to go alone. Uneven paths I am very unsteady on uneven pavements and steps when the pavements are wet, sometimes the walking sticks can slip if you aren't careful I easily overbalance in places that are unfamiliar, reasonably ok indoors 20

21 Grouping these themes a strong trend can be identified suggesting a combination of worry and fear around falling leading to increased concern in outdoor or public spaces and personal limitations around mobility and travel. These limitations may then become barriers to accessing those services that are intended to alleviate the problem. When the broader benefits of reducing social isolation are considered it becomes apparent that services that want to have a positive impact on service users will need to consider early identification of those people at risk of fear of falling, and early intervention in maintaining mobility and confidence in mobility, and regular travel outside the home at a much earlier stage than after a first, even minor fall. Appendix A Survey 21

22 22