Practical Ideas for Preventing Falls in Dementia

Transcription

1 Practical Ideas for Preventing Falls in Dementia An example of a falls prevention training session Julie Whitney and Amanda Buttery

2 The need for falls prevention What percentage of care home residents fall approximately each year? a. 30% b. 40% c. 50%

3 Falls prevention training in London Training sessions in 14 homes to 256 members of staff Three sections risk factors, falls in dementia and post fall management. Use of a case study to examine dementia specific risk factors and methods to address these

4 Case study - Mr Smith Falls history 6 falls in last 6 weeks (before that 2 falls in a year) Day and night no real pattern Mostly unwitnessed Has hit head and sustained bruising Always occur during times when he is restless and mildly agitated and trying to get up all the time

5 Mr Smith Medical conditions Vascular dementia Benign prostatic hypertrophy (BPH) Osteoarthritis knees and hips Hypertension (high blood pressure)

6 Mr Smith Fall risk factor? Medical conditions Vascular dementia Benign prostatic hypertrophy (BPH)? Osteoarthritis knees and hips Hypertension?

7 Mr Smith Medications Amlodipine Tamsulosin

8 Mr Smith Fall risk factor? Medication Amlodipine Tamsulosin?? Orthostatic (postural hypotension)? BP after 5 minutes lying down = 135/87 (pulse 77) BP after 1 minute = 129/80 (pulse 86) BP after 3 minutes = 133/88 (pulse 80) No evidence of Blood Pressure (BP) drop

9 Mr Smith Medications Amlodipine Tamsulosin No high risk medications Sleeping tablets, antidepressants, anti-psychotics

10 Mobility Unsteady walking Other risk factors.. Unable to stand unsupported and steady Use of a walking frame Behaviour Impulsivity Frequent walking Anxiety Agitation

11 Mr Smith Is still able to get out of the chair but is unsteady when he walks and requires a walking frame and supervision to be safe. He often forgets this and gets up on his own without his frame. He spends much of the day trying to get up and walking around the home. It is not clear where he is trying to go or what he would like to do.

12 Fall risk factor? Other risk factors.. Mobility Unsteady walking Unable to stand unsupported and steady Use of a walking frame Behaviour Impulsivity Frequent walking Anxiety Agitation

13 Mr Smith why is he falling? No drop in BP No risk factor medications No clear environmental cause Possible reasons: Unsteadiness Forgets to use frame Frequent walking without supervision

14 What to do? It may be possible to improve balance and mobility with exercise but.. Has to be performed regularly Challenging Ongoing More practical to address the behaviours associated with increased risk?

15 Human psychological basic needs Kitwood

16 Group activity Each group has one petal Please discuss: How unmet needs in this petal might lead to the behaviours associated with increased fall risk (i.e. restlessness, frequent walking, trying to get up all the time, agitation) What could be done to try and meet the need One person to feedback from your group

17 Comfort Comfort needs Pain, hunger, thirst, soiled or wet pad, noise, lighting, seat, needing the toilet, pressure Identifying lacking needs Pain scales, GP assessment, providing food/drink, helping to the toilet, noting length of time sitting down, observation for response to certain environments. Addressing needs Often achieved in identifying, regular analgesia, toileting programme, avoiding certain environments

18 Inclusion Inclusion needs Lonely, isolated, left out. Identifying lacking needs Attempts to be included, behaviour changes when actively included Addressing needs Methods to optimise inclusion (not necessarily just through organised activities)

19 Identity Identity needs Lack of familiar environment, people, belongings. Lack of a role. Identifying lacking needs Disorientation, trying to get out and leave / go home / go to work Addressing needs Familiar items, developing relationships, routine, role based on previous, this is me

20 Attachment Attachment needs Looking for relationship and feeling safe and nurtured. Identifying lacking needs Clingy, tactile, affectionate, improves when with company/attachment item Addressing needs Doll therapy or soft toy / animal Opportunities for interaction

21 Occupation Occupation needs Bored, looking for something to do, looking for a role Identifying lacking needs Restless, fiddling with items, sorting and moving things Addressing needs Activity appropriate to that person and within their capabilities Create a role

22 Grading ability to participate in activity Level Abilities Suitable leisure activities Planned Exploratory Sensory Can explore different ways of carrying out an activity Can work towards completing a task Can look for objects in obvious places Can carry out FAMILIAR tasks in FAMILIAR environments Enjoys the experience more than completed result Needs complex tasks breaking into stages Responds to bodily sensations Can be guided to carry out single step activities Newspapers, board games, computer games, cooking, gardening, quizzes / crosswords Exercise, arts / crafts, food tasting, board games, DIY, gardening, flower arranging, cooking, conversation Sensory box, smells, food tasting, hand massage, exercises, music, singing, wiping tables, polishing, sweeping Reflex Can make reflex responses to stimulation Uses body language to respond to social engagement Smells, massage, lights, textured objects, chimes, sensory mobiles

23 Rummage bags /boxes Mostly for those at sensory level Ask families to help to produce Change what is in it It is not a replacement for human company

24 STOP Falls tips Seek reasons for frequent activity Observe the person carefully. Are they uncomfortable, bored, lonely, anxious? Try not to stop all activity Don t restrict all walking as physical activity is good for maintaining strength and balance Occupation Occupation Occupation! Make sure that personalised meaningful activity is available and that the person can participate Plan for supervision Identify risk times/activities and provide supervision Consider movement sensors

25 Resources Chartered Society of Physiotherapy College of Occupational Therapists Free resource-living well through activity in care homes: the toolkit Separate toolkits for care home staff and managers

26 Resources National Institute for Health and Care Excellence - NICE Falls guidelines Mental wellbeing of older people in care homes- Tailored resource for managers of care homes for older people Mental wellbeing in over 65s: occupational therapy and physical activity interventions Social Care institute for Clinical Excellence - SCIE Social Care TV film Avoiding unnecessary hospital admissions among older people: residential care homes.

27 Resources Managing Falls and Fractures in Care Homes for Older People Good practice self-assessment resources and training

28 Conclusion Falls are common but not inevitable Much can done to prevent falls Great resources available to prevent falls including checklists to review your care homes approach to falls prevention

29 Any Questions? Contact details Dr Julie Whitney NIHR/HEE Clinical Lecturer Clinical Age Research Unit Kings College Hospital Dr Amanda Buttery Innovation Fellow Health Innovation Network

30 References and further resources Kitwood, T (1993). Person and process in dementia. International Journal of Geriatric Psychiatry, 8, Kitwood, T (1997). Dementia Reconsidered: The person comes first. Buckingham: Open University M technique DVD. Hand and Foot 'M' Technique. J Buckle. Public Health England. Reasons why people with dementia are admitted to a general hospital in an emergency: National Dementia Intelligence Network briefing. PHE publications gateway number: Royal College of Physicians. Fallsafe resources. The End-of-Life Namaste Care Program for People with Dementia. Second Edition. Joyce Simard (author). ISBN: Published: Jul 2013 Health Professions Press. The Pool Activity Level (PAL) Instrument for Occupational Profiling. Fourth Edition. Jackie Pool (author). ISBN: Published 2012 Jessica Kingsley Publishers. The Health Innovation Network