i-hom-fra In Home Falls Risk Assessment Tool i-hom-fra In Home Falls Risk Assessment Tool

Transcription

1 i-hom-fra In Home Falls Risk Assessment Tool i-hom-fra In Home Falls Risk Assessment Tool This falls risk assessment tool (i-hom-fra) was exclusively developed for use with older people at home in the community. It draws its heritage from a previous tool developed in response to the needs of allied health professionals within South Australia. The development of i-hom-fra was underpinned by a combination of three distinct yet interlinked processes. They were systematic mapping of the current best evidence for falls risk (research evidence), feedback from end users and stakeholders (clinical expertise) and subsequent piloting by physiotherapists and occupational therapists from multiple health sectors in South Australia (clinical utility). The tool also includes a range of clinically relevant indicators, which complement evidence-informed falls risk factors, and together can be used to underpin health care decisions. The i-hom-fra is currently undergoing psychometric testing to establish its reliability and validity and as such it is presently being used across a range of clinical settings and research studies, which will result in ongoing refinement of the tool. For further information about i-hom-fra, including its use, please contact the Southern Community Falls Prevention Team, Southern Adelaide Local Health Network ( FALLS ) or Domiciliary Care, Department Communities and Social Inclusion, Clinical Advisor, Physiotherapy, Telephone: An initiative of the Southern Adelaide Local Health Network (SALHN) and Domiciliary Care (Dept. Communities and Social Inclusion) page i

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3 i - HOM - FRA In Home Falls Risk Assessment Subjective Assessment 1. Presenting problem (reason for referral) (consider client s perception) 2. Social situation (include transport options, meal preparation, shopping, showering, cleaning, social/family support. Please Specify.) Lives Alone: 3. Medical history (consider Parkinson disease, stroke, peripheral neuropathy, depression, dementia, diabetes, osteoporosis, cerebrovascular disease, arthritis, hypertension, fractures) 4. Medication (consider client s knowledge and management of medications, how well the client feels that the medications are working for them, and any side effects) Current medications Do you currently take 4 or more medications? NB: If the answer is = Medication Falls Risk Factor. Have you had your medication reviewed by your GP or Pharmacist in the last 12 months? MEDICATION FALLS RISK FACTOR page 1

4 Clinically Relevant indications for a review of medication by a GP or pharmacist: - Is taking more than 12 doses of medications per day - Had significant changes made to the medication regime in the past three months - Is attending a number of different doctors - Is taking one or more psychoactive medications - Was recently discharged from a hospital (in the past four weeks) - Has multiple medical conditions - Suspected of not managing or adhering with their medication regime - Shows symptoms that suggest an adverse medication reaction (eg. Confusion, dizziness, reduced balance) 5. Functional Mobility/Decline Aids used outdoors Aids used indoors Able to manage stairs/steps Able to mobilise around community, e.g. to shops, bank Recent change in mobility Recent change in Pain associated with walking Able to catch public transport a) How long can you walk before you need a rest? mins. E.g.: NB: If a client cannot walk for 30 minutes in total, including brief rests = Functional Mobility/ Decline Falls Risk Factor b) What limits your walking? c) Do you undertake regular physical activity? If yes, describe DECREASED FUNCTIONAL MOBILITY/DECLINE FALLS RISK FACTOR page 2

5 6. Falls History NB: The World Health Organization defines a fall as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level. a) Have you fallen in the last 12 months? NB: If the answer to a) is = Falls History Falls Risk Factor. b) How many times have you fallen in the last 12 months? times. c) Do you have near misses? How often d) Circumstances surrounding major falls/near misses in last 12 months? (location, time, activity, consequence, able to get up off floor, witnessed/unwitnessed) FALLS HISTORY FALLS RISK FACTOR 7. Fear of Falling a) Has fear of falling made you avoid any of your usual activities? NB: If = Fear of Falling Falls Risk Factor b) Is this answer appropriate to the client s abilities? Describe FEAR OF FALLING FALLS RISK FACTOR 8. Specific Problems Vision Do you wear bifocals or multi-focals? Was your last eye/spectacles check-up more than 2 years ago? NB: If to one or more questions = Vision Falls Risk Factor VISION FALLS RISK FACTOR Clinically Relevant Indicator: Consider any problems with steps/ stairs or stepping on and off gutters while wearing these glasses. page 3

6 8. Specific Problems continued Vitamin D 3 Have you been diagnosed with Vitamin D 3 deficiency? (Consider bone density and osteoporosis issues) NB: If = Vitamin D3 Falls Risk Factor If yes, are you taking any supplements for it? VITAMIN D 3 FALLS RISK FACTOR Dizziness During the past two months, have you had any episodes of feeling dizzy, unsteady or like you were spinning or moving, lightheaded or faint? If then, Has this dizziness been present for at least one month (either intermittently or persistently)? NB: If to both questions = Dizziness Falls Risk Factor DIZZINESS FALLS RISK FACTOR Footwear Does the client have poorly fitting shoes, slippery soles, heels too high, worn or old shoes, shoes difficult to do up, wearing socks with no shoes? NB: If = Footwear Falls Risk Factor FOOTWEAR FALLS RISK FACTOR Feet Does the client have foot pain leading to antalgic gait or abnormal gait, painful corns or calluses, long toenails, foot swelling or bony deformity? NB: If the above question= Feet Falls Risk Factor FEET FALLS RISK FACTOR Lower Limb Sensation Does the client have poor gross sensation in lower limb(s)? NB: If = Lower Limb Sensation Falls Risk Factor LOWER LIMB SENSATION FALLS RISK FACTOR Continence Do you have to get up most nights to urinate? Do you suffer from urge incontinence? NB: If to one or more = Continence Falls Risk Factor CONTINENCE FALLS RISK FACTOR Clinically Relevant Indicator: Consider if the client requires bone health review Consider if the client s continence has any impact on their level of mobility Consider if the client s level of mobility affects their ability to be continent page 4

7 8. Specific Problems continued Cognition Are there any identified cognitive/behavioural issues? (Consider short and long term memory, orientation, poor attention, risk taking behaviour and poor concentration). NB: = Cognition Falls Risk Factor COGNITION FALLS RISK FACTOR Clinically Relevant Indicators For Further Consideration Psychosocial issues (Sourced from client, carer, friend, GP, etc) Mental Health such as Anxiety, Depression issues Alcohol Intake (Guidelines recommend no more than 2 std drinks/ day) Use of alcohol Occasionally or regularly Type: Quantity and frequency: / Skin frailty (Risk of tearing, pressure areas) Consider if the client has any of the following: Thin, frail skin that tears, bruises with minimal trauma, poor circulation, sensation, gross swelling feet, ankles, lower legs, immobility, dampness, poor nutritional status, skin areas subject to friction or shear Nutrition Client weight/bmi: Appetite has changed in the last 6/12 s Has lost or gained weight, or someone else commented that the client has lost or gained significant amounts of weight in the last 6/12 s Is a diagnosed diabetic If been diagnosed as a diabetic has the client had involvement with a dietitian? Personal Safety Plan Does client own a personal alarm? If yes, does the client wear the alarm? What would you do if you fell, were injured, ill or unable to get out of bed? (e.g. Contact person, key safe, home access) Describe: page 5

8 Objective Assessment 1. Balance Test Able Unable Comments a) Feet Together b) Single Leg Stance Eyes open Can the client stand with their feet together for 30 seconds? Eyes closed Time achieved: Right Can the client stand on each leg for 5 seconds? Left Time achieved: c) 180 Degree Turn Can the client complete the turn taking 5 steps or less?. of steps taken: d) Tandem Steps Can the client perform 5 consecutive tandem steps?. of steps taken: NB: 2 or more unable answers = balance falls risk factor 2. Muscle Strength BALANCE FALLS RISK FACTOR Sit to stand test: Is the client able to perform 5 consecutive chair stands from a seated position in less than 12 seconds? Time to complete: Details: NB: If client unable to perform Sit to Stand Test in less than 12 seconds = muscle strength falls risk factor MUSCLE STRENGTH FALLS RISK FACTOR 3. Gait & Speed Timed up and Go test (stand from chair, walk 3m, walk back and sit in same chair) Can the client complete the test in less than 15 seconds? Time: Gait details: NB: If client unable to perform TUG in < than 15 seconds = gait and speed falls risk factor. GAIT AND SPEED FALLS RISK FACTOR page 6

9 4. Home Environment (Assess any environmental hazards and the client s interaction and functional status within the context of their home environment). Environment Current environment: Is it Safe for the client? Recommendations(s) Front Access Back Other i.e internal Outdoor pathways Indoor pathways Lighting (indoor) Lighting (outdoor) Shower/Bath Transfers Toilet Transfers Chair Transfers (dining/lounge) Bed Transfers/Bed Mobility Any other issues NB: One or more no answers = environmental falls risk factor ENVIRONMENTAL FALLS RISK FACTOR page 7

10 Goals What do you enjoy doing? What do you need to be able to keep on doing this? What would you like to do more of? Additional Comments page 8

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12 For more information Southern Adelaide Local Health Network Southern Community Falls Prevention Team FALLS ( ) Domiciliary Care Department for Communities and Social Inclusion (DCSI) Clinical Advisor, Physiotherapy Telephone: Saravana Kumar School of Health Sciences International Centre for Allied Health Evidence University of South Australia Telephone: (08) saravana.kumar@unisa.edu.au The i-hom-fra tool was developed through a partnership between Southern Adelaide Local Health Network, Domiciliary Care (Department for Communities and Social Inclusion) and University of South Australia. The i-hom-fra tool is free to use in its original form. The end user(s) shall not modify, abridge, condense, adapt, recast, or transform the i-hom-fra tool in any manner or form, without the prior written agreement of the developers. This includes, but is not limited to, any change to the words and/or the organisation of the questions contained in the i-hom-fra tool. Please contact the developers if you intend on changing the i-hom-fra tool from its original form Government of South Australia. All rights reserved. Printed July 2014.