NHS ENGLAND. North
A guide to help care home staff to manage and prevent falls and risk of fractures, with an emphasis on person centred care and continuous improvement. It looks a preventing falls through activity and exercise; risk factors in falls, risk assessment and screening, management following a fall, and the importance of education. The guide includes key references to national falls prevention in care homes best practice and NICE quality standards. It also provides links to wider resources and tools. The resource can be used to benchmark existing policies and procedures with care homes to ensure the care given reflects evidence-based practice.
KEALL Michael D, et al
Background: Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. This study tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. Methods: This study is a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. This study randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which was derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, this stanalysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. Findings: Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085–1263), the crude rate of fall injuries per person per year was 0·061 in the treatment group and 0·072 in the control group (relative rate 0·86, 95% CI 0·66–1·12). The crude rate of injuries specific to the intervention per person per year was 0·018 in the treatment group and 0·028 in the control group (0·66, 0·43–1·00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0·74, 95% CI 0·58–0·94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0·61, 0·41–0·91). Interpretation: The findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested.
Purpose: The purpose of this paper is to provide a narrative review of what is currently known about the high rates of falls, and fall injuries, which are experienced by people with learning disabilities (LDs) throughout their lives. Design/methodology/approach: Narrative review. Current evidence is summarised as key points and recommendations for practitioners and researchers. Findings: People with LDs experience similar rates of falls as older adults in the wider population, but throughout their lives, or at an earlier age. Originality/value: Key points and recommendations are summarised for practitioners and researchers to promote fall prevention strategies and interventions for people with LDs.
HARFLETT Naomi, et al
An economic analysis of three schemes from Dorset Partnership for Older People Projects (POPP), focusing on their value and effectiveness in preventing malnutrition and preventing fire related injuries. Dorset POPP schemes use a community led preventative approach and aim to improve the quality of life of older people and to save money by preventing ineffective use of publicly funded services. The report uses published figures of the costs of malnutrition and the economic value of preventing fire injuries and applies the figure to contact monitoring and costs data from three of the Dorset POPP projects to provide an estimate of the potential economic value. The schemes are: the Wayfinder Programme, which provides signposting and support on services such as welfare benefits and pensions, retaining independent living, social activities, telecare and lunch clubs; the Community Initiatives Commissioning Fund (CICF), which funds initiatives identified by local people such as lunch clubs, social clubs, and neighbourcare schemes; and Safe And Independent Living (SAIL) multi-agency referral scheme, which provides a multi-agency referral approach to enabling access to signposting, support, and services. For all of the interventions included in the analysis, just a very small proportion (often less than one per cent) of the contacts or referrals made would be needed to prevent malnutrition or fire related injuries, in order to save money.