Falls Pathways: Preventing the Revolving Door | 5 Webinar Insights
At the recent Felgains webinar, “Falls Pathways: How can we Prevent the Revolving Door?”, we heard from 3 NHS professionals who shared their expert knowledge on falls: Dr David Shipway, Consultant Physician & Perioperative Geriatrician at North Bristol NHS Trust; Louise Balson, Falls and Frailty Lead at South Western Ambulance Service; and Amy Hassan, Head of Dorset UCR.
Each presentation was full of valuable data, insights and expertise on falls and how we can prevent the revolving door. In this article, we’ve pulled out 5 key insights for you…
1. Why are older persons more likely to fall over?
At a very simple level, falls occur because of a loss of balance. But there is a lot more physiologically at play. There are a host of complicated neurophysiological processes that happen in your body to keep balance. Watch this part of the webinar for Dr David Shipway’s full description of how this works.
All these processes need to happen incredibly quickly for the body to react and maintain balance, and the complexity of this is demonstrated by how long it takes children to balance and then walk after they are born. So, at the other end of the life spectrum, these processes that enable a human to stand and walk are the first to break down, increasing the risk of falling.
These are the very same processes that the body requires to get back up again. So if the processes have deteriorated sufficiently to contribute to a fall, the same deterioration will hinder the fallen person’s ability to get back up again – which leads us on to insight 2…
2. Falls very easily become a vicious cycle
A frail older person who falls at home may be uninjured but suffer a long lie. This long lie can then lead to a pressure injury, acute injury and delirium. The resulting illness reduces their mobility, and they become more susceptible to secondary and tertiary complications. This inflammatory cascade makes them frailer and increases their vulnerability to falling again – with long-term and permanent ramifications.
We know from research papers that a person can lose 40% of their muscle strength if immobilised for just one week1. It shouldn’t therefore be a surprise that these people who come into hospital that then suffer from this vicious cycle can’t and don’t go home, because they are initially medically unwell, but then because of deconditioning in hospital have extensive rehabilitation or care needs. Current pressure on social care means this discharge doesn’t happen quickly, and so these people are occupying beds and creating hospital capacity challenges and ambulance handover delays.
In short, even if an older person sustains no immediate injuries from a fall, the complications of just a long lie can be extremely serious – highlighting that it is essential to break this cycle as early as possible.
3. COVID lockdowns and shielding have made falls more common
Prior to the Covid-19 pandemic, the 4th most common reason for ambulance callouts was non-injury falls. Because non-injury falls have a lower medical need, these patients can experience a long lie waiting for an ambulance resource just to lift them up from where they have fallen. This not only presents a poor patient experience, but it likely causes further harm to that person.
This graph, shown to us by Louise in the webinar, demonstrates the projected increase in the number of older adults experiencing at least one fall a year due to deconditioning – an increase of over 110,000 falls in addition to pre-pandemic levels.
Lockdowns and shielding regulations during the COVID period have had a substantial detrimental effect on the physical, psychological, and functional capacity amongst the older population. And the effects of this are now being felt by ambulance services, with calls to 999 for falls almost doubling what they were prior to 2020. This means that the need for implementing solutions is only getting more important – which leads us onto insight 4…
4. Right care, right place, right person, right time
Amy’s presentation truly highlighted the difference that a rapid response to a fallen person can make, as the 2 slides below demonstrate. We’d fully recommend you watch that part of the webinar here to see her explain the full process of each response to our faller ‘Tom’ and the dramatic difference in outcomes he would experience.
Preventing long lies and the vicious cycle with early intervention is key. Response Services, Care Homes and Social Care should be putting the right equipment – such as Raizer Lifting Chairs – in place to enable a quick response.
By providing the right care and meeting the needs of the fallen person there and then, organisations can reduce the risk of injury, hospital admission, and further care needs – reducing the pressure on ambulance services, acute trusts and health & social care as a whole.
“The most important thing in regards to preventing long lies, is about the better care for our patients. It’s providing the right care, in the right place, by the right person, at the right time.”
Service Lead at Dorset UCR
What is the Raizer?
The Raizer is a motorised lifting chair that assembles around a fallen person and lifts them up to a seated or perching position. It is easy to assemble and use for the caregiver, and it is safe, smooth and very reassuring for the fallen person.
5. More awareness and promotion about how best to use resources is still required
And lastly, it was clear from the webinar that despite progress with falls programmes and teams set up to improve falls response, there is still a lot of scope for improvement in how resources are utilised. As Amy said, the automatic response is still often to call 999 – so there needs to be a lot more public awareness and promotion about how and when to use 999, 111, GP practises and other services.
And within ICSs, initiatives are needed to give more teams access to 999 and 111 call stacks. Whether that be Urgent Community Response Teams, Frailty Teams, Falls Response Teams, the Fire Service, the Voluntary Sector, Third Sector, or Community First Responders. As Amy said, these organisations need to be brought together to provide a coordinated response to falls.
Watch the full webinar recording here
Watch this Webinar as we take you through what a fall looks like, the stats around falls, and the story of a person who has fallen, showing what happens if there is a quick response, and what happens if there isn’t.
As these 5 key insights show, falls can present a massive problem without the correct response. But by providing the right care, in the right place, by the right person, at the right time, health systems can make a real difference in reducing ambulance callouts, hospital admissions and system-wide pressure.
1: The impact of extended bed rest on the musculoskeletal system in the critical care environment, S Parry and Z Puthucheary: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600281/#CR12
Dr David Shipway BM BCh, Louise Balson, Amy Hassan
Dr David Shipway is a Consultant Physician & Perioperative Geriatrician at North Bristol NHS Trust, with a specialist interest in perioperative medicine, assisting surgical teams to look after patients whose surgery is complicated by their other medical problems, age or overall frailty. Louise Balson is the falls and frailty lead at South Western Ambulance Service (SWAST). She is a trained Paramedic. Amy Hassan is the Head of Dorset UCR and formerly an Occupational Therapist in ED (Emergency Department). Amy has been key in setting up Dorset's 2 hour crisis response team to treat people in their own homes and prevent hospital admissions.