It is widely recognised that falls represent a significant health issue, particularly amongst older adults. Statistics show that 30% of people aged 65 and older fall at least once a year, and the prevalence increases with age, with 50% of those aged 80 and over experiencing falls associated with poor outcomes.
These figures underline the importance of addressing falls as a public health issue, reflecting the NHS shift towards preventative care with support for self-management to improve health outcomes as an integral part of the NHS Long Term Plan.
Falls prevention – an open referral pathway
Every locality across the country has some form of Falls Prevention Service, but this looks very different dependent upon the area served. On the Wirral peninsula, The Wirral Independence Service falls prevention facility is managed by Medequip as an integral part of the Council’s Community Equipment Services contract.
So how does the service work? For Wirral, it’s all about keeping people active and independent in order to continue to do what they want and need to do in life. The service is focused on preventative action; those participating do not need to have had a fall but must be able to mobilise in the community as a key criteria.
Designed around an open referral pathway, the service can be accessed through direct referrals from a GP or other NHS service as well as self-referrals and word of mouth. The team targets a three-week lead in time so no lengthy waits are experienced.
Medequip’s multi-disciplinary team at Wirral Falls consists of experienced clinicians including nurses, occupational therapists, physiotherapists and technical instructors. Each case begins with a multifactorial falls risk assessment based on NICE guidelines and conducted by falls practitioners.
Individual assessments
The initial assessment looks at why the individual has fallen or is considered to be at risk of a fall, examining the medical history, medical conditions, taking lying and standing blood pressure measurements and looking at the overall home environment. The objective is to analyse each person individually, to assess and give advice and also to signpost to other services, liaising back with the GP as appropriate.
The clinicians at Wirral Falls have a wide remit; if they identify that individuals are struggling at home, they can prescribe low level equipment and adaptations such as grab rails, addressing both home and medical needs.
Introducing movement for strength
If appropriate following the assessment, individuals are then moved onto the strength and balance programme pathway. This begins with a six-week programme of one-to-one visits for home exercises, progressing from seated through to standing, working through and building intensity.
Individuals then go on to attend classes held at various locations across the Wirral for an eight-week chair-based programme, working on dynamic balancing. As appropriate, this programme is followed up by a twelve-week advanced postural stability course, challenging balance and improving strength.
The results
At the end of each stage, a detailed personal assessment looks at balance, strength and confidence to assess progress. Once discharged, a follow-up review is conducted after six weeks to ensure this progress is maintained.
The Wirral Falls team is contracted to receive 1500 referrals each year, and has continuously achieved the target. Statistics demonstrate a ‘no further falls’ figure of 87% of attendees – significantly above the 70% figure targeted by Wirral Council.
Alongside the falls prevention work for individuals, the Medequip team also carries out public outreach to community groups and provides assistance for care homes with full risk assessments, identifying falls risk factors, and falls prevention training for care home staff.
Jenny Kettell, a nurse by background, heads up the service. “We’re all passionate about falls prevention – we know it works and we can see the improvements for the people we reach each and every day,” she explained. Jenny’s clinical team is led by occupational therapist Catherine White, supported by nurse Mark Orme and physiotherapist Zuzana Ame. Technical instructors Natalie Chittick, Andrea Kay, Karen Parkinson and Adrian Hunt-Seviour complete the team, with administrative support from Kate Ellison and Natalie Evans.