My practice

Our service for older people who have osteoporosis or have had
falls is developing. One recent improvement is the screening of all
patients over the age of 64 who present at A&E for risk of
falls. They are screened by the nurse and then referred to the
occupational therapist to carry out a falls risk assessment that
covers medication, vision, hearing, walking, balance, transfers and
footwear.

Miles Morgan,* aged 76, attended A&E after he fell at home
while transferring from his bed to his commode in the early hours
of the morning. He was found by his care worker who visits every
morning to help him wash and dress. He was taken by ambulance to
hospital where he had his painful hip x-rayed for fractures.
Fortunately, there were no bone injuries and doctors hoped that he
would be able to return home that morning.

He was finding it difficult to stand up due to hip pain and it
was identified that he was at risk of further falls. Miles would be
likely to have difficulties with some of his activities of daily
living for the next couple of weeks until his hip pain resolved
itself.

Social services arranged a temporary increase to his care
package, so that he could have help in the evening. He was also
provided with a toilet frame and bed leaver to enable him to get on
and off the toilet and get in and out of bed independently and with
reduced pain. With this additional equipment and care, he could be
discharged safely back home that morning.

Miles was referred to his GP to arrange an x-ray of his spine to
check for crush fractures – an indicator for osteoporosis. His GP
was also asked to review his medications as he was on a combination
of different types. If people are taking four or more types of
medication a day, their risk of falling is significantly
higher.

Miles was told about the benefits of exercises to improve
strength and balance and to build up confidence. Older people
prefer this to concentrating on hazard reduction, which can be
viewed as limiting activity rather than promoting it. He agreed to
attend a six-week falls prevention programme at the day
hospital.

Miles uses bifocal glasses that meant he was less likely to see
anything close to him that might cause him to trip. His last eye
test was over two years ago and he agreed to have his eyes
re-tested.

Falls prevention works best when a range of interventions from
health and social care professionals are provided. It is important
that those giving advice to older people stress the benefits of
strength, balance and keeping confident, rather than turning them
off, or frightening them, with talk of hazards and risk.

* Not his real name

See also Help the Aged advice leaflet Don’t Mention the F-word!
(www.helptheaged.org.uk)

James Lampert is an occupational therapist at East Kent
Hospitals NHS Trust.