GP presentation notes Older Persons Day 2019 ***Note these notes - - PDF document

GP presentation notes Older Persons Day 2019

***Note – these notes are for guidance only*** Slide No Slide Title Accompanying Notes 1 CSP Title None 2 Title Slide I’m (insert name) and I’m a (job title) at (insert employer name). I’m here today, (as part of Older People’s Day) to present some information about falls and activity and the ways in which physiotherapy can have a positive impact

• n preventing and reducing falls – which as we all know can blight and limit

the lives of many older people. As a profession, physios are passionate about preventing falls and I hope this presentation will demonstrate why a referral to a physiotherapy service is so important for this patient group – both from a clinical and cost effectiveness point of view. In addition, I’ll also be using the presentation to highlight key information and resources which can help with assessing risk and encouraging patient self-care. 3 ‘Falls are a common…..’ The population is ageing – people are likely to live another 20 years over the age of 65. 70% of hospital admissions are for older people yet 1 in 4 admissions are avoidable and physio-led falls prevention services are a cost effective way of keeping older people out of hospital. Older people account for 70% of NHS expenditure but prevention, early intervention and rehabilitation can reduce that. Older people are often discharged with care packages that are costly but these can be reduced or discontinued with effective rehabilitation. The case is similar for the approximately 18 million people with long term conditions in England This situation can be changed, however, when an individual’s needs are met. Nobody wants repeated GP visits, unnecessary hospital admissions or to have to resort to a move into a care home. Older people and people with LTC want to enjoy the best quality of life they can, remain independent and get back to independence as soon as possible after illness or injury. Falls are a common but often overlooked cause of injury and account for a large percentage of hospital admissions. The exact number of falls in the UK is not known as many older people fall but it goes unreported if no serious injury is sustained. Therefore we know that the actual number of falls is likely to be much higher than the figures reported. People often feel that a fall (especially if it is a one off) is nothing to be concerned about. They don’t realise the impact a serious fall can have on their lives and ability to function and remain independent. Physio-led falls prevention services improve strength, balance and coordination, reducing the risk of a fall and can help identify other risk factors.

4 Facts about falls Falls are the second leading cause of accidental or unintentional deaths worldwide. Falls can cause injuries such as bruising and cuts, fractures, head injuries, spinal injuries and even death. Falls can also lead to a severe loss of confidence leading to decrease in the ability to mobilise and social isolation. Women and older age groups tend to be at a higher risk of falls. 5 Impact of falls As per slide It doesn’t have to be this way. Physiotherapists can help prevent falls, improve balance and increase self-confidence, strength and stamina among

• lder people. For many this can mean the difference between staying in their
• wn home and moving into a care home.

6 Why people fall There are a number of risk factors associated with falls and often more than

• ne risk factor is present – falls tend to be multi-factorial in nature. Some of

the common risk factors are:  Previous falls: Research has shown that people who have a fall are more likely to have further falls.  Medication: polypharmacy is a major contributor to falls, especially if people are on 4 or more medications. There are a number of groups

• f culprit medications including BP tablets, sleeping tablets, anti-

depressants and pain killers.  People getting up at night: this is normally related to issues with balance in the dark and when people are tired or more disorientated. A simple Romberg test will give an indication of whether someone has issues with balance in this situation.  Postural hypotension: often characterised by people feeling dizzy on standing - this is a major cause of falls  Foot wear and foot care: slippers with trodden down backs, kitten heels, in-growing toenails and other issues with feet can often affect balance and contribute to the risk of falls.  Slips and trips also contribute to falls  Long term conditions: the presence of one or more long term conditions has a major effect on the risk of falls in an older patient.  Home environment: can be a key factor - clutter, trailing wires and loose mats can all cause falls, as can reaching up to cupboards or bending down low.  Alcohol: as people get older their alcohol tolerance decreases meaning their balance is impaired more easily with less alcohol intake.  Lack of strength, balance and mobility: this is a huge factor in causing falls and something that can be easily rectified by undertaking simple exercises regularly.  Vitamin D levels: lack of vitamin D is a common problem in the elderly especially among those who are housebound and again is a major contributor to causing falls.  Vestibular issues: many older people have issues with dizziness which are not always correctly diagnosed and treated. Referral to your local ENT service will determine the right cause of action if not just a sample case of BPPV. 7 ‘After a fall…’ As per slide 8 What happens after a serious fall After someone has had a fall they often lose confidence and become wary or frightened of mobilising. They then stop being so active due to this fear and

consequently lose muscle strength and balance. This leads to them becoming more unsteady which increases the fear and leads to a further decrease in

• activity. This feeds into a downward spiral where the person continues to lose

even more strength, which leads to a greater loss of confidence and a further decrease in activity. The consequences of this include a lack of ability to mobilise, social isolation and further falls with more serious consequences. Physiotherapy can assist by improving people’s confidence to mobilise and ensuring that they stay on their feet and able to undertake the activities they enjoy. Physiotherapy can also have positive effects on a number of long term conditions, such as diabetes, osteoporosis, heart disease and COPD, by encouraging this activity. 9 CSP FPEM In 2014 CSP worked with the NHS Yorkshire and Humber commissioning support unit to produce a falls prevention economic model. The model answers the question, “Is physiotherapy a cost-effective way of preventing falls in a given elderly population?” Answer is a resounding, “Yes” – physiotherapy can probably prevent around 160,000 serious falls and spend of £252 m across the UK each year. For every £1 spent on physiotherapy, around £4 is returned in prevented NHS spending. 10 TUAG The Timed Up and Go is a simple test that can be used to determine if someone is potentially at risk of falls (can show video in slide if preferred) It can be carried out in most environments including the person’s own home

• r in the surgery setting if you have a suitable area.

The person should sit on a standard chair, placing his/her back against the chair and resting his/her arms on the chair’s arms. Regular footwear and customary walking aids should be used. The person should walk to a line that is 3 meters away, turn around at the line, walk back to the chair, and sit down. The test ends when the person’s buttocks touch the seat. The person should be instructed to use a comfortable and safe walking speed. A stopwatch should be used to time the test (in seconds). If it takes the person 14 seconds or longer to complete the test, they are at higher risk of falls and should be referred to the local falls service for a multi- factorial assessment. 11 Gait Speed Gait speed is another simple measure that can be used to determine if someone may be at risk of falls. It again can be carried out in most environments including the surgery setting. (Can show video if preferred). It is carried out in the following way: Measure and mark a standard distance, e.g. 3m. Then measure and mark 1m before the start, and 1m after the end. Put a marker at the start and the finish line. Ask the person to start walking. When the person passes the start line start timing and finish when they cross the finish line. This is so that the person walks the whole of the 3m at their usual pace without speeding up or slowing down at the first and last markers. Again, consider a referral to physiotherapy if a patient needs to be tested or has been tested and requires help to prevent falls. 12 How to get up from a fall If you have been called out to someone who has fallen and is still on the floor and the person who has fallen is uninjured, there is a simple method for assisting them up from the floor if they are able (talk through back chaining technique on slide). If they are injured or unable to get up then the paramedic

service should be called as they will have the correct equipment to assist the person up and will be able to assess their injuries. 13 Falls and Exercise Physiotherapists are expert in assessing and providing advice and guidance with regard to exercises for strength and balance. Taking into account the patient’s individual needs they can provide a tailored programme that will work on the issues affecting the patient and refer on to group exercise classes where appropriate. 14 Evidence for Exercise Various studies have shown that exercise is instrumental in preventing falls. In 2011 Sherrington and colleagues published a study showing that to prevent falls 50 hours of exercises was needed. This was broken down into twice weekly sessions for 6 months and included both strength and balance

• components. Ideally, all patients at risk of falls would be referred onto a

physiotherapist for further assessment and provision of an exercise

• programme. The exercises in the Get Up and Go animation and leaflet

(available on the CSP website) provide a good starting point for patients whilst they are waiting to see a physiotherapist or for those who are beginning to have issues with their balance. A review in 2018 by Public Health England and the Centre for Ageing Better found muscle, bone strengthening and balance activities, which are being neglected by many, are vital for health and future wellbeing. 15 Animation The CSP have also created a short animation to show patients how physical activity can impact on muscle mass in later life. Please share this animation with your patients and circulate it via social media. Additionally, if you have a screen in your surgery waiting room - we can arrange for the animation to be show on it. DISCLAIMER: The activities described here should not cause any harm. They might not, however, be suitable for all people, particularly those at risk of falls and fractures. Consult a chartered physiotherapist or your GP before embarking on any new fitness regime, and if you do experience pain or discomfort as a result of any of the exercises, stop immediately. 16 In conclusion As per slide. Physiotherapists can keep older people mobile and independent, reduce or prevent falls and keep older people independent in their own

• homes. Physio-led falls prevention services are a cost effective way of

keeping older people out of hospital. If a patient is at risk of a fall – send them to a physio. 17 Useful links Here’s some useful links where you’ll find more information on the evidence for physiotherapy and a series of helpful, resources for patients. These are free to download and can also be ordered from the CSP’s Enquiries team. Add in own links if appropriate. 18 OPD slide Thank you. 19 CSP title slide None