HNEAHSMarch 2008

Lorraine Lovitt

NSW Falls Prevention Program

Fall injury in older people

• Falls are the most common cause of serious injury in older people, and the home is the most common place where falls occur

• Estimates that 1 in 3 people > 65 years in community will fall each year: 30% will require medical attention and 10% will have multiple falls

• Falls are the leading cause of injury in hospitals and hospital incidences related to falls. A serious fall frequently becomes the precipitating event into residential care

Fall injury in older people

In NSW in 2004-05: • 28, 178 people aged 65 years and over had a

fall that resulted in hospitalisations

• 8,888 males: 19,287 females, a rate of 2,962 per 100,000 (Population Health Division, 2007)

• cost of fall related injury is expected to rise dramaticallyover the next 50 years unless effective prevention and lower treatment costs occur

• In NSW with no effective measures in place an • additional 800 new hospital beds allocated to fall injury

treatment will be required • 1,200 nursing home places’*

*(Moller 2003), WHO, Global Report on Falls Prevention in Older Age August 2007

Fall injury in older peopleProjections

Projected bed day demand in New South Wales based on current risk and treatment patterns

National Falls PreventionFor Older People Plan:

2004 onwards

Department of Health and Ageing

To support a nationally consistent approach to effectively preventing falls

•National planning to review and progress policy

National Falls PreventionFor Older People Plan: 2004 onwards

Implementation Strategy short term strategy• Progressing the supplementation of residents of aged care

facilities with vitamin D and calcium, as well as those aged 65 years and over with an identified vitamin D deficiency (WA, SA & AUSTRALIAN GOVT)

• Promote implementation of the Australian Council for Safety and Quality in Health Care Falls Prevention Best Practice Guidelines within residential aged care facilities (including through relevant accreditation standards) (NSW CEC & WA)

Australian Council for Safety and Quality in Health Care

Best practice guidelines for Australian hospitals andresidential aged care

facilitiesSept 2005

Australian Commission S&Q www.safetyandquality.org

•Format revised for download 07•Process for updating evidence 08

National Falls PreventionFor Older People Plan: 2004 onwards

• Progressing the Development of a National Resource to inform Consistent Practice in Community Settings

(Qld, NSW, Victoria, NT ACT)

• Adoption of the Qld Community best-practice guidelines

• Develop a dissemination and implementation strategy

Flow for Falls Prevention

Health Promotion

Lead

Primary Prevention

O H & SEnvironmental

Hazard Management

Partnerships Strategies

Older people engage in physical

activity that includes

strength and balance

Community Awareness• Information • Education• ‘Good news’ media

Range of Potential Partners

Providers of Physical Activity•Tai Chi•Fitness Leaders•Fitness Gyms• CHEGS•Active> 50•Heart Moves

•CALD Communities eg Italian, Sikh, German, Sudanese, Arabic, Chinese

• Community Service providers e.g. flexi HACC• Community Participation Forum – Peer Education• Local Gov A’s

•community workers• council walking /exercise groups•senior Expos

•Disability services e.g. Vision Australia, Northcott• Disadvantaged communities• Aboriginal Medical Services

Public Services

Local Government

Multifactorial FallsRisk Assessment and Management and/or Referral

•Falls and medical history•Medications•Strength, balance, mobility•Vision•Urinary incontinence•Nutrition•

Strength&

Balance Training

Group &/ or

in-home

monitoring

•Allied Health: Public/Private•Occ Therapist•Phys Therapist•Podiatry

•Community Nursing•Private Nursing Services•Day Therapy•Allied Health •ACAT•Transition Care•Pharmacist•GP’s — Divisions/Practice Nurses•Rehab Services (physio)•Exercise Physiologists

•Fitness service

•HACC•DVA•MPs•RACF•CACP & EACH•CRC•Carelink

Secondary PreventionMed- High Risk

Potential Partners

time limited

ED ASET

ED staff

•Screen•Register

Falls prevention assessment and plan of careInformation on physical activity& falls prevention

•Allied Health •Occ Therapist•Phys Therapist

•Community Nursing

•Private Nursing

•Day Therapy

•Allied Health

•ACAT

•Transition Care

•HACC

•DVA

•MPs

•RACF

•CACP & EACH

•CRC

•Carelink

•GP & GP Practice Nurses

Health Aged Care Services

ADMIT

NOT ADMIT

Range of other Community services

•Information on physical activity& falls prevention•Referral for assessment and follow-up

Referral Network

DischargeDischarge planners, (SW, OT, Dietitian, ) ComPacks, Ward Staff

Discharge

Management PolicyTo

Reduce Fall Injury in Older People

To reduce fall injury among older people in

NSW

•Review of evidence•Consultations 2008

NSW StateNSW State--widewide

Expert Advisory Groups

Manager, Injury Prevention Policy Branch

NSW Department of Health

NCAHSFalls Co &AFMC*

NSCCAHS Falls Co & AFMC*

HNEAH Falls Co & AFMC*

SESIAHS Falls Co & AFMC*

SSWAHSFalls Co & AFMC*

SWAHS Falls Co & AFMC*

GSAHS Falls Co &AF MC*

GWAHS Falls Co & AFMC*

Falls InjuryPrevention Network

Prince Of WalesMedical Research

Institute(Project Officer)

Injury Risk Management Research

Centre (IRMRC)University of NSW

(Monitoring and Evaluation)

Department of Health•Health System Performance –Quality & Safety•Inter-Government& Funding Strategies – Aged Care Integration •Asset & Contract Services

NSW Leader Falls Program

Clinical Excellence Commission

Acute Care

Implementation of “BIG GREEN BOX”• Development of supporting materials:

– best-practice tips and a trigger DVD • Rural Telehealth initiative (May- June 07) – DVD/CD

• IIMS reporting and monitoring

• Performance monitoring - CEs Performance agreement• Hospital falls: deaths and injury (Sac 1 and 2) • Population Health: fall-related admissions to hospital

Lorraine Lovitt

lorraine.lovitt@cec.health.nsw.gov.au

NSW Falls Prevention Injury Network

(Prince of Wales Medical Research Institute)

www.powmri.edu.au/fallsnetwork