Falls and falls related injuries are a growing problem for people with an intellectual disability (ID) and as they too as a population are living longer, is on the increase as highlighted in The Irish Longitudinal study on Ageing – Intellectual Disability Services (TILDA-IDS) Wave II report (2014). This report also highlights the incidence of osteoporosis in ID population with 7/10 having reduced bone density. There was no education resource available to inform people with an intellectual disability, health and social care staff caring for them or their families on raising awareness on these facts.
Through the Forever Autumn Community of Practice and engagement with service providers and service users in St Michaels House and Daughters of Charity Disability Support Services, Happy Bones and Best Foot Forward! have been developed. The education resources comprise of films, easy read leaflets and booklets for use by service providers, service users, their families and friends from
Other progress within FACOP is being made around the following documentation: - falls prevention and management policy, falls screening tool, falls assessment tool.
Raising falls awareness is now high on the agenda across many service providers of ID services.
Sinead Foran is the Course Leader for the BSc in Intellectual Disability Nursing in Waterford Institute of Technology and she is currently undertaking a PhD in relation to Falls in Older Adults with an Intellectual Disability - She has written a paper entitled
Expanding Assessment of Fear of Falling among Older Adults
with an Intellectual Disability: A Pilot Study to Assess the Value of Proxy Responses with two colleagues Mary McCarron, and Philip McCallion - it is available to download here.
Globally falls are one of the most common adverse clinical incidents in the acute hospital setting with a prevalence rate of about 38% (Briggs & Steel 2007). For older adults admission to hospital is often associated with a change in physical and/or cognitive functioning. Combined with an unfamiliar environment this change in functioning can increase the risk of falls (Groarke, 2012). There are many initiatives in place in Irish hospital settings to assess and identify those at risk of falling. Examples of these will be made available on this web site.
An important fact to consider is education to patients and the general public on falls and falls prevention. An example can be seen in the falls booklets available here put together by staff in Mater Misericordiae University Hospital, Dublin and Waterford Regional Hospital.
As older adults move to reside in residential care setting they have been identified as having one or more of the following - increased care needs due to chronic disease process, frailty, poor safety awareness, reduced mobility, dementia. Often they have reached their rehabilitative potential. As such they may also be at increased risk of having a fall. Awareness of this increased risk needs to be highlighted to all staff, the residents and their families in residential care settings to help reduce the risk of potential falls.
In St Mary’s, a large care facility for older adults, predominantly over 80 years of age, it was recognised the patients and residents are at a high risk of falls. In 2012 Forever Autumn – a falls awareness and prevention programme was developed. Forever Autumn is a campus wide initiative with multidisciplinary involvement which included:
A review of the Falls Prevention and Management Policy
Introduction of a new Falls Risk Assessment Tool
Introduction of new Falls Risk Symbols
Introduction of Falls Reduction Measures
Development of an Education Resource for staff on all of the above
Comparison of data collection pre and post programme demonstrates a reduction in falls across the campus and increased falls awareness among all staff. This programme has been shared and implemented in other care settings.
To reduce the risk of falls in residential care setting the Forever Autumn Community of Practice recommends that all residential units should have in place:
A falls prevention and management policy.
A process for screening assessment and interventions for patients at risk
A process for reporting falls and fall related injuries.
A structure for educating staff on falls and fracture prevention all staff have a role in preventing falls
St Mary's Hospital in Phoenix Park, Dublin have devised a falls safety information booklet for clients and carers - a copy of this is available to download from the link under articles of interest in this section.
Many falls in the community go unreported. There are many missed opportunities to prevent subsequent falls and injuries in community dwelling older adults. Measures to address this are currently under development and have been implemented in some areas. This coordinated approach by health care professionals and ancillary staff aims to heighten the awareness of falls working in community settings. FACOP community group will share some of those initiatives over the coming months.
Education sessions to community groups ie active retirement groups, day centres, church groups
These sessions are interactive and provide information to older adults on
Bone health - diet and exercise for good bone health, osteoporosis, DXA scans, treatment of osteoporosis
Falls awareness – falls risk factors, making your environment falls safe – indoors and outdoors, importance of reporting falls
The sessions have proven to be a great success and are ongoing.
Activity Within the Community of Practice
Download St Mary's Falls Booklet