Development of Evidence-Based Practice Change Proposal I

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Independent Nurse: Professional - Fall prevention - Reducing falls among the elderly Author: Sarah Wild Date: June 17, 2005 From: GP Publisher: Haymarket Media Group Document Type: Article Length: 1,539 words

Full Text: A new intergenerational approach is encouraging older people to overcome their fear and talk about falls, writes Sarah Wild.

An elderly person dies every five hours in the UK as a result of falling, and statistics show that a third of people over the age of 65 fall at least once a year.

In addition to the pain and suffering experienced by these patients, it puts a heavy burden on hospitals and emergency services, costing the NHS three times the budget allocated for primary care, mental health and CHD combined.

Positive steps to reduce the number of falls have, however, been taken by proactive organisations such as Northumberland Care Trust, one of 21 sites selected to take part in a one-year programme co-ordinated by the National Falls Collaborative.

Innovative ideas

This has led to the development of some imaginative schemes that are designed to reduce falls in Northumberland by 30 per cent. Other goals set by the trust in 2003 included creating a falls register and increasing the number of elderly people who receive a personal and environmental risk assessment.

In response to these targets, falls registers have been implemented in four GP practices involved in the programme and a risk assessment screening tool tried out in A&E, the community and by individuals.

Falls prevention cards (pocket-sized checklists) have been circulated to home carers across Northumberland, and educational sessions offered to care home staff, for example 'podiatry upskilling' and 'low-vision training'.

In addition to practical initiatives, exercise programmes have been developed, such as a handyman scheme to help older people carry out household tasks such as changing lightbulbs (opposite, below).

To raise awareness of the issue of falls, and the many initiatives introduced to help prevent them, booklets and posters have been used alongside events such as the Autumn Falls Fair, involving 20 stands taken by relevant organisations.

However, the most innovative method of disseminating information has only just been completed. The project, which is already the recipient of a Queen's Nursing Institute (QNI) Innovation and Creative Practice award, demonstrates an intergenerational appr-oach to combating falls. Jane Steven, project manager for the North Northumberland Falls Collaborative, explains how the initiative came about. 'We needed to tackle the problem that many elderly people don't tell anyone when they have fallen because they are embarrassed or afraid of being put into a care home,' she says.

'Others think falling is an inevitable consequence of getting old. We wanted a different way of getting the message across that would spark discussion, and I had the idea of getting older people to tell their falls stories, with younger people acting them out on video.'

Expanding the concept

Ms Steven developed this idea by liaising with Sue Spencer, a Sure Start health visitor in Berwick and chair of the Berwick Borough Safe Steps, which is designed to reduce the number of accidents involving children under the age of five.

The proposed initiative was relevant to Ms Spencer as 39 per cent of children's accidents involve falls, and she considers public health to be an integral part of her health visitor role. Ms Steven also consulted colleagues from Berwick Borough Family Centre, plus Age Concern, who came up with the idea of using puppets to act out the stories, given the barriers to videoing children.

The small rural town of Wooler was chosen for the project due to its large number of elderly inhabitants. Over-65s make up a third of the total population, compared with 17.59 per cent across the whole of Northumberland.

Meanwhile, funding was secured from the QNI, which granted the initiative pounds 6,000, supplemented by around pounds 4,500 from Awards for All. This enabled project leaders Ms Steven and Ms Spencer to push ahead with finding artists to design and produce the puppets, enlist a professional video-maker and bring participants on board. Additional help with the project's organisation was provided by one of the parents involved in Sure Start, who was able to boost her management skills along the way.

Finding older people to take part in the project turned out to be less straightforward than expected, as individuals approached were unsure what the scheme would involve - working with children to address a public health issue was a new concept for most of them. Sessions were designed to be fun and to encourage intergenerational interaction, and this involved a range of creative activities such as screenprinting. The participants were required to attend a two-and-a-half hour session per week, for six weeks, with the older people arriving an hour before the children.

'It was quite difficult finding older people to participate, even though Age Concern and the district nurse helped us to recruit them, as many have busy lives,' says Ms Spencer, who admits that targeting an existing social group might have been easier than approaching individuals to take part. 'We eventually found six participants, though this fell to a mainstay of five. The eight kids involved in the initiative came from an after-school group in Wooler, which meets at the Berwick Borough Family Centre.'

The two artists, Nicola Balfour and Virginia Kennedy, facilitated the sessions together, building up a good relationship with participants.

They were supported in this by Glynnis Reynolds, the representative from Age Concern, and video-maker Harry Henderson.

Breaking the ice

A core group of participants was established by the third week, when the theme of falling was formally introduced. 'To break the ice, we began by looking at historical pictures of Wooler and the older people talked about what it used to be like,' says Ms Steven.

This progressed to the telling of falls stories, one of which, a tale of two elderly ladies who live next door and help each other to avoid falls, was chosen and interpreted by the children, and turned into a puppet show. 'A script was developed, puppets were made and the children performed a live visual show for their parents,' explains Ms Spencer.

A video of the show was later filmed, creating an educational tool featuring clips of some of the intergenerational interaction that took place during the sessions, plus interviews with older people involved in local falls prevention schemes.

The final product

Feedback from focus groups was gained throughout the lengthy editing process, and 50 videos and 50 DVDs were recently completed, to be distributed among the project's participants. Copies will also be shown in schools and made available to carers and other local groups.

'The video acts as a general introduction to the topic of falls, without being overtly educational,' says Ms Steven. 'We've also produced a sheet that will act as a memory jogger to those showing the video, as we want groups to be able to use it themselves, without our involvement.'

The project has achieved its dual purpose, according to Ms Spencer, and has boosted her management and creative skills too. 'As well as raising awareness of falls in elderly people, we raised awareness in children too, of their own falls and those of their grandparents,' she says. 'Jane and I benefited from a range of QNI workshops, covering subjects such as presentation skills, creativity and leadership. We also met colleagues from around the country, which was useful.'

Although the scheme has been time-consuming, running from January 2004 to May this year, Ms Spencer would recommend it to nurse colleagues in other areas and plans to put her new skills to good use. 'I would repeat the exercise, even thought it takes up a lot of time,' she says. 'In future, we hope to use a similar intergenerational approach in another project, developing an interactive CD- ROM that could be used in schools.'

TOP BENEFITS OF THE INTERGENERATIONAL INITIATIVE

- Promoted partnership working between different agencies (Sure Start, Northumberland Falls Collaborative, Age Concern, Berwick Borough Family Centre and the wider community).

- Encouraged interaction between children and older people, plus mutual understanding.

- Raised participating children's awareness of falls, teaching them not only to be careful themselves, but also to be thoughtful towards older people (for example, not leaving toys on the stairs at home). It also encouraged their grandparents to inform someone if they

have a fall.

- Encouraged elderly people to talk openly about falls without embarrassment or fear of repercussions.

- Allowed participants to develop creative skills and project leaders to boost their management and leadership skills.

- Produced an educational tool that will raise awareness of falls across Northumberland.

NORTHUMBERLAND'S KEY FALLS PREVENTION SCHEMES

- Development of falls registers.

- Provision of personal and environmental risk assessments.

- Circulation of falls prevention cards (pocket-sized checklists) to home carers.

- Autumn Falls Fair, involving 20 stands taken by different organisations to raise awareness of the danger of falls.

- Information packs about falls distributed to older people at flu vaccination time.

- Medication reviews.

- Sloppy slippers scheme, whereby elderly people are able to exchange their old, ill-fitting slippers for new ones.

- Handyman scheme, helping elderly people with household tasks.

- Exercise programmes.

- Falls education programme for carers.

- Bottle-in-the-fridge scheme encouraging older people to write down relevant personal details and place them in a bottle in the fridge, so that they can be accessed in an emergency.

- Intergenerational rural falls initiative.

Copyright: COPYRIGHT 2005 Haymarket Media Group http://www.haymarket.com/home.aspx Source Citation (APA 7th Edition) Wild, S. (2005, June 17). Independent Nurse: Professional - Fall prevention - Reducing falls among the elderly. GP, 28.

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