10 Topics

Topic 1 – Falls in older people: the impacts

• outlines how a fall can be a life-changing event for an older person, impacting on their independence and wellbeing, with implications for their family/whānau and significant others
• sets the scene for the 10 Topics and introduces the remaining nine topics
• explains why the national falls programme aimed to prevent falls and reduce harm from falls at individual, health system and population levels by encouraging the implementation of effective interventions

Resource: Topic 1 – Falls in older people: the impacts

Patient story: Topic 1 supplement: Patient story staff perspective

Topic 2 – Which older person is at risk of falling? Ask, assess, act

• explains how to ask about falls to identify older people at risk of falling
• complements Topic 3 (assess) and Topic 4 (act), which together explain the process of asking, assessing and acting to reduce harm from falls
• describes simple screening questions that can identify which older people to target for multifactorial risk factor assessment and interventions tailored to their personal risk factors
  

Resource: Topic 2 – Which older person is at risk of falling? Ask, assess and act

Topic 3 – Falls risk assessment: a multifactoral approach

• explains how to identify a person’s risk factors for falling
• complements Topic 2 (ask) and Topic 4 (act), which together explain the process of asking, assessing and acting to reduce harm from falls
• explains how we should systematically check for falls-related risk factors we can do something about
• discusses exploring with the older person and their family/whānau which interventions and supports will work best for them

Resource: Topic 3 – Falls risk assessment: a multifactorial approach

Resource: Topic 3 supplement: Questions and answers about falls QSMs

Topic 4 – Addressing risk factors in an individualised care plan

• covers the importance of using an individualised care plan for each older person when considering and responding to the risk factors for them falling
• explains how to address risk factors
• complements Topic 2 (ask) and Topic 3 (assess), which together explain the process of asking, assessing and acting to reduce harm from falls 
• explains why we should adopt an interdisciplinary and individualised approach and how we can achieve such an approach

Resource: Topic 4 – Addressing risk factors in an individualised care plan

Topic 5 – Safe environment and safe care are essential to prevent falls

• explains the actions you can take to improve the safety of the environment for older people who risk falling
• examines environmental safety assessment and modification programmes that are successful in reducing falls by older people living in the community who are at risk of falling
• includes required readings on:
  • patients’ perspectives of falling in hospital 
  • recommendations for environmental safety relevant to your setting.

Resource: Topic 5 – Safe environment and safe care are essential to prevent falls

Topic 6 – After a fall: what should happen?

This topic looks at how a fall by an older person requires:

• prompt attention to any injuries
• an investigation of underlying conditions that might have caused the fall
• an assessment and actions focused on reducing the risk of the older person falling again.

Resource: Topic 6 – After a fall: what should happen?

Resource: Topic 6 supplement: St John ABCDE assessment

Link: Topic 6 supplement: Skin tears (Milner article in Nursing Review)

Topic 7 – Why hip fracture prevention and care matter

• explains how to reduce the risk of falls-related fracture by treating osteoporosis and how to predict an older person’s risk of hip fracture 
• shows that improvements in care for patients with a hip fracture can prevent avoidable complications that compromise recovery.

Resource: Topic 7 – Why hip fracture prevention and care matter

Resource: Topic 7 supplement: Strategies to improve hip fracture and care

Topic 8 – Medicines: balancing intended benefits and increased falls risks

• provides an overview of medicines associated with an increased risk of falling or falls-related harm
• looks at how reducing or changing the use of the medicines can reduce falls
• includes required readings on:
  • general considerations in managing medicines in older people 
  • stopping medicines as part of medicines optimisation review and modification. 

Resource: Topic 8 – Medicines: balancing intended benefits and increased falls risk

Resource: Topic 8 supplement: Which medicines increase the risk and consequences of falls?

Resource: Topic 8 supplement: Atlas tutorial 2017

Topic 9 – Improving strength and balance to prevent falls

This topic explains how exercise helps to prevent falls in older people, in particular how:

• certain types of exercise programme are effective in reducing the number of older people who have a fall and the number of falls that older people have 
• exercises designed to improve older people’s balance and increase their strength help reduce the risk that they will fall. 

Resource: Topic 9 – Improving strength and balance to prevent falls

Topic 10 – An integrated approach to falls in older people: what part can you play?

• includes themes of coordinated care, patient experience and quality of care 
• asks you to look at what you can do within your sphere of influence and networks to use the evidence to improve practice and service provision to reduce harm from falls
• includes required readings that:
  • look at the meaning of person-centred care for people with multiple health problems
  • conveys practical wisdom you can use for projects to improve the quality of health care, and are examples taken from real life. 

Resource: Topic 10 – An integrated approach to falls in older people: what part can you play?

Resource: Topic 10 supplement: Whanganui falls prevention and fracture liaison workplan