Facing the fear of falling

Week three of our Falls Awareness September blogs by 

Rebekah Wilson. Ayrshire and Arran Falls Lead

captureLast week I took part in a session and experienced the ‘aging suit’.  The age simulation suit offers the opportunity to experience the impairments that may be faced by older people.  My vision and hearing were restricted as were the movements of my joints, my grip strength and coordination. Once suited up I was set some usual daily tasks – pouring a glass of water, writing a shopping list and finding and folding some items in the room.  I managed my chores but with a real challenge and what struck me most as I reflected on the session was how properly frightened I had been of falling.



download-5Not surprisingly, many people who have a fall develop a fear of falling again, becoming more cautious, stopping doing things and losing confidence in abilities. However it is also very common for people to worry about falling even if they have not had a fall and it is believed that it is experienced by up to half of older people living in the community. Having fears about falling is often distressing, limiting life in so many ways it can become a serious concern. Constantly worrying about falling can prevent us from having an active and fulfilling life.

Being frightened of falling is such a challenge to those who are feeling the fear and to those who are caring for frightened people. How can we help people who have a fear of falling?

Let’s talk about the fear…
img_20160820_082202714There is a German proverb ‘Fear makes the wolf bigger than he is!’

It would seem that a good place to start is to talk about it! It is so important to have someone listen to your fears and acknowledge them.  Recognising and understanding the existence of fear of falling and the extent it can impact on everyday function is a positive step to addressing the fear.  The trauma of someone who has had a long lie following a fall cannot be overlooked when providing interventions for the recovery of the physical injury from the fall.  Yet in making recommendations and providing interventions to the person and their family and carers, I am increasingly aware and mindful of how my approach can reinforce risk aversion and fear. As Ann Murray, National Falls Programme Manager mentioned ‘overemphasising risks and focusing only on safety may inadvertently stigmatise falls or cause people to restrict their activities’.



The cycle…


It’s a cycle seen all too often. It starts with a fall, then inactivity, then weakness and finally greater risk for falling and injury.  Although appropriate caution is healthy, avoiding too many activities puts you at risk.  The more worried you become of falling the less likely you are to keep active and restrict activities unnecessarily due to reduced confidence.

Since physical capacity declines with age, keeping active is an important way to reduce the impact of this inevitable decline. Fearful individuals often slow their walking, widen their stance, and make other adjustments that badly affect their balance.

Anxiety can make you act in ways that help you feel safer – for example, holding onto things because you think you will fall and for many people this then results in not going out anymore. Avoiding or stopping doing things can make life difficult and most certainly less enjoyable.

What strategies can help?

The good news is that it is possible to break the fear of falling cycle.  People all have different attitudes and levels of tolerance to risk and I believe that AHP’s have a valuable role in working with individuals, caregivers, family and friends to achieve a balance of risk and activity.


Limiting activity won’t prevent falls but taking the opportunity for falls prevention and management will prevent falls.

Multifactoral falls risk screening can identify falls-related risks factors that can be treated, modified or better managed. Following a falls risk screen and then providing individuals with an action plan provides some ‘self-defence’ strategies and gives a measure of control in lowering risk for falling and falling injuries. Reducing fear can contribute to maximising an individual’s capacity and control over life and has the potential to impact positively on preventing further ill health.

There are things we can suggest to support people to reduce their fear of falling.

Staying active

Stay active and make use of local supports available

Set small goals to help restore confidence

Where possible get active out of the house as well as remaining active in your own home.

Continue with favourite hobbies or take up new ones

Get involved with local community clubs or groups



Positive thinking

Think about the times you have not fallen.

Think about your progress.

Tell yourself how well you are doing.

Try to think positively.

Enjoy the present.

Keep your sense of humour!


Look after yourself

Eat healthily, get enough sleep and exercise regularly to help stay healthy and active.

Learn to pace yourself.

Allow time for yourself each day.

Practice relaxation exercises.




Find a solution

by Toni-Michelle Lee, Moray Falls Lead Officer


How-to-Develop-a-Business-Plan-in-Six-Easy-StepsWell it’s been a busy week for me as Falls Officer in Moray (luckily not with actual falls) and for the last while I’ve been gearing up to this moment! Around three months ago I was asked to try and find a solution for picking up the uninjured fallers across Moray and implement a pathway. Without any extra staff resource and a small budget for equipment, this was no easy task.

We all suffer falls occasionally but as we get older we are more likely to have a fall. An 85-year-old is five times more likely to have a fall than a 65-year-old. Many falls, particularly among older people, result in the likes of hip fractures. Following a fall, many people often fear it will happen again and this leads to a loss of confidence which limits their daily activities and therefore threatens their independence. When I was first in post, I preached to all who would listen “Falls is everyone’s responsibility”….with this in mind, I set to work. I thought about the health professionals who were already out there, out in people’s homes, out in the community, out with fallers. Those on the ground who are identifying and picking up uninjured fallers on a daily basis – it’s the sheltered housing wardens, the OT’s, the home carers, the district nurses to name but a few. If these personnel had access to falls equipment, they could assist with picking clients up on a more official basis, couldn’t they? Many do already….

screen-shot-2016-09-12-at-07-35-44My next thought was to the falls equipment itself, I started attending equipment demonstrations and seminars and although there was lots of efficient equipment I thought fit the bill, I didn’t see exactly what I was looking for – that is, until I saw the “Raizer”. If you have haven’t already seen it, I recommend going on line and having a look – simple but completely effective.  It was exactly what I’d been looking for, with full battery charge it does up to 100 lifts, maximum weight is 23.5 stone, quiet and quick – it can be built around the faller but the biggest plus for me is it comes with a remote control, so only one responder is needed. http://www.yorkshirecareequipment.com/moving-handling/fall-lift-assists/raizer-emergency-lifting-chair

I bought seven Raizers in total, with the thought that each of the community hospitals across Moray could house one. Being that Moray is so geographically dispersed, the hospitals are the ideal locations. They have 24 hour, 7 day a week access and there is one in each locality. This way, the ground staffs are able to leave the faller, pick up the equipment and re-attend the faller which would be far quicker than paramedic attendance, not to mention the inefficiency of an emergency service being used for non-injury and surely a positive influence on the negative impact experienced by fallers. Shared responsibility by all means a better service for clients and a lesser impact on staff within the community care teams.

After months of many meetings, composing equipment policies, falls policies, training, speaking to all stakeholders involved and obtaining the buy-in needed from staff – we are ready to go! Raizer training is being held over 4 days for anyone and everyone within the realms of community care and I personally will be dropping off the equipment to every community hospital within Moray this week – exciting times.

PathI am not saying this pathway will be seemless and without flaws, and it does depend upon the buy-in and contribution of all staff but that’s exactly what community care in Moray is all about – providing an efficient, effective and positive service that promotes independent living – after all….”Falls is EVERYONES’S responsibility”.

Taking positive steps to prevent falls

Screen Shot 2016-09-02 at 08.23.19

Taking positive steps to prevent falls

Ann Murray, National Falls Programme Manager   

email ann.murray3@nhs.net    Twitter @annahpfall


Most of us will have experienced a fall at some time in our lives. For many, this will have resulted in little more than embarrassment. Think Madonna at the Brits. However, as we get older, falls are more common and the consequences of falls tend to become much more serious.

UnknownFalls facts

For AHPs not already actively involved in falls prevention and management, there are some falls facts that are worth knowing:

  • Around one third of people aged over 65 fall each year – the cost to health and social care services of managing the consequences is substantial. In Scotland, this amounts to well over £471m annually. Less easy to quantify is the personal cost to the person, their family and friends.
  • A fall is a symptom not a diagnosis; it can often be the first sign of a new or worsening health problem or a decline in a person’s functioning. A fall can also be the first indication that someone is becoming frail – although not everyone who falls is frail.
  • Whether or not an injury is sustained, a fall can be a ‘tipping point’ in a person’s life, triggering a downward spiral of loss of confidence, inactivity, isolation and dependence.

In other words, falls matter.

Falls are not an inevitable part of getting older

Most people over 65 don’t fall. So falls should never be considered ‘normal’.

Risk factors for falls have long since been identified, and can be personal (such as muscle weakness, poor balance, dizziness, visual, cognitive and foot problems) and/or environmental (such as poor lighting, low temperature, clutter and uneven surfaces). Falls will often be the result of an interaction of several risk factors.

How can falls be prevented?

In short, falls prevention is about:

  • identifying then addressing factors that are likely to be contributing to a person’s risk of falls.

For example…
Screen Shot 2016-09-02 at 08.24.42

  • taking steps to minimise potential harm from falls – such as optimising bone health and putting strategies in place to summon help quickly in the event of a fall.
  • minimising risk while enabling a physically active, meaningful and independent life – arbitrarily restricting activity to prevent falls will only serve to weaken muscles and bone, increasing the risk of falls and harm.


UnknownThe good news

In Scotland, there is more going on than ever to prevent falls and the resultant distress and harm. We’ve had a National Falls Programme for a number of years, co-created a vision for falls prevention and management and fracture prevention – the ‘Up and About Pathway’ – and our first Framework for Action was published in 2014. Locally, Falls Leads are driving improvement. There are numerous examples of successful and innovative falls prevention initiatives across Scotland, many of which are AHP-led.


The Up and About Pathway (QIS 2010) Framework for Action, 2014-16 (SG, 2014)

However, there’s more to do – falls continue to be a growing challenge as our population ages.

What can we do as AHPs? 

Talk about falls

Because a fall can signal a decline in a person’s functioning or health, it presents an opportunity to identify and address underlying problems that might not otherwise have come to attention. If a person you’re in contact with reports…

  • a fall
  • an injury due to a fall
  • problems with daily activities or new care needs since a fall

… have a conversation about falls every time, to identify people who could benefit from either self management information and/or multifactorial falls risk screening and interventions. In fact, any contact with an older person potentially provides an opportunity for a conversation about falls prevention.

To support self management, you can sign post people to a range of useful resources, such as NHS inform’s Falls Information Zone, Smartcare’s Falls Assistant online tool and the Chartered Society of Physiotherapy/Saga booklet, Get Up and Go.

Screen Shot 2016-09-05 at 07.59.00

Take action to prevent and manage falls

Multifactorial falls risk screening and interventions involve working with a person, their family or carers to systematically check for and act on falls-related risks factors that can be treated, modified or better managed.  Identified risk factors should be linked to interventions in an individualised and outcomes based plan.

AHPs are involved in delivering interventions to tackle a number of risk factors, including those relating to muscle strength, balance, mobility, environmental hazards, activities of daily living, fear of falling, cognitive impairment, foot pain and deformity, nutrition, hydration and bone health.

If you’re unable to carry out screening and the relevant interventions yourself, find the teams or services in your area that can help with this, and agree how you can work together to provide the information, interventions, support or care that may be required to prevent falls.

Work with partners to prevent and manage falls

Of course, falls prevention and management isn’t the preserve of AHPs; work with health and social care, third, independent, community safety and housing sector partners to support self management, identify people at high risk and take an integrated and co-ordinated approach to prevention and management.

imagesAnd finally, a positive approach…

With reason, people who fall and professionals can view falls as a threat to a person’s identity and independence. Overemphasising risks and focusing only on safety may inadvertently stigmatise falls or cause people to restrict their activities. Asking about falls need not reinforce negative assumptions about old age – setting meaningful goals to preserve or restore a person’s function, independence and quality of life is both positive and enabling.



AHPs and Data: Cost of Collecting vs. Value of Knowing? If You Don’t Count You Don’t Count!

By Euan McComiskie (@EMAHPInfo)

AHP Advisor, NHS National Services Scotland

AHP Informatics Lead, NHS Lothian

As an AHP (Physiotherapist) who has worked in a range of settings; wards, teams, hospitals, and boards, I know that AHPs provide excellent care and services in many areas. We diagnose, rehabilitate, educate, enable, support, manage and lead to expert levels. But there is one thing we’re not so very good at: understanding the power of and using information to inform our practice or more simply, data!

QuotesIn my experience, a fear of the unknown and a lack of skills, knowledge and confidence in the AHP workforce are the main barriers to using powerful data to define and improve AHP services. However, that need not be the case.

There are a small but growing band of AHPs around Scotland who are trying to improve AHP data locally, regionally and nationally to make sure that we can evidence the impact we have on the users of our services and how they are delivered. We are seeing AHPs throughout Scotland improving their understanding and skills in this area through for example, participating in the NES NMAHP eHealth Leadership program, and the NMAHP eHealth Network. The last year has seen an increasing number of AHP eHealth Leads employed in NHS boards and the Scottish Government sponsoring an AHP to provide national leadership within the eHealth policy team. This is all very important in terms of growing the AHP eHealth workforce and the positive start of AHPs as leaders and experts in data-land!

cropped-ahp-logo-3.jpgA working group led by Lesley Holdsworth (SG Clinical eHealth Lead for AHPs) is working to try to embed some nationally agreed standardised eHealth skills and knowledge as part of the curriculum for all AHP courses in Scotland. A part of this work will also involve setting up a “digital playground” where AHP students can get training access to electronic systems so they can learn about digital healthcare alongside their theoretical and practical learning. The group are also using the experiences of others in the UK in developing this approach but Scotland would be the first country in the UK to have a national approach in place. Scotland leading the UK is a good thought!

Once the changes are made to the curriculum we will start to see newly-qualified AHPs coming into the workforce not only as digital natives outside of work but they will be expecting to use their eHealth skills and knowledge in their day to day practice. We need to embrace their ideas, give them time and space to develop, and the support needed to transform their ideas in to service improvements. Growing an eHealth-enabled AHP workforce in this fashion may go some way to changing how AHPs have traditionally thought about data. A recent study by QMU Physiotherapy students gave more support for this work when they looked at the readiness to accept technology in the workplace. They surveyed 487 NHS Lothian AHPS and QMU AHP students and were able to group them all into categories as well as some cross-group comparisons. A brief summary of their results is included below with the high number of sceptics and low number of explorers and pioneers a clear suggestion that more work is needed to get the AHP workforce ready to embrace data and Informatics with open arms.


We have put our toe in the water on two occasions previously with regard to national AHP data. A national census day was held in 2006 to explore a snapshot of one day’s national AHP data. This suggested that more work was needed to provide further definitions on some data items which triggered the National Clinical Datasets Development Programme (NCDDP) in 2009. However, neither of these projects was able to produce regularly reported and nationally completed data for AHP services. . More recently, efforts have been made to develop the AHP Operational Measures project which hopes to do just this.

Phase 1 of this work aimed to explore the feasibility of being able to extract useful information about AHP services. Two territorial boards working with ISD colleagues helped with this and provided their own data in line with a proposed national dataset which were then tested to determine their value to a range of users from clinicians to service managers, AHP Directors and policy makers.  The results so far have been well received widely throughout Scotland and viewed as valuable by the AHP and eHealth teams in the pilot boards. This is a promising strat however it was agreed that further work was needed including a wider consultation of the dataset to ensure that its relevant to all AHPs including those working in social care.

Phase 2 of the Operational Measures project hopes to address these issues and support a wider roll out and is planned to start in late summer with funding decisions imminent. During phase 1 it became evident that there was some work needed within the boards to allow AHP Operational measures data to be submitted. Therefore, to support phase 2,  Margaret Hastings is working with NHS boards on an improvement program which will help boards prepare for national data collection, It is also envisaged that this work will be one of the key data sources as AHP services in Scotland measure their performance as part of the Active and Independent Living Improvement Programme (AILIP) which has replaced the National Delivery Plan (NDP).

GraphIn the coming few years there will be an increasing need for data from AHPs to support improved effectiveness and efficiency and also to support different ways of working as we accelerate the integration agenda. Without the knowledge and skills to understand, collect and use this data we run the risk of not being able to steer our own future. We know there’s still a long way to go but for the first time, we can see the future and a way to take Scottish AHPs to the next level of data richness, evidencing impact and public health intelligence. Remember, if you don’t count, you don’t count!

Onwards and upwards!


Dietitians shaping the future of Scotland’s health

14th September at the Carnegie conference centre, Dunfermline

It is now less than one month to go until Scotland’s first national dietetic conference. Do you have a ticket or are you one of the 40 posters being considered for 3 prizes? Tickets are still available at only £60 per BDA member and provide great value for money.

The event has been well supported by a range of exhibitors and health boards across Scotland. 150 people are expected to attend and they will hear from a selection of high profile speakers, including Jan Beattie (Scottish Government), Helen McFarlane (HIS), Fiona McCullough (Hon Chair BDA), Joyce Thompson (Chair BDA Scotland Board), Carrie Ruxton (Food Standards Scotland), Rob Packham (Perth and Kinross Integration Joint Board) and Debbie Provan (NHA Ayrshire and Arran). Workshops will cover the 3 conference themes of:

  • Innovation,
  • Empowering and engaging patients and public involvement, and
  • Workplace health.

To view the programme click here.

Chair of the planning group for this event, Evelyn Newman says:

“ This event has been a vision of the BDA Scotland Board for several years and I am delighted that so many colleagues, companies  and national agencies have signed up to make it such a success. It will be a great day to showcase the role of dietitians in shaping Scotland’s health, to encourage networking, sharing, and raise the profile of a small but significant profession. I hope that dietitians and interested parties from all Boards will have the opportunity to attend, and will maybe add a couple of additional delegates in the final weeks leading up to it”

For those of you using social media, please look out for Facebook updates from both BDA Branches (https://www.facebook.com/BDAWOSBranch/ and https://www.facebook.com/bdaeastscotlandbranchpage/?fref=ts) and via Twitter (https://twitter.com/BDAEastScotland and https://twitter.com/BDA_Events). Use the #BDASCOT16 to share news of the event with others and help share the outputs of the day by uploading photos and commentary on the 14th.

We look forward to welcoming you to Dunfermline in Septemeber.

A Walking Success

In line with everything Olympics at the moment – AHPScot are republishing this blog from a year ago. You don’t need to be a world class athlete to be able to be exposed to all the benefits any sort of regular exercise can provide you with.


Mandy Trickett Macmillan AHP, NHS Tayside. In response to patient feedback, new walking routes have been designed by patients, volunteers and staff at Macmillan Day Care to encourage physical activ…

Source: A Walking Success