Our contributing editor for Fall Prevention Month, Dr. Eoghan O’Shea, attended a long-term care conference on behalf of the CMA from Nov. 14 to 16; he heard presentations relating to the intersection between the different facets of long-term care and fall prevention.

 Revera Retirement and Long-Term Care Homes‍

Revera is a Canadian organization with retirement and long-term care homes across the country. They hope to reduce fall-related injuries in their facilities by 50% by the end of 2020. They plan to use effective screening tools and timely and risk-specific interventions and investigations to reduce falls and fall-related injuries; the cornerstone of their approach is collaboration and innovation.

In 2016, Revera launched an internal survey, including all levels of staff, to identify fall risks and associated injuries. Ten per cent of falls were found to happen at night; consequently, a commitment was made to improve lighting, update room designs and educate and train workers, patients and their family members on slip and fall prevention to minimize the risk of injury.

The chief medical officer at Revera, Dr. Rhonda Collins, is passionate about fall prevention. She has met in person with family physician staff members to discuss deprescribing medications (when it is possible to do so) that contribute to an increased falling risk. Patients benefit when this type of systematic risk reduction is implemented along with use of technology to track patients’ records and prompt their continued participation in Revera’s tiered, evidence-based exercise program, which was developed with input from the Canadian Centre for Activity and Aging. [1]

Falls Initiative in Long-Term Care

Falls Initiative in Long-Term Care was a series of short presentations in which long-term care homes shared their new best practices in dealing with falls.

A presenter from Alexander Place outlined a new multidisciplinary approach and three separate types of rounding that rely on the knowledge of front-line staff. This format promotes patient-centred brainstorming and provides a venue for everyone to have their voice heard. [2]

The Toronto Rehab Institute employed “Dementiability” methods, taking a multidisciplinary approach to meet presumed unmet needs including boredom and loneliness. They decided to bring programs to the residents, not the residents to programs. Activities were moved to the dining room and away from the nurse's desk. Residents who fell were also asked why they thought they had fallen. Improvement in residents’ behaviour and falls statistics were noted when residents were given the opportunity to reproduce activities they had carried out at home, such as folding towels and preparing meals, and to interact with babies who were brought to the facility by volunteers. Residents thrived with increased activity. [3]

Long-term care homes are ready and willing to embrace technology changes including smartphones and monitoring devices to reduce the risk of falling. In Dr. O’Shea’s opinion, in the not-too-distant future pharmacists will play a stronger role inappropriate medication prescribing: regulated pharmacy technicians will work at long-term care homes, stocking automated medication dispensers and using bar codes.  He also expects that regulatory bodies and policies will result in system changes and possible removal of certain medications with low benefit but high risk.

[1] Griffin,Krista, and Stelmacovich, Kim. Revera’s falls improvement aim: driving innovation and collaboration. Presentation at the This is LTC Conference, 2018 Nov. 14–16.

[2] Sipos,Jennifer. Falls reduction: a multi-disciplinary approach. Presentation at the This is LTC Conference,2018 Nov. 14–16.

[3] Iaboni, Andrea, Marcil, Meghan, Ooteghem, Karen, et al. Innovations in managing fall risk in people with advanced dementia. Presentation at the This is LTC Conference, 2018 Nov. 14–16.