For older people or those with limited mobility a fall can have a major impact on their lives. A clinic at Gisborne Hospital is working with people who are at risk of falling. The aim is to understand what might cause the falls and what can be done to avoid them.
Fifty years of lifting and moving people in her role as a nurse in Hawkes Bay hasn’t done Phenella Cust’s hips and knees any favours but nothing compares to the effects of a major fall in March.
“I guess I had some tissue damage. I would be walking along and then suddenly without warning my knee would just give way, says Phenella. I have had nine falls in the last 12 months. I live on my own and the falls were becoming quite frightening. Then I had a major fall and ended up in Gisborne hospital for five weeks. “
“It has really had an impact on my lifestyle. I feel so frustrated because I just can’t do all the things that I want to do. That was not the case before the fall. I used to be a wardrobe mistress for Centre Stage Theatre Group. I have only been back in Gisborne less than a year and I wanted to get involved in theatre costuming again. But after the fall I need to use a crutch to walk and I am knackered by the end of the day. “
“I attended the clinic with the hope that something can be done to help me get rid of this crutch and maybe build up my hip muscles. “
Each month the clinic brings together five clinicians who will meet with people who have complex medical needs and are at risk of falling, says Physician Dr Inte Malik. “During the clinic people will have an ECG to check for fast, slow or irregular heart rates. They will then have a blood test to check for any underlying disease or abnormalities.”
Then the 'speed dating' begins. First they meet with Falls Prevention Clinical Nurse Specialist Laura Pepere. Community based Laura assesses each person in their own home before they attend the clinic. Next they meet with a pharmacist to look at the medications people are on, what affect they may be having and if any medications could be stopped to prevent falls.
A meeting with members of the physiotherapy team is vital to look at a person’s gait and balance and to see what can be done to make people more stable. The occupational therapist will discuss a person’s lifestyle to understand if there are any risks that can be managed or any equipment that could be used to make a home falls free.
Lastly people will meet with Physician Dr Malik.
“At each meeting the clinician completes an assessment of the person’s risk of falling,” says Dr Malik. “After the clinic all the clinicians meet to compare notes and make holistic recommendations for each person. We believe this approach will make real difference to the number of injuries we see from falls. A bad fall can really change the course of a person’s life and take a long time to recover from. There is also the financial cost. Each broken hip costs the health system around $47,000.”
A fall has certainly had an effect on Raymond Biddle’s ability to do much around the home. Raymond uses a wheelchair at home and a walker when he is out and about. While negotiating the doorway at home he left the wings of his wheelchair down and ended up tipping backwards and falling on to the concrete.
Painful broken ribs and four weeks in hospital were just some of the consequences of that incident.
“I always put the wings down now,” says Mr Biddle. “I have had another fall out of my chair since then. At least this time it was onto grass. The clinic was good to find out how I am progressing. The best result would be that I don’t fall again.”
There is a limit to how many people we can see in the clinic each month, says Dr Malik. “Referrals from all Tairawhiti GPs are managed through Laura Pepere who is based at Three Rivers Medical.
Mr Raymond Biddle is flanked by Occupational Therapist Jordana Sweeney left and Dr Inte Malik (right). Behind them are Mrs Phenella Cust and the other staff involved in the clinic.