Da Birte Poula Rolner fik rollator for ikke at gå og falde, skulle hun lige lære den at kende - og ergoterapeut Lotte Kirkegaard Blomberg gav en hånd med træningen. Da Birte Poula Rolner fik rollator for ikke at gå og falde, skulle hun lige lære den at kende - og ergoterapeut Lotte Kirkegaard Blomberg gav en hånd med træningen.
4. sep 2017 KL 11:01

Fald er da noget, man forebygger

Når ældre falder, kan det få alvorlige konsekvenser. Men mange fald kan forebygges – og ergoterapeuter er rigtig gode til det, så det gælder bare om at komme i gang, mener ergoterapeut Sidsel Seir Jørgensen fra Aarhus Kommune, der har lavet en instruks om faldforebyggelse. På plejehjemmet Kløvervangen har ergoterapeut Lotte Kirkegaard Blomberg været med til at reducere antallet af fald med 45 pct.
Skribent: 
Trine Vu
Foto: 
Helene Bagger

Når en af de ældre på plejehjemmet Kløvervangen i Skødstrup nord for Aarhus falder, mødes et tværfagligt faldteam for at kortlægge omstændighederne omkring faldet. Teamet mødes første gang, en beboer falder, og efterfølgende en gang om måneden, hvis beboeren bliver ved at falde. Falder en ældre herre f.eks. i løbet af natten på vej til toilettet, så trommes teamet sammen og gennemgår systematisk omstændighederne omkring faldet. Og det virker. Siden årsskiftet har Kløvervangen arbejdet efter Aarhus Kommunes instruks og reduceret antallet af fald med 45%.

Ergoterapeut Lotte Kirkegaard Blomberg, som p.t. fungerer som mentor på alle faldmøder på plejehjemmet, fortæller:

- Den systematiske tilgang betyder, at vi kan se, hvis der er et mønster i, hvornår en beboer falder. Det kan f.eks. være noget med beboerens døgnrytme og vores arbejdsrutiner, der bliver tydeligt. Hvis en beboer f.eks. har haft flere fald sidst på eftermiddagen eller om natten, kan det være, at aftenvagten skal gå ind til beboeren lidt oftere i det tidsrum.

Det tværfaglige faldteam består af beboerens kontaktperson, en ergoterapeut, en fysioterapeut og en sygeplejerske, og ifølge Lotte Kirkegaard Blomberg er netop tværfagligheden vigtig.

Fakta om fald på plejehjemmet Kløvervangen

Plejehjemmet Kløvervangen begyndte at arbejde tværfagligt og systematisk med fald den 1. januar 2017, hvor de tog Aarhus Kommunes nye instruks for fald i brug. Udover at bruge instruksen fra Aarhus Kommune, har man på Kløvervangen også besluttet at screene alle nye beboeres risiko for fald, idet de flytter ind på plejehjemmet. Det sker med henblik på at forebygge det første fald.

En sammenligning af antal fald i perioden januar-maj 2016 og antal fald i samme periode i 2017 viser det nævnte fald på 45,2 %.

Den tværfaglige faldforebyggelse er dog måske ikke eneste årsag til, at antallet af fald på plejehjemmet er næsten halveret, siden Lotte Kirkegaard Blomberg og hendes kollegaer begyndte på den systematiske forebyggelse. I samme periode begyndte ergoterapeuterne på Kløvervangen nemlig, at ADL-vurdere beboerne hyppigere end ellers, ligesom andre tiltag kan have haft en positiv indflydelse på udviklingen.

- Det tværfaglige team giver det optimale resultat, fordi vi ser på situationen med forskellige øjne. Som ergoterapeuter bidrager vi især med at se på de kognitive funktioner og beboerens døgnrytme og adfærd. Vi er især gode til at se på helheden. Hvorfor er beboeren faldet? Har han skiftet medicin for nylig? Har der været ændringer i hans træning? Har længere tids sygdom afkræftet ham? Hvis faldet er sket om natten, kan det være, fordi der ikke er lys nok på toilettet, men det kan også skyldes noget så enkelt som det, at en beboer ikke får pudset sine briller og derfor ikke rigtig kan se. Når vi sidder sammen og gennemgår omstændighederne systematisk, kommer der nogle ting frem, man ellers ikke ville have tænkt på, forklarer Lotte Kirkegaard Blomberg.

Og indsatsen virker. Siden årsskiftet har Kløvervangen reduceret antallet af fald med 45%.

- Jeg er overrasket over, hvor mange fald vi faktisk har undgået på den her måde, siger hun og tilføjer, at det dog ikke er alle fald, man kan undgå.

- Især når det gælder borgere med demens, er det ikke alle fald, vi kan forebygge, men så ser vi på, om vi med hjælpemidler kan begrænse skaderne af et fald. Det kan være en fordel at bruge hoftebeskyttere, eller hvis der er tale om en beboer, der falder ud af sengen, kan vi lægge en madras ved siden af sengen, så vedkommende ikke slår sig. Vi kan også vælge at sætte en sensor op, så personalet hurtigt kan komme til hjælp, hvis beboeren står op for at gå på toilettet, siger Lotte Kirkegaard Blomberg og tilføjer, at ikke mindst når det gælder hjælpemidler, kan ergoterapeuter noget særligt.

Vi ser på hele mennesket

- Fordi vi ser på hele mennesket, kan vi nogle gange se, at den mest oplagte løsning måske alligevel ikke er den rigtige. Det kan være en dame med demens, der umiddelbart ville have gavn af hoftebeskyttere til at afbøde fald. Men hvis brugen af hoftebeskytterne betyder, at hun ikke længere selv kan gå på toilettet, fordi hun ikke selv kan tage hoftebeskytterne af, så er det måske alligevel ikke den rigtige løsning for hende, forklarer Lotte Kirkegaard Blomberg.

I Aarhus Kommune sidder ergoterapeut Sidsel Seir Jørgensen og nikker.

Hun har været med til at udarbejde og implementere kommunens instruks for forebyggelse af fald, som netop ved hjælp af systematisk registrering og gennemgang af omstændighederne omkring hvert enkelt fald, skal spare de ældre for unødige risici og kommunen for nogle af de omkostninger, der følger de alvorlige fald.

Fald er nemlig både farlige og dyre.

Især hoftebrud koster både kroner og liv, og tal fra Sundhedsstyrelsen viser, at 95% af alle hoftebrud skyldes fald. De fleste af dem, der får et hoftebrud er ældre, og halvdelen af dem, der ved fald pådrager sig en hoftefraktur, kommer aldrig til at gå så godt som før, og 20% dør inden for seks måneder efter faldet.

Der er altså god grund til at forebygge fald, og ifølge Sidsel Seir Jørgensen burde ergoterapeuter melde sig på banen:

- Ergoterapeuter har utrolig meget at byde ind med i forebyggelse af fald. Det er bare som om, mange ikke rigtigt har forstået det endnu. Vi ser, at der generelt er fokus på medicin og fysioterapi, men der er mange andre ting, der kan forebygge fald, siger Sidsel Seir Jørgensen og forklarer, at det blandt andet handler om, at ergoterapeuter har et godt blik for helheden og for brugen af mere eller mindre traditionelle hjælpemidler.

Metronom som hjælpemiddel

Et af de eksempler, Sidsel Seir Jørgensen fremhæver, handler om en kvinde med Parkinsons Sygdom.

- Kvinden blev ved med at falde, uden at man kunne sætte en finger på hvorfor. Men endelig fandt man i det tværfaglige faldteam ud af, at det var fordi, hun havde problemer med at finde rytmen, når hun skulle op at gå, og løsningen blev, at kvinden fik en metronom, som kunne slå rytmen for hende, når hun skulle til at gå. Hun kunne let selv tænde metronomen og blev på den måde både selvhjulpen og fri for at falde, fortæller Sidsel Seir Jørgensen og nævner desuden arbejdet med sanseintegration som et vigtigt, ergoterapeutisk redskab til forebyggelse af fald.

Fakta om fald

Tidligere fald er en stærk indikator for fremtidige fald, idet ældre mennesker, der er faldet én gang, vil have en 2-3 gange øget risiko for at falde igen inden for det næstkommende år.

Ethvert fald indebærer en risiko for at komme til skade. 40-60 % af faldene fører til skader, hvoraf 30-50 % er mindre skader, ca. 6 % er brud og ca. 1 % er hoftebrud.

For mennesker over 60 år stiger risikoen for fald med alderen. Hver tredje over 65 år falder mindst én gang om året. Kvinder falder hyppigere end mænd.

For mennesker over 65 år, er skader den femte hyppigste årsag til død, og det der hyppigst forvolder skaderne er fald.

Sundhedsstyrelsen definerer fald som en utilsigtet hændelse, der resulterer i, at en person kommer til at ligge på jorden/gulvet/et andet lavere niveau.

Kilde: Sundhedsstyrelsen

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