Offering elderly a cwtch after a fall ‘cuts hospital admissions’

HEALTH professionals in Wales are giving elderly people a “cwtch” after a fall in a bid to keep them out of hospital.

But while those who have taken a tumble may benefit from a cwtch, in this case it is also a mnemonic setting out how to handle the situation.

Traditional best practice states that when older people have fallen, they should not be moved and they should not be given any food or drink until an ambulance arrives.

But this approach is being turned on its head, with mounting evidence suggesting leaving someone where they have fallen can cause serious physical problems, according to the Swansea Bay University Health Board.

This in itself can lead to them needing hospital treatment as a result of pneumonia or dehydration when the fall itself might not have done.

The problems caused by current practice are exacerbated by long ambulance wait times, it said.

The cwtch system offers a fivepoint plan for dealing with a fall: Can you move them?

Will it harm them – for example by causing any new neck or back pain?

Treat – dress wounds or offer pain relief;

Cup of tea – most elderly people eat or drink after a fall; and

Help – know when to call an ambulance or doctor.

The system was developed by Debra Clee, an emergency nurse practitioner in Older People’s Assessment Services (OPAS) at Morriston Hospital in Swansea.

Ms Clee said: “We are trying to change the narrative out there and say that if they can be moved then we need to move them.

“We are finding that they are being admitted, not because of the fall but because of the long lie, as we call it.”

Ms Clee continued: “When you hear stories about someone never recovering from a fall, often it’s not the injury itself but being left on a hard surface for a very long time. This can cause acute kidney problems, it can give them pneumonia, it can cause muscle tissue to break down.

“If they are not being given anything to eat or drink they can become dehydrated. By the time they come to us they are not fit for surgery, if it’s needed, and are quite unwell.”

The Cwtch system has been introduced in nursing homes in Swansea and will be rolled out to those in Neath Port Talbot. Ms Clee said there were circumstances where a patient should not be moved, but even on those occasions the patient can usually be offered painkillers and something to eat or drink.

“In many cases they can be helped up, maybe given a cup of tea and put into bed with some paracetamol,” she said. “Within a few hours or by the next morning they could be up and about again. If necessary, a GP can be called to see them or they can be taken to the minor injury unit.”