Healthcare Services for Older People Who Have Fallen With Potential Head Injury

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Falls is a common problem that impact older people (\>65 years old). One in three people over the age of 65, and approximately half of those aged 80 and above experience a fall each year. Falls can have devastating consequences and lead to head injury, bone fractures, loss of confidences and death. Up to a third of older people who fall are taking anticoagulant and/or antiplatelet medications (blood thinners) for manage long-term conditions such as atrial fibrillation, ischaemic heart disease, and stroke. Due to concerns of bleeding in the brain after a fall, current national guidelines recommend that older people on anticoagulant or antiplatelet medications should be taken to hospital for assessment to consider whether CT head scan is needed. This is recommended even if patients do not have any signs of head injury, or worrying symptoms such as headache, weakness, or vomiting. Performing a CT head on every older person on blood thinners who has fallen is not cost-effective nor practical. Current evidence suggests that the risk of bleeding in the brain is low (approximately 5%) in older people. Studies have reported that there is no increased risk of bleeding in the brain even if older people are on blood thinners, particularly if they do not have any worrying symptoms. However, many older people are often brought into hospital despite having no symptoms of head injury. This can lead to long waiting times to be seen in the Emergency Department. For some older people, unnecessary hospital admissions can have a negative impact on their ability to walk, cause infections, confusions and pressure sores. The risk of being in hospital may not outweigh the small risk of having a brain bleed, particularly if they do not have any signs of head injury or worrying symptoms. Older people could have a comprehensive falls assessment, review of medications and follow-up outside of the hospital setting. Alternative services to hospital admission for older people have been developed in the recent years to support people in their preferred place, and reduce pressures in the emergency departments. We know from clinical practice that services such as urgent community response teams, acute frailty wards, same day emergency care or hospital at homes often manage older people who have had a fall with possible head injury. Yet, no research studies have specifically reviewed care pathways and outcomes for older people on anticoagulant or antiplatelet medications who have had a fall and head injury with no symptoms outside the hospital. We want to understand how the services in Hampshire and Isle of Wight region are working to support older people on anticoagulant and antiplatelet medications who have had a fall with head injury. We want to know what challenges healthcare workers experience, and what suggestions they have to improve this. This can help us improve service delivery for older people.