The community falls service is a citywide specialist service working with older people to reduce their risk of falling. We provide specialist assessment, treatment and advice to older people, usually aged 60 years and above, in their own homes or in a community/clinic setting, to reduce the risk of falling and to maintain safety and independence. As we are a specialist service, we see people with complex falls needs, such as unexplained falls, or falls associated with a loss of consciousness or dizziness.

The Leeds Falls Service incorporates the Leeds Community Healthcare NHS Trust (LCH) Community Falls service and Leeds Teaching Hospitals NHS Trust (LTHT) Falls Clinic. The service comprises consultant geriatricians, an advanced clinical practitioner (ACP), pharmacist, specialist physiotherapists and therapy assistant practitioners.

The service supports a comprehensive geriatric assessment (CGA) model, providing specialist comprehensive falls assessments, and medical and therapy assessments and interventions to complex high risk falls patients. Investigations and diagnostic tests are arranged according to individual patient need. The service runs twice monthly MDT meetings to discuss certain patient cases, supporting their management in the community, and providing care closer to home to reduce the need (where appropriate) to attend a clinic appointment.

Assessment and venue options dependent on the patient’s clinical need:

• Patient’s own home: Specialist comprehensive falls assessment, prevention and management by physiotherapist or ACP, including vestibular assessment and rehabilitation as required. Dependent on complexity and need, the ACP will complete an advanced health assessment, providing further specialist assessment (for example, cardiovascular, neurological), to determine the need for investigations to support a diagnosis where the patient presents with unexplained falls, loss of consciousness or dizziness. Structured medication reviews will be provided by the pharmacist as required.
• Patient discussion at virtual falls MDT meeting with consultant geriatrician, ACP, pharmacist, and physiotherapist, following an assessment by the community falls service of the patient in their own home, investigations, diagnostic tests and medication changes are arranged according to individual patient need.
• Clinic (geriatrician-led): Hospital-based clinic for patients who cannot be managed in the community with the above support and require face to face assessment by the geriatrician.
  Criteria:
• Older adults usually aged 60 years and over and registered with a Leeds GP (referrals for patients under 60 years old will be considered on an individual basis if specialist falls management is required).
• Patients identified as being complex falls patients, presenting with unexplained falls, unexplained syncope, unexplained dizziness or unexplained balance issues, where further specialist assessment, investigations and/or diagnostic tests may be required.
• Patients presenting with “difficult to treat” postural hypotension.

Knowledge

• To develop a greater knowledge and understanding of a multifactorial falls risk assessment as part of a CGA.
• To develop an awareness of evidence-based practice in relation to falls risk assessment, prevention and management.
• To develop an understanding of medications that contribute to increasing falls risk.
• To develop an awareness of the different intervention options, community services, and referral pathways available to support management of falls risk factors identified and individual patient need.
• To understand that not all patients who are falling need assessment via admission to hospital but can be managed safely and appropriately in the community.
• To understand the different clinical roles within the Community Falls Service and importance of multidisciplinary team working.

Skills

• To ensure informed consent where possible or to evidence that assessment/treatment is delivered in the patient’s best interest.
• To be able to complete a comprehensive multifactorial falls risk assessment, analysing the information gained to identify falls risk factors relevant to the individual patient.
• To be able to complete an objective assessment of a falls risk patient, incorporating a CGA.
• To clinically reason why a patient may be falling, and consider potential medical management.
• To be able to analyse the information to formulate a treatment plan with shared decision-making.
• To be able to identify the need for further tests/investigations to support identifying any potential medical causes for falls, and recognise when discussion with other healthcare professionals is required.

Communication

• To use appropriate communication techniques to communicate with the patient to gain and synthesise relevant information.
• To be able to communicate appropriately with patients with communication difficulties, such as hearing impairment, English as a second language (ESL), limited English proficiency (LEP), dementia and cognitive impairment.
• To be able to clearly explain to patients, family or carers any advice and recommendations.
• To communicate effectively with other healthcare professionals as required to support continuity of patient care.

You will be invited by LTHT to attend an induction and welcome lecture where you will be given more detailed information about your community placement and what to expect.

We expect you to attend 100% of sessions on the programme as a mark of respect for your colleagues and particularly your patients. Failure to attend, or absence without permission, can have serious consequences and may result in you being excluded from the University.

• MBChB attendance and absence student guidance

If you are unwell and unable to attend any of the clinics allocated in your timetable, please contact the Medical Education Team at lcht.medicaleducation@nhs.net to let them know as soon as possible, and notify your placement office.

The School of Medicine, in collaboration with placement providers and students, has developed a dress code for MBChB and physician associate students while on clinical placement.

• Dress code guidance for clinical placement providers

Course Evaluation
We are open to suggestions for improving this clinal placement, please complete the short placement questionnaire that will be circulated to you via email at the end of your placement at LCH. You can also provide feedback when completing your evaluation forms via the medical school. Please also feel free to let our team know directly how you are finding the placement or to raise any concerns or suggestions with them.