[PDF] - Prevention of Falls Network Prevention of Falls Network Europe PDF Document

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Figure 9. Mortality rate (age stan

dardised - per 100,000) due to falls in the elderly (65+) in the EU25 and EEA, in countries having less than 10% "Other and unspecified" (Table 1)

164.5 112.2 94.9 89.1 73 66.4 65.3 61.7 57.8 50.3 38.9 35.1 33.1 24.8 14.4 20 40 60 80 100 120 140 160 180 Hungary Czech Republic Finland Slov enia Italy Poland Latv ia Ireland Belgium Austria Iceland Lithuania Slov akia Estonia Gr eece

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death resulting from injury resulting from injury

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1 in 3 >65’s

1 in 3 >65’s and 1 in 2 >80’s fall p.a. and 1 in 2 >80’s fall p.a.

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UK Ambulance Service Ambulance Service are for people are for people aged 65+ who have ‘fallen’ but aged 65+ who have ‘fallen’ but nearly nearly half half are not taken to Hospital. are not taken to Hospital.

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Falls more common in people with

Falls more common in people with multiple medical multiple medical conditions conditions and with and with poor function and mobility poor function and mobility

There are

There are global variations global variations in fall rates ( in fall rates (eg eg China 6 China 6-20%, 20%, Japan 20%), and few figures are available for developing Japan 20%), and few figures are available for developing world world

Appear to be

Appear to be racial differences racial differences in likelihood of a fall (white in likelihood of a fall (white Caucasians particularly at risk) Caucasians particularly at risk)

Women

Women are more likely to fall than men, and to suffer are more likely to fall than men, and to suffer non non-fatal injuries (higher risk of osteoporosis) fatal injuries (higher risk of osteoporosis)

Social deprivation

Social deprivation linked to linked to nocturia nocturia and falls at night and falls at night

(WHO 2007, Booth 2009) (WHO 2007, Booth 2009)

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Objecti ve 1: Improve outcomes and improve efficiency of care after hip fractures – by following the 6 “Blue Book” standards Hip fracture patients Objecti ve 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care

Non-hip fragility fracture patients

Objecti ve 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention

Individuals at high risk

f 1st fragility fracture
r other injurious falls

Objecti ve 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards

Older people

DH 2009: falls & fracture care & DH 2009: falls & fracture care & prevention: four key objectives prevention: four key objectives

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65+ years, 1 year, n= 530,

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OT home visit < 3 wks

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list of recommendations and

telephone call 2 wks later

Subjects with fall(s): 36%

vs 45% [p=0.05]

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Luukinen, 2007 Campbe l l, 2005 Schoe nfelder, 2000 Sihvonen , 2004 Lord, 2003 Buchn er, 1997 Author, Nowalk, Tai C hi, 2001 Mulrow , 1994 Day, 200 2 Reinsch, 1992 Skelton, 2005 W o l f, Balance, 1996 W o

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W o l f, Tai Chi, 1996 year McMurdo , 1997 Korpelainen, 2 006 Morg an, 2004 Campbe l l, 1999 Hauer, 2001 Vouke l atos, 2 007 Fabe r, Functi o nal walking, 2006 Li , 2 005 Lord, 1995 Schne l le, 200 3 Stei nb erg, 2000 Fabe r, Tai Chi, 2006 Li u-Ambrose , Resistance , 2004 Li n, 2007 Bunout, 2005 Li u-Ambrose , Agility, 2004 Resnick, 2002 Latham, 2003 Madurei ra, 2007 Carter, 2002 G reen, 2002 Toulotte, 2003 W o l f, 2003 Cerny, 1998 Sakamoto, 2006 Rubenstein, 2000 Means, 2005 Protas, 200 6 Suzuki, 2004 Campbe l l, 1997 Nowalk, Re sist./Endurance, 2001 Robertson, 2001 0.83 (0.75, 0.91) 1.29 (0.90, 1.83) 0.60 (0.36, 0.99) 0.49 (0.24, 0.99) 0.93 (0.80, 1.09) 1.15 (0.82, 1.61) 3.06 (1.61, 5.82) 0.38 (0.17, 0.87) 0.78 (0.62, 0.99) 0.61 (0.40, 0.94) Effect 0.77 (0.46, 1.28) 1.26 (0.90, 1.76) 0.82 (0.70, 0.97) 1.24 (0.77, 1.98) 0.69 (0.50, 0.96) 0.98 (0.71, 1.34) 0.78 (0.41, 1.48) 0.51 (0.36, 0.72) size (95% CI) 0.53 (0.28, 0.98) 0.79 (0.59, 1.05) 1.05 (0.66, 1.68) 0.87 (0.36, 2.10) 0.75 (0.46, 1.25) 0.67 (0.46, 0.97) 1.32 (1.03, 1.69) 0.45 (0.33, 0.62) 0.85 (0.57, 1.27) 0.62 (0.38, 1.00) 0.90 (0.79, 1.03) 0.96 (0.76, 1.22) 1.80 (0.67, 4.85) 0.67 (0.32, 1.41) 1.22 (0.70, 2.14) 1.03 (0.36, 2.98) 0.71 (0.04, 11.58) 1.08 (0.87, 1.35) 0.48 (0.25, 0.93) 0.88 (0.32, 2.41) 1.34 (0.87, 2.07) 0.08 (0.00, 1.37) 0.75 (0.52, 1.08) 0.87 (0.17, 4.29) 0.82 (0.64, 1.04) 0.90 (0.42, 1.91) 0.41 (0.21, 0.77) 0.62 (0.26, 1.48) 0.35 (0.14, 0.90) 0.68 (0.52, 0.89) 0.96 (0.63, 1.46) 0.54 (0.32, 0.91) 100.00 2.64 1.88 1.22 3.85 2.74 1.40 0.98 3.38 2.21 % 1.88 2.75 3.80 2.04 2.81 2.86 1.41 2.67 Weight 1.48 3.05 2.04 0.88 1.89 2.56 3.31 2.87 2.38 1.98 3.97 3.34 0.72 1.13 1.67 0.65 0.11 3.46 1.34 0.70 2.21 0.10 2.58 0.31 3.34 1.11 1.40 0.88 0.80 3.13 2.27 1.84 0.83 (0.75, 0.91) 1.29 (0.90, 1.83) 0.60 (0.36, 0.99) 0.49 (0.24, 0.99) 0.93 (0.80, 1.09) 1.15 (0.82, 1.61) 3.06 (1.61, 5.82) 0.38 (0.17, 0.87) 0.78 (0.62, 0.99) 0.61 (0.40, 0.94) Effect 0.77 (0.46, 1.28) 1.26 (0.90, 1.76) 0.82 (0.70, 0.97) 1.24 (0.77, 1.98) 0.69 (0.50, 0.96) 0.98 (0.71, 1.34) 0.78 (0.41, 1.48) 0.51 (0.36, 0.72) size (95% CI) 0.53 (0.28, 0.98) 0.79 (0.59, 1.05) 1.05 (0.66, 1.68) 0.87 (0.36, 2.10) 0.75 (0.46, 1.25) 0.67 (0.46, 0.97) 1.32 (1.03, 1.69) 0.45 (0.33, 0.62) 0.85 (0.57, 1.27) 0.62 (0.38, 1.00) 0.90 (0.79, 1.03) 0.96 (0.76, 1.22) 1.80 (0.67, 4.85) 0.67 (0.32, 1.41) 1.22 (0.70, 2.14) 1.03 (0.36, 2.98) 0.71 (0.04, 11.58) 1.08 (0.87, 1.35) 0.48 (0.25, 0.93) 0.88 (0.32, 2.41) 1.34 (0.87, 2.07) 0.08 (0.00, 1.37) 0.75 (0.52, 1.08) 0.87 (0.17, 4.29) 0.82 (0.64, 1.04) 0.90 (0.42, 1.91) 0.41 (0.21, 0.77) 0.62 (0.26, 1.48) 0.35 (0.14, 0.90) 0.68 (0.52, 0.89) 0.96 (0.63, 1.46) 0.54 (0.32, 0.91) 100.00 2.64 1.88 1.22 3.85 2.74 1.40 0.98 3.38 2.21 % 1.88 2.75 3.80 2.04 2.81 2.86 1.41 2.67 Weight 1.48 3.05 2.04 0.88 1.89 2.56 3.31 2.87 2.38 1.98 3.97 3.34 0.72 1.13 1.67 0.65 0.11 3.46 1.34 0.70 2.21 0.10 2.58 0.31 3.34 1.11 1.40 0.88 0.80 3.13 2.27 1.84 Favours exercise Favours control 1 .25 .5 1 2 4

RR = 0.83

95%CI 0.75-0.91 P<0.001

17% reduction in falls

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I² = 62% moderate heterogeneity

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OTAGO

OTAGO

Individually tailored programme: Campbell, BMJ 1997

80+ years, n=233, home-based, physiotherapist
1 year, falls 32%, injuries 39%

Nurse delivered programme at home: Robertson, BMJ 2001

75+ years, n= 240, home-based, district nurse
1 year, falls 46%, serious injuries and hospital costs

Nurse programme at GP centres: Robertson, BMJ 2001

80+ years, n=450, home-based, general practice nurse
1 year, falls 30%, injuries 28%

Visually Impaired Older People: Campbell, BMJ 2005

1 year, home-based. Only effective with full compliance, falls 28%

6 month programme: Liu-Ambrose, JAGS 2008

70+ years, home-based, cognitive function improvements after 6 months

and after 1 year falls 47%

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Skelton et al. J.Aging Phys Act 2004; 12 (3); 457-458 & Age and Ageing, 2005: 34: 636-639

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Community Dwelling older people

Community Dwelling older people - mild deficits of strength/balance mild deficits of strength/balance

2x/week for 15 weeks

2x/week for 15 weeks – Cut trip and fall rate by Cut trip and fall rate by half half

Frail older adults aged 70-97
2 x/week for 48 weeks
no significant reduction in risk of falls

Wolf et al. J Am Wolf et al. J Am Wolf et al. J Am Wolf et al. J Am Geriat Geriat Geriat Geriat Soc 2003; 55: 1693 Soc 2003; 55: 1693 Soc 2003; 55: 1693 Soc 2003; 55: 1693-

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Community Dwelling older people aged 70+

Community Dwelling older people aged 70+ Community Dwelling older people aged 70+ Community Dwelling older people aged 70+

3 x/week for 24 weeks

3 x/week for 24 weeks 3 x/week for 24 weeks 3 x/week for 24 weeks

Increased

Increased Increased Increased Falls Self Falls Self Falls Self Falls Self-

Efficacy

Efficacy Efficacy Efficacy (ABC) and (ABC) and (ABC) and (ABC) and Decreased Decreased Decreased Decreased Fear of Falling Fear of Falling Fear of Falling Fear of Falling (SAFFE) (SAFFE) (SAFFE) (SAFFE)

Li et al. J Li et al. J Li et al. J Li et al. J Li et al. J Li et al. J Li et al. J Li et al. J Gerontol Gerontol Gerontol Gerontol Gerontol Gerontol Gerontol Gerontol B B B B B B B B Psychol Psychol Psychol Psychol Psychol Psychol Psychol Psychol Sci Sci Sci Sci Sci Sci Sci Sci Soc Soc Soc Soc Soc Soc Soc Soc Sci Sci Sci Sci Sci Sci Sci Sci 2005; 60:P34 2005; 60:P34 2005; 60:P34 2005; 60:P34 2005; 60:P34 2005; 60:P34 2005; 60:P34 2005; 60:P34-

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Individually tailored GROUP exercise as part of a multifactorial intervention (staff training, environment modification, drug review etc) Reduces falls - Becker et al. J Am Becker et al. J Am Geriat Geriat Soc 2003; 51:306 Soc 2003; 51:306-313 313 Improves mobility - Jensen et al. Aging Jensen et al. Aging Clin Clin Exp Res 2004; 16: 283 Exp Res 2004; 16: 283-292 292 Reduces falls risk factors Reduces falls risk factors - Dyer et al. Age Ageing 2004; 33:596 Dyer et al. Age Ageing 2004; 33:596-602 602

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Raise awareness Raise awareness in the general population that undertaking specific in the general population that undertaking specific physical activities has the potential to improve balance and pre physical activities has the potential to improve balance and prevent vent falls falls

2. 2.

When offering or publicising interventions, When offering or publicising interventions, promote benefits which fit promote benefits which fit with a positive self with a positive self-identity identity

3. 3.

Utilise a variety of forms of Utilise a variety of forms of social encouragement social encouragement to engage older to engage older people in interventions people in interventions

4. 4.

Ensure the intervention is Ensure the intervention is designed to meet the needs, preferences designed to meet the needs, preferences and capabilities and capabilities of the individual

f the individual

5. 5.

Encourage self Encourage self-management management rather than dependence on rather than dependence on professionals by giving older people an active role professionals by giving older people an active role

6. 6.

Draw on Draw on validated methods validated methods for promoting and assessing the for promoting and assessing the processes that maintain adherence, especially in the longer processes that maintain adherence, especially in the longer-term term

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Num ber of admissions - following a fall at home

500 1000 1500 2000 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year Num ber of adm issions due to falls at hom e

The role of the OTSW includes:

Completion of a Falls Risk Screening and Data Collection Tool. Raising awareness of falls, consequences and prevention. Promotion of functional independence and safety. Provision of advice and support to both patients and carers. Guided by the Screening Tool, formulates a person centred Action Plan and seeks patient consent. Action Plan makes recommendation for referrals on to specialist services and also advice for the patient/carer.

The CFPP patient pathw ay sees an average of 250 clients/month

20% 20% 17% 18% 9% 4% 4% 3% 2%1% 1% 1% 0% Physiotherapy including exercise sessions Falls Clinic Occupational Therapy Pharmacy Pendant Alarm Podiatry COPT Audiology Continence Dietician SWOT Sensory I mpairment DADS

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