Falls and Osteoporosis Linked FALLS,FRACTURES AND OSTEOPOROSIS STRATEGY: “ Falls,osteoporosis and fracture prevention are of major importance because they engender considerable mortality, morbidity and suffering for older people and their relatives and incur costs due to hospital and social care. The numbers of older people is projected to rise over the next years. The incidence of falls, osteoporosis, and fracture increases with age. There is a strong evidence base for” what works” to address and prevent falls, osteoporosis and fractures. It is recognised that the most effective interventions address multiple factors at the same time. Many risk factors relate to different agencies, such as home care, community safety as well as housing and the NHS The way forward in Fife is therefore through a multi-agency approach which will be facilitated by establishing a Managed Care Network for Falls Osteoporosis and Fractures. “

Main injuries across Europe European Network on Safety among Elderly (EUNESE) Priorities for Elderly Safety in Europe 2006

Falls in the UK 28,000 women aged > 90 yrs 11 million people aged > 65 yrs Fractures costs £1.8 billion pa 1 Hip Fracture every 10 mins 1 Wrist Fracture every 9 mins 1 Spine Fracture every 3 mins 500 admitted to Hospital every day 33 never go home Annual European Home and Leisure Accident Surveillance Survey (EHLASS) Report UK 2000

How common are falls? In > 75s, falls are the leading cause of death resulting from injury 75-80% of falls are not reported 1 in 3 >65’s and 1 in 2 >80’s fall p.a. 10% of all call-outs for UK Ambulance Service are for people aged 65+ who have ‘fallen’ but nearly half are not taken to Hospital. Skelton & Todd, WHO 2004, Gillespie et al. 2003

INTEGRATED PLANS > 95% hip fractures due to a fall > 90% of hip fractures due to osteoporosis OSTEOPOROSIS FALLS FRACTURE Falls, Fragility & Fractures, Cryer & Patel, 2002

Consequences of Hip Fracture By Year 2031 =100,000 hip fractures a year Risk of hip # 10x higher for those in residential settings than in own home 50% of individuals will die, moving into a nursing home or be in hospital within six months of Hip # 80% do not regain pre morbid mobility, underlying medical conditions, poor strength, balance and muscle asymmetry all contribute to poor outcome

Cost to the Individual Injuries include: –Cuts and lacerations, –Deep bruises, Soft Tissue Injuries, –Dislocations, Sprains –Increase in joint pain Less than 5% of all falls result in a fracture Long lie’s & complications Depression, fear of falling Avoidance of activities and social isolation Skelton & Todd, WHO, 2004

Intrinsic vs Extrinsic - we are all ‘trippers’ Over HALF the falls experienced in the home are due to environmental hazards - trips, slips, unsafe or unlit stairways A decline in a person’s intrinsic risk factors (declining function and balance) mean that the extrinsic risk factors (loose mats, slippery floors) no longer just cause a correctable trip - they cause an injurious fall

D - Drugs and Alcohol Cumulative effect of medication / time of day Prescribed medications / multiple drug regimes - analgesics - sedatives - antidepressants Heavy drinkers (> 7 units per week) (Campbell et al, 1989, O’Loughlin et al 1993) Mixing medications with alcohol

A - Age Related Physiological Changes Deterioration in physical function and systems (strength, power, endurance, coordination, reaction, balance, proprioception and neural control) Decrease in function capacity, mobility and activity Deterioration in feet (bunions, corns, circulation, neuropathies) Increase in cognitive impairment and depression

M - Medical Acute Infections Cardiovascular control - postural hypotension, drop attacks, heart disease, stroke, tia’s Dementia, Alzheimers Disease Parkinson’s Disease Thyroid dysfunction Peripheral Neuropathies or myopathies Malignancies Impaired hearing or vestibular function (Menieres Disease, Tinnitus) Impaired vision (macular degeneration, glaucoma, cataracts, visual acuity, contrast sensitivity, adaptation to dark)

M - Medical 2 Foot deformities - bunions, corns, hard skin, arthritis, oedema Urinary incontinence or urgency Receiving community health or social services Recent discharge from hospital Use of assistive walking aids - cane, zimmer Malnutrition / Anaemia - Nutritional recommendations are 10-20µg rda Vitamin D and 1,000mg rda calcium, Vit B12 deficiency leads to sensory abnormalities

E - Environment Personal risk factors: glasses (bifocals and varifocals) footwear and clothing Outdoors: Poorly lit pathways Uneven pavements Slippery leaves Rubbish, building materials, obstacles Bus drivers! Indoors: Loose carpets Wires and cables Unstable furniture Change of level Poor lighting Cold muscles Sentimentality or “never been a problem before”

Further Information Distance Learning Tools ( kiss of life mutimedia) Falls and Bone Health