Presentation for Healthcare Professionals Created for the Chartered Society of Physiotherapy by Kate Bennett Specialist Physiotherapist

“Falls are a common, but often overlooked, cause of injury “Falls are a common, but often overlooked, cause of injury. Around one in three adults over 65 who live at home will have at least one fall a year, and about half of these will have more frequent falls” http://www.nhs.uk/Conditions/Falls/Pages/Introduction.aspx

Some facts about falls Falls are the second leading cause of accidental or unintentional injury deaths worldwide Rate of falls is approximately 3.6/ 100 person-years, with women and older age groups at greater risk. WHO, 2016 Gribbin, J. et al (2009) Incidence and mortality of falls amongst older people in primary care in the United Kingdom. Q J Med; 102:477–483

Impact of falls in the UK Falls and fractures in people aged 65 and over account for over 4 million hospital bed days each year in England alone The healthcare cost associated with fragility fractures is estimated at £2 billion a year. WHO, 2016 Royal College of Physicians. 2011. Falling Standards, broken promises: report of the national audit of falls and bone health in older people

Why people fall Previous falls Medication Night time mobility Postural hypotension Issues with eyesight Foot wear and foot care Slips and trips LTCs Home environment Alcohol Lack of strength, balance and mobility Vitamin D levels Vestibular issues

“After a fall, an older person has a 50 per cent probability of having their mobility seriously impaired and a 10 per cent probability of dying within a year” (Help the Aged, 2008. Towards Common Ground)

What happens after a serious fall? Leads to people being less active A fall leads to fear of falling Leads to a decrease in strength and balance Leads to another fall Leads to people being less active Leads to greater fear of falling Leads to a decrease in strength and balance etc. etc…

CSP Fall Prevention Economic Model In 2014 the Chartered Society of Physiotherapy produced a Falls Prevention Economic Model It answers the question, “Is physiotherapy a cost-effective way of preventing falls in a given elderly population?” Answer is a resounding, “Yes” – physiotherapy can probably prevent around 160,000 serious falls and a spend of £252m across the UK each year. For every £1 spent on physiotherapy, around £4 is returned in prevented NHS spending. www.csp.org.uk/preventingfalls

Timed Up and Go A simple test to determine if your patient is at a higher risk of falls http://www.csp.org.uk/getupandgo If the test takes 14 seconds or more, your patient could be at risk of falls – refer onto your local falls service for a multifactorial assessment.

Gait speed Another simple test that may indicate a higher risk of falls https://www.youtube.com/watch?v=vrm4JP7l1Ms Gait Speed = distance / time: e.g. metres/sec. Values of 0.6 – 1.0 m/s are suggest an increased falls risk. Abu Samah, Z et al (2016). Can gait speed test be used as a falls risk screening tool in community dwelling older adults? A review. Polish Annals of Medicine 23 (1):61-67

How to get up from a fall

Falls and exercise “Many older adults would not choose to participate in an exercise programme even if it reduced falls to 0%” World Congress for Physical Therapy (WCPT) 2017

Evidence for exercise A study in 2011 showed that a dose of at least 50 hours of exercise is required to reduce falls This breaks down into a recommendation of two hours per week strength and balance training over a period of 6 months. Sherrington et al. 2011 ‘Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations.’ New South Wales Public Health Bulletin “A tailored exercise programme can reduce falls by as much as 54 per cent.” Falls prevention exercise – following the evidence (Age UK 2013)

Exercises to assist with strength and balance Due out End of September

In conclusion Falls are a big problem amongst the older population leading to major injury, loss of independence and social isolation Reasons behind falls are often complex but simple interventions such as exercise can reduce the risk significantly Strength and balance exercises have been shown to be effective at reducing falls and the risk of falls By acting now to prevent falls you can ensure your patient’s independence is maintained and they are given the best chance to live an active and fulfilling life, free from disability and the other potential consequences of a fall.

Useful links and resources www.csp.org.uk/thinkphysio www.csp.org.uk/getupandgo www.csp.org.uk/ageukfalls

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