The Great Balancing Act – perspectives from older people on falls risk

Dr Kristy Robson is a Lecturer in Podiatry at Charles Sturt University, a regional university in Australia. In this blog she shares a recent Age and Ageing publication that explores the behavioural decisions older people make when they knowingly and unknowingly undertake activities or tasks that pose a risk of falling. She tweets @KristyRobson2

Fall related injuries in older people constitute a significant public health issue in Australia and internationally. Falling represents the leading cause of unintentional injury in this population with approximately one third of older adults falling each year. Effective management of falls in older populations has proven to be challenging. Despite the substantial focus on falls prevention by the Australian government over the last decade the age standardised hospital admission rates attributed to falls continue to increase. The complexity of managing falls risk in the diverse populations found within Australia, coupled with an ageing population and finite resources, drives the need to better understand factors that can influence falling from the perspective of the older person.

Other than exercising? Another way for fear of falling…

Mr. Tai-Wa LIU is a Senior Lecturer at the Open University of Hong Kong.  In this blog, he shares a recent Age and Ageing publication looking at the effectiveness of cognitive behavioral therapy in reducing fear of falling and improving balance among older people.

Whenever you are afraid of losing balance in doing something, it means you might have fear of falling.  For example, a baby first tries to stand on its own, or a kid learns cycling.  We all have had this fear of falling, especially in situations where we might get hurt or be embarrassed in public. This fear is normal and self-protective in nature, but the reality is that older people with excessive levels of this fear could lead to restricted activity of daily living, limited social participation and physical deconditioning.  Eventually, it could lead to increased fall risks and form the vicious cycle of “fear of falling and actual falls”.

For some reasons, such as deteriorated physical ability or previous fall experiences, fear of falling is common among older people.  The origin of this excessive level of fear is believed to be psychological and stems from the impaired balance confidence and over-pessimistic view regarding the consequences of falls. 

Spring Speakers Series: Developing an Intervention for Falls in Dementia

Louise Allan is a Geriatrician with a specialist interest in the Neurology and Psychiatry of Old Age. Her research interests include the non-Alzheimer’s dementias and the physical health of people with dementia. She will be speaking at the upcoming BGS Spring Meeting in Nottingham.

Between 47-90% of people with dementia (PWD) fall at least once a year (almost ten times more often than controls). After a fall, PWD are less likely to recover well, more likely to be hospitalised, are hospitalised for longer and are more likely to require increased care. We currently know little about the care received by these patients. There is evidence to suggest that staff may perceive PWD as less capable of rehabilitation and staff in community services providing follow-up care may not have specific training in the care of PWD.

The Other “F” Word: Is upstream prevention the way forward for falls?

Steve Parry works in acute medicine and older people’s medicine. He has a special interest in investigation and treatment of falls and blackouts in adult patients of all ages. He is BGS Vice President – Academic and Research.

Since those heady days in the late 90s when our local falls service was started by Rose Anne Kenny, falls services have moved from novelty to mainstream in the UK’s care of older people landscape. But has this service ubiquity made a difference?

Probably. Possibly. Or perhaps not. It’s almost impossible to say. Falls are notoriously poorly recorded and coded, though falls surrogates like hip fracture, the tip of the falls iceberg, provide at least a hard outcome measure universally recorded. Here, however, despite a decade and a half of falls and bone health services, the news is not good.

We must do more to ensure no-one misses out on rehab

Professor Karen Middleton is Chief Executive of the Chartered Society of Physiotherapy. Karen is a Fellow of the Society of Orthopaedic Medicine, and, in that capacity, has taught physiotherapists and GPs on a national and international basis. Here she discusses the report Recovering after a hip fracture:
helping people understand physiotherapy in the NHS.

It’s the overwhelming feelings of regret and loss that get me. Every time. Whenever I hear a family member say they ‘can only wonder what might have been’ or a patient talking about what they can no longer do.

Whenever I see our Rehab Matters film I know that the fictional story it depicts is playing out in real life, behind closed doors, in homes across the country. It cuts deeply, as a physiotherapist, to hear these stories of how a lack of access to rehabilitation has changed a life.

It makes me burn at the injustice of so many people missing out. Because I know how access to high-quality rehabilitation can change a life for the better – how it can return a person to the things they love, and to the things they do with the people they love. How it can restore independence and a sense of self-worth. How it can restore a life; how it can save a life. 

Taking control of our homes as we get older

Dr Rachael Docking is Ageing Better’s Senior Evidence Manager. Rachael’s remit is to work on their evidence work stream and manage one of their programmes of work, as well as providing cross-cutting evidence support to other work-streams. Rachael leads on their homes and neighbourhoods programme and has also been managing a commissioned review on inequalities in later life.

Jill is 68 years old. She’s still working and cares for her husband. With reduced mobility due to osteoarthritis, Jill has been in a lot of pain, living in a house that wasn’t suited to her changing needs and didn’t know where to turn to for help. She began to develop coping strategies like shuffling upstairs on her bottom, and couldn’t bathe or shower properly.

After a needs assessment from a local occupational therapist, Jill had a number of adaptations installed at home, including a wet room and extra stair rail. As a result she can now shower herself and though still in pain, the adaptations have helped her remain in her own home.

Silent compression fractures: a missed opportunity

Agnes Jonsson is a graduate of University College Dublin in 2013 and is currently working as a Registrar in Orthogeriatrics in St. Vincent’s Hospital in Dublin. Her areas of interest are dementia care and quality improvement. She wrote this blog with input from Dr. Yasser Aljabi, Orthopaedic Registrar. Together they are working to create a pathway of care for vertebral fractures in St. Vincent’s Hospital.

Osteoporotic fragility fractures have an estimated annual cost of 2 billion pounds in the UK. This includes the cost of acute hospital stay, rehabilitation and social care. Only a very small proportion of the cost is invested in pharmacological management and secondary prevention of osteoporosis. The National Osteoporosis Foundation recommends treatment with antiresorptive agents for patients with confirmed osteoporosis on DXA and for patients with neck of femur or vertebral fractures. Vertebral compression fractures have recently started to attract increasing amounts of attention, similar to that shown for hip fractures years ago prior to the implementation of hip fracture pathways of care.

Catching some zzz’s with Z-drugs? You might want to reconsider

Dr Ilan Matok heads the pharmacoepidemiology research unit in the Hebrew University of Jerusalem’s School of Pharmacy, and directs research evaluating the safety of medication. Their research was recently published in Age and Ageing.

Insomnia is a very common medical complaint, and increases with age. Patients with insomnia often report increased daytime fatigue, confusion, anxiety, and depression. While insomnia can have a significant negative impact on quality of life, a recent study highlights the need for careful consideration in the use of sleeping medication to manage this condition, especially among older adults.

It is widely recognized that the use of traditional “benzodiazepine” type sleeping medication (e.g. nitrazepam), increase the risk of fractures and falls in older adults. However, less is known about the safety of “non-benzodiazepine” sleeping medication, otherwise known as “Z-drugs” (e.g zopiclone). In fact, these drugs have been marketed as safer than benzodiazepine medication, and are often perceived as such by clinicians and patients alike.

Catch a falling star

Dr Kawa Amin is a consultant Geriatrician, Consultant Lead for the Falls Service and Geriatrics Departmental Lead for Safety & Quality at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT). He also represents the BGS on the advisory group for the National Audit of Inpatient Falls (NAIF). Deborah Watkins is a Physiotherapist and the Falls Lead at BHRUT.

Falls are a major cause of disability and mortality for older people in the UK and the problem is likely to increase with an ageing population.  The associated mortality and morbidity from a fall is high with individual consequences ranging from distress, pain, physical injury and loss of confidence to complete loss of independence which impacts on relatives and caregivers.  Usually nurses are the first discipline to attend to a patient following a fall.  

Autumn Speaker Series: Exercise during periods of decompensation. What is the current evidence?

Stephen Lim is a Clinical Research Fellow and a Specialist Registrar in Geriatric Medicine in Academic Geriatric Medicine at the University of Southampton. His research interest is in physical activity and deconditioning in hospital. He will be speaking at the upcoming BGS Autumn Meeting in London. He tweets at @StephenERLim

Hospital-associated deconditioning is high on the agenda across hospitals in the UK and many hospital trusts have jumped on the ‘endPJparalysis’ bandwagon to encourage patients to get up and get moving, – and rightly so! It is encouraging to see that healthcare professionals and non-clinical staff members are increasingly aware that prolonged bedrest and immobility is bad medicine.

During an acute illness, older people are at risk of worsening sarcopenia and consequently a decline in physical function. The hospital environment, altered mental state, physiological stresses and poor nutrition (as a sequelae of the acute illness), are some of the important risk factors contributing to a loss of function.