Who is at greatest risk of dying after a broken hip?

Toby Smith is a Lecturer in Physiotherapy at the Faculty of Medicine and Health Sciences, University of East Anglia. His recent paper published in Age and Ageing has identified those people who are at greatest risk of dying following a broken hip. He tweets at @tobyosmith.shutterstock_158328935

Hip fracture is a major challenge for health services worldwide, and can be catastrophic for the individual who experiences it, in addition to their friends, family and carers. The consequences of a broken hip can range from physical disability through reduced mobility and loss of independence, to death. It has been estimated that approximately 25% to 40% of people following a hip fracture die within the first 12 months after their injury. This has been, in part, attributed to the fact that many of these people are older and have numerous medical conditions which place them at greater risk of death irrespective of their hip fracture.

Given this high risk and the large number of people who experience a hip fracture annually, our team aimed to identify characteristics which could predict who would be at greatest risk of dying following a hip fracture. Continue reading

What can older people tell us about their experiences of therapeutic exercise as part of a falls prevention service?

Janet Husk is a Patient Safety and Quality Improvement Manager at the Clinical Effectiveness and Evaluation Unit of the Royal College of PhysiciansFallsService

The answer is a great deal as you can see in this article on ‘older people’s experiences of therapeutic exercise’ – available online in Age and Ageing. Don’t think it was just  younger people (55 to 74 years) that responded; some people that completed a questionnaire were over 95 years of age which just goes to show that people of all ages were exercising and  were able to give important feedback about their experiences of NHS run therapeutic exercise programmes to reduce falls. Continue reading

NHFD national report shows care for hip fracture patients is improving

The National Hip Fracture Database is a joint venture of the British Geriatrics Society and the British Orthopaedic Association, and is designed to facilitate improvements in the quality and cost effectiveness of hip fracture care.  Follow it on Twitter @NatHipFracData NHFD2

Hip fracture is a common, serious and costly injury affecting mainly older people. It usually results from the combination of osteoporosis and a fall from standing height or less.  Care is complex and involves surgical, medical and rehabilitation interventions.

The National Hip Fracture Database 2013 report covers casemix, care and outcomes of 61,508 cases submitted between 1 April 2012 and 31 March 2013 by 180 hospitals in England, Northern Ireland and Wales. Continue reading

Preventing falls in care homes: a question of balance

Ahead of her session at the BGS Falls and Postural Stability Conference in September, Kate Robertson writes with Alex Macdonald for the Geriatric Medicine blog about falls in care homes.

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Falls in older adults are common and the rate is three
times higher in people in care homes than in those living in their own homes. Falls in care homes are associated with considerable mortality and morbidity-hip fractures are significantly more prevalent than in community-dwelling older people, with rates in female care home residents estimated as high as 50.8 hip fractures per 1000 person-years.1

Continue reading

Healthcare professionals come together for the BGS Falls Symposium

We finish our coverage of falls awareness week with a blog by Bryony Elliott, Geriatric Trainee in Nottingham. She tweets at @BryonyBryboss.

On Friday the 7th June interested health care professionals from around the country assembled at Nottingham City Hospital to learn about Falls. It was the Trent BGS Falls Symposium.

What struck me first was the diverse group of professionals in the lecture theatre. Looking at the delegate list there were consultants and trainees in geriatric medicine, physios, occupational therapists, nurse specialists, and from all across the country too. A variety of people with a lot of enthusiasm, which was great to behold. Continue reading

Too many older people falling due to poor eye sight

Kamlesh Chauhan is President of the College of Optometrists 
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It may seem obvious to some that there is a strong link between how well you can see and your chances of suffering a fall, especially as you get older. Yet our new research has revealed that it’s not so obvious to almost a third (32%) of people in the UK with parents over the age 65.

Up to one in three people over 65 will experience a fall each year so it is not surprising that nearly half of those who took part in our research said they had an older friend, parent or relative who had fallen. However, it is surprising, and worrying, that fewer than three per cent of people questioned said their parents’ deteriorating eyesight was a cause for concern.

The financial and human repercussions of falls are significant: Age UK estimates that the cost to the NHS of treating older people who have suffered a fall is up to £4.6m a day, and suffering a fall can seriously reduce quality of life as the chances of a full recovery reduce with age. Tragically, in some cases a fall can be fatal.  Continue reading

Looking after feet to reduce the risk of falling

Philip Hurst is National Development Manager – Health at Age UKfalls dancers

Anyone can trip or fall. If we are honest with ourselves, I wouldn’t mind betting that every one of us can remember an embarrassing moment where we stumbled in the street and carried on, pretending it didn’t happen and praying that no one saw. But as we age our risk of falling increases and the consequences can be devastating. We need to do all we can to reducing the risk of falling. An obvious, but curiously often overlooked, place to start is to look after our feet.

Falls Awareness Week, which this year takes place between 17th-21st June, is a wonderful way of raising awareness of the dangers of falling and what can be done to prevent it. It is not only people who are more at risk of falling who need to be more aware. All health and care professionals who come into contact with older people need to know what messages to give and how they can help . Continue reading

Vitamin D and bone health: A practical clinical guideline for patient management – National Osteoporosis Society Guideline

Dr Terence Ong is a Research Fellow at Nottingham University Hospitals NHS Trust.

Professor Opinder Sahota is Professor of Orthogeriatric Medicine and Consultant Physician at Nottingham University Hospitals NHS Trust

image by epSos.de

image by epSos.de

Vitamin D is not, in the truest sense, a vitamin because it is not exclusively obtained through diet alone. It is a secosteroid, mostly obtained intrinsically by the effect of ultraviolet radiation on previtamin D compounds and subsequent hydroxylation in the liver and kidneys.

Vitamin D plays an important role in calcium and phosphate homeostasis through its effect on gut and bone metabolism. Besides that, it also plays a key role in muscle function. In recent years, our understanding of vitamin D has expanded and we are starting to appreciate its much broader role in areas such as the immune system, cancer and cardiovascular disease. Continue reading

All down to numbers?

Dr Frances Healey is a registered nurse who is Associate Director for Patient Safety at NHS England and a Research Associate at Newcastle University. Follow her @FrancesHealey

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In our paper in Age and Ageing, Terry Haines and I present findings on the predictive values of the Morse Falls Risk Score, using data drawn from routine clinical practice in an acute hospital setting. However the data were cut, we found no clearly clinically useful predictive values, and the threshold score most commonly used to indicate a patient at risk of falls performed no better than tossing a coin. As we discuss, our findings are not new, but echo a series of studies carried out over the past two decades on all versions of falls risk scores. Concerns about falls risk scores relate not only to their predictive value, but for the potential for scoring to become a substitute for action, for scoring to override common sense, and for scoring to lead to a ‘one size fits all’ approach, despite the differing needs and wishes of individual patients. Continue reading

National Hip Fracture Database Reports on Developments in Acute and Post-Acute Care

Dr Helen Wilson, is co chair of the National Hip Fracture Database (NHFD), a joint endeavour of the BGS and the British Orthopaedic Association to improve the care of patients with fragility fractures.

Hip fracture, which usually results from the combination of a fall and pre existing osteoporosis, is the most common serious injury of older people, with around 76,000 cases occurring per year across the UK. Many patients are already frail. Mortality is high, residual disability common, and care costly. Although there is good evidence on best practice in surgical, medical and rehabilitation care following hip fracture, such care and its outcomes – in terms of return home and also of mortality – continue to vary.

The NHFD has published a supplement to its 2012 National Report which demonstrates continuing improvements in acute care but  highlights variations in post-acute care and overall length of NHS stay. Continue reading