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. 

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.  

What is this pill called dance?

Debra Quartermaine is a Qualified Nurse and currently works as the Falls Prevention Co-ordinator as well as the Dance for Health programme coordinator at Cambridge University Hospitals NHS Foundation Trust. Debra has experience of nursing in a variety of specialties including general medicine, care of the elderly, learning disabilities and mental health.

Thousands of emotions well up inside me throughout the day. They are released when I dance.- Abraham Lincoln

Since 2013, two pilot projects, funded through Addenbrookes Charitable Trust [ACT], and Addenbrookes Arts, involving weekly dance and movement sessions were run on elderly care, stroke rehabilitation and neuro-rehabilitation wards at Cambridge University Hospitals NHS Foundation Trust. An evaluation showed that the sessions enhanced wellbeing and health through supporting increased movement, more positive moods, and greater socialisation.

‘Look out’ – assessing a patient’s vision for falls prevention, what should it look like?

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

As part of my role on the NAIF advisory group I have been involved in the development of a new bedside vision assessment tool which enables ward staff to quickly assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital.

Being acutely unwell is and in a different environment, is a stressful experience.  Even with reassuring care from clinical teams treating them, older people often need extra support in a ward environment.  Can you imagine how frightening such an experience might be for a patient with visual impairment?  It’s perhaps no wonder that poor vision is a risk for delirium.  

How do geriatricians improve outcomes after hip fracture?

Jenny Neuburger is a Senior Research Analyst at the Nuffield Trust  (@NuffieldTrust) and a Visiting Research Fellow at the London School of Hygiene & Tropical Medicine. She and her co-authors have recently published research in Age and Ageing journal.

We have just published a paper showing that geriatrician involvement in hip fracture care can improve patient outcomes.  Patients treated on wards with higher numbers of geriatrician hours tended to have lower mortality within the 30 days after presentation.

We measured geriatrician hours worked in orthopaedic departments using data collected via the National Hip Fracture Database annual survey each year from 2010 to 2013 for English hospitals.  Over this period, geriatrician hours increased from 1.5 to 4.0 hours per patient, reflecting investments made in response the financial incentives introduced under the Best Practice Tariff scheme.

The steps we are taking to reduce inpatient falls

Prof Finbarr Martin is a Consultant Geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Medical Gerontology at King’s College London. He is a former President of the British Geriatrics Society.

How good is your department and hospital at preventing your patients falling? About 600 inpatients fall every day. As clinicians, we are fully aware of the injuries that can result from older people falling in hospital and the serious effect a fall can have on their recovery. So what can we do to prevent this happening? NICE guidance suggests we can reduce the number of falls by up to a third. The issue is high on the national patient safety agenda, but we need to be able to gather reliable data to ascertain if greater awareness is leading to the falls rate reducing.

Last year, the London Royal College of Physicians carried out an audit of hospital policies and practice in falls prevention, producing a national picture and a report on each hospital in England and Wales. The audit items were based on guidance from NICE and NPSA. You can access the national report here. Please find the time to take a look at your hospital’s data.

Catching older people before they fall – a simple intervention to help identify those at risk

Simon Thomas is an Honorary Fellow of the School of Pharmacy, Keele University and a Director at Prescribing Decision Support – a Keele University spin-out company that delivers knowledge-based e-media systems designed to support healthcare decision making. Most recently, Simon has worked with NICE and Boehringer Ingelheim Ltd on the development of an innovative anticoagulation therapy decision support tool that assists patients and doctors in shared decision-making. Simon can be contacted at s.thomas@keele.ac.uk

Falls and fall-related injuries in older people is a high-risk, high-cost problem. Notwithstanding the considerable human impact – distress, pain, injury, loss of confidence, loss of independence and mortality – falls account for the largest number of emergency hospital admissions for older people in the UK and cost the NHS over £2 billion each year.

Is there ever a case for shared rooms in hospitals?

Jacqui Close is a consultant in Orthogeriatrics at the Prince of Wales Hospital in Sydney, Director of the Falls and Injury Prevention Group at Neuroscience Research Australia and President of the Australian and New Zealand Society for Geriatric Medicine. Her research interests range from injury epidemiology, to intervention studies and implementation research.

The days of the Nightingale ward are thankfully gone. No longer do we see two long neat rows of beds with starched sheets.  Whilst the occupants of the bed were rarely encouraged to roam freely, the close proximity of the beds allowed for easy spread of highly mobile viruses and bacteria. Even in the absence of an understanding of infection risk, many complained about the lack of dignity and privacy resulting from this ward design.

Time has moved on and there is recognition of the multiple benefits of single rooms for all patients including older people. Single rooms allow for the delivery of health care which minimizes infection risk, respects privacy, promotes dignity and on the whole reflects with wishes of those people unfortunate enough to require a period in hospital. But is a single room right for everyone and can we be flexible in the way we deliver care?

July issue of Age & Ageing now available

(This is a corrected version of a blog published last week) 

The July 2015 issue of Age and Ageing, the journal of the British Geriatrics Society is out now!

A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

• Pharmacotherapy for type 2 diabetes
• Exercise regimens and bone health
• Balance training for in-patient rehabilitations
• What are frailty instruments for?
• Oestrogen replacement in postmenopausal women

The Editor’s View can be read here.

This issue’s free access papers are:

• Systematic review of EASY-Care needs assessment for community-dwelling older people
• Patterns in health-related behaviours and fall injuries among older people: a population-based study in Stockholm
• A comparison of subjective and objective measures of physical activity from the Newcastle 85+ study