Presentation for Healthcare Professionals

2. 1 October 2019 Presentation for Healthcare Professionals Created for theChartered Society of Physiotherapy by Kate Bennett Specialist Physiotherapist

3. “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 this rises to approximately half of all people aged over 80 years” Falls: applying All Our Health, Public Health England (2018). www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health

4. Falls are the second leading causeof accidental or unintentional injury deaths worldwide • Rate of fallsamong community-dwelling older people over 64 years of age, 28-38% fall each year. Of those who are 70 years and older, approximately 32-42% fall each year. The frequency of falls increases with age and frailty level. Some facts about falls Falls, World Health Organization (2018), www.who.int/news-room/fact-sheets/detail/falls A Global Report on Falls Prevention – Epidemiology of Falls, Yoshida, S (2011), World Health Organization

5. 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. Impact of falls in the UK WHO, 2016 Falling Standards, broken promises: report of the national audit of falls and bone health in older people, Royal College of Physicians (2011)

6. Why people fall • Home environment • Alcohol • Poor strength and balance • Vitamin D levels • Vestibular issues • Being inactive • Lack of mobility • Previous falls • Medication • Night time mobility • Postural hypotension • Issues with eyesight • Foot wear and foot care • Slips and trips • Long term conditions

7. “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” Towards Common Ground – The Help the Aged manifesto for lifetime neighbourhoods, Age UK (2008)

8. What happens after a serious fall? A fall leads to fear of falling Leads to people being less active 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…

9. In 2014the 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. CSP Fall Prevention Economic Model The cost of falls, The Chartered Society of Physiotherapy (2018), www.csp.org.uk/costoffalls

10. A simple test to determine if your patient is at a higher risk of falls • 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. Timed Up and Go

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

12. How to get up from a fall

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

14. Evidence for exercise “A tailored exercise programme can reduce falls by as much as 54 per cent.” • A review in 2018 advised on the amount of activity adults over the age of 65 should do • The recommendationwas to do at least 150 minutes of moderate aerobic activity such as cycling or walking every week and • Strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms. Falls prevention exercise – following the evidence (Age UK 2013) Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations, Sherrington et al (2011), New South Wales Public Health Bulletin 22 (3-4):78-83

15. Activities to assist with strength and balance DISCLAIMER: The activities described here should not cause any harm. They might not, however, be suitable for all people, particularly those at risk of falls and fractures. Consult a chartered physiotherapist or your GP before embarking on any new fitness regime, and if you do experience pain or discomfort as a result of any of the exercises, stop immediately.

16. In conclusion • Falls are a big problemamongst the older population leading to major injury, loss of independence and social isolation • Reasons behind falls are often complexbut simple interventions such as exercise can reduce the risk significantly • Strength and balance exerciseshave been shown to be effective at reducing falls and the risk of falls • By acting now to prevent fallsyou can ensure your patient’s age better, 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.

17. www.csp.org.uk/nevertoolate • www.csp.org.uk/ageukfalls • www.csp.org.uk/thinkphysio • www.nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults/ Useful links and resources

18. Thank you for watching