FALLS PREVENTION

We Can Make A Difference

Cost to the Nation £ 1 billion per year and rising!

Ann GatesHead of Medicines ManagementNorth Eastern Derbyshire PCT

What Is A Fall?

A sudden unintentional change in position causing an individual to land at

a lower level

For Us The Results Are Dramatic

•There are causes

•Surprise . . Projects and Pilots

•Plenty of advice on prevention

•Medicines get some of the blame

•There’s certainly guidance!

•There are consequence

What Should We Consider First?

•There are demands on emergency services

Budgets of Course!

•Home adaptation & rehabilitation•Primary Care follow-up costs•Winter pressures-bed blocking

•Hospital admissions -if anyone has a bed!

And It Costs A Lot!

Start Saving!

Acute Hospital Cost £4,808Long Stay & Social Costs £7,125Primary Care Costs £164

Total Costs £12,124

Annual Costs Per Population £942,000,000

(Dolan, P & Tagerson D 1998)

That’s Not Going To Please Mr Milburn!

The Individual Isn’t Going To Be Very Happy Either!

•Loss of function

•Increased isolation and loneliness

•Fear of further falls

•Loss of dignity

•Loss of mobility & independence

Time For A Few Statistics40-60% lead to injuries

30-50% are minor5% lead to fractures

5-6% lead to major injuriesMinor Injuries –LacerationsBruisesAbrasionsSprains

And they hurt!

Major Injuries –FracturesDislocationsLacerationsSoft tissue damage

And they hurt a lot!

0

500

1000

1500

2000

2500

30003500

65-69 70-74 75-79 80-84 85+

Male

FemaleRate / 100,00Age-specific hospital admission rates for falls

[SE Thames 1991-2]

Cryer et al

Age group- years

Hospitalisation

Interesting!

80% of women would rather be dead than experience loss of independence and quality of life that results from

hip fracture and admission to a nursing home

Salkeld et al 2000 BMJ

0

5

10

15

20

25

30

[National Center for Health Statistics USA 1986]

Deaths % Causes of injury death in people aged 65+ years

Falls Motor Suicide Procs Aspiration Fire Homicide Poison Other

Studies have identified over 400 risk factors

Life’s A Risky Business!

Environmental –•Loose carpets•Bathtub handles•Poor lighting•Unsafe stairs•Ill-fitting shoes

Medication –•Antidepressants•Sedatives/hypnotics•Diuretics

Medical Conditions•Vision•Cognitive impairment

Nutrition•Ca and vitamin D deficiency

Lack of exercise•Reduced power•Poor balance•Unsteady gait

Alcohol

Guidance

• Health of the Nation- Policy assessed 1998– “Failed over its 5 year span to realise its full potential….

By 1997 its impact on local policy making was negligible”

• Saving Lives- Our Healthier Nation 1999– Reduce risks for falling/stumbling in older people

• NSF Older People 2001

• NICE guidance on falls prevention 2003

While I Have Been Talking . .

FOUR older people will have been seriously injured

SIX older people will have had another injury

Drug Therapy Is More Likely To Cause A Fall If . .

•The patient has more than four drugs•A new drug was started within the previous two weeks

And . . .

•Lots of drugs increase the risk of falling

•They aggravate problems for those who are already fallers

Can We Help At-Risk Patients?

YES!!!•Does the patient need the drug?

•Does poor compliance cause problems

• Do effects lead to falling -anti hypertensives?

•Do side effects lead to falls -drowsiness?

Drug Problems

Sedative drugsbenzodiazepines, tricyclics, phenothiazines, barbiturates and antihistamines

Cardiovascular drugsdiuretics, beta-blockers, ACE inhibitors, alpha-blockers, calcium channel blockers and vasodilators

What Drugs Can Do

In the elderly, drugs like• Digoxin cause dizziness• Baclofen cause muscle weakness• Phenytoin cause ataxia• Prochlorperazine and metoclopramide cause Parkinson’s features• Procyclidine cause visual impairment

They Can Also Cause Confusion

Drugs like:•Digoxin in overdose cause acute confusion

•Cimetidine confuses when there is renal or

liver impairment

•Corticosteroids can confuse

•Methyldopa can confuse

Most commonly prescribed drugs that cause falls

Drug PercentageLaxatives 49Diuretics 44Antispychotics 30Hypnotics/anxiolytics 29Antiplatelet 28Antidepressants 25Analgesics 27Ulcer-healing drugs 21Musculoskeletal drugs 16Nitrates & calcium-channel blockers 15Antiparkionsonian drugs 12

Furniss L, Burns A, Craig SKL, Scobie S, Cooke J, Farragher BEffects of pharmacists’ medication review in nursing homes - randomised controlled trial. Br J Psych (2000); 176: 563-67

As Ever, There Is No Shortage Of Advice

DTI “Avoid Slips, Trips, Broken HipsDTI “Step Up To Safety’’

The Falls Prevention Services

•Wear appropriate flat shoes•Wear glasses (if you need them!)

•Have regular eye checks

•Treat cataracts (if you’ve got them!)

The Falls Prevention Services

•Make sure home is well-lit

•Avoid loose rugs

•Wear hip protectors

The Falls Prevention Services

•Adopt a multi disciplinary approach

•Patients Environment- heat, stairs

•Local councils-Pavements, street lighting

•Local exercise classes-tai chi

Good Practice

•Wycombe PCT – community pharmacists

•Cambridgeshire – tackling falls

•Government NSF – older people

•Barnet – health promotion project

•Colchester GH – medication reviews, interface pharmacist

•Greater Derby PCT – osteoporosis nurses

While We’ve Been Here . . .

About 120 older people will have had a minor injuryAbout 90 older people will have been seriously injuredOne older person will have died

All as a result of a FALL

Don’t Forget . . .

Falls are very expensive and, as the old saying goes . . .

A Fall and the Money are Soon Parted