1. Specialist PSI Exercise Module Prevalence and Consequences of Falls - Injurious falls - Non-injurious falls - Location of falls - Direct and Indirect costs - Fear of falling - Long Lies

2. Specialist PSI Exercise Module One in three people aged > 65 years fall each year After the first fall, there is a 60 per cent chance of falling again No two fallers are the same! 75-80% of falls are not reported to a health professional 1 person dies every five hours as a result of a fall in the UK

3. Specialist PSI Exercise Module What is a fall? “an event which results in a persons coming to rest inadvertently on the ground or other lower level” (Kellog) or “a trip or slip that results in a person, with or without consciousness, unintentionally landing on the floor or lower level (Skelton and Dinan)   Includes: tumbling down the stairs, falling up stairs, falling onto a chair, the bed or the floor, sliding out of bed, slipping in the bath   Does not include: tripping and correcting yourself, banging into the wall, being knocked or pushed over

4. Specialist PSI Exercise Module Saving Lives - Our Healthier Nation National Priority: National Priority: –To reduce the rate of accidents - defined as those requiring a visit to a hospital or consultation with a doctor - by at least a fifth by 2010, from a baseline at 1996.

5. Specialist PSI Exercise Module National Service Framework for Older People 2001 Standard 6: Falls. To reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen To reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen Key Interventions: Prevention – including prevention and treatment of osteoporosis Prevention – including prevention and treatment of osteoporosis Improving the diagnosis, care and treatment of those who have fallen Improving the diagnosis, care and treatment of those who have fallen Rehabilitation and long-term support Rehabilitation and long-term support Individualise prevention: …identifying those most at risk …identifying those most at risk …balance, gait and mobility problems …balance, gait and mobility problems

6. Specialist PSI Exercise Module NICE CG21 Falls (2004) Case/risk identifications Case/risk identifications Multi-factorial falls risk assessment Multi-factorial falls risk assessment Multi-factorial interventions Multi-factorial interventions Education and information for patients and carers Education and information for patients and carers Healthcare staff training Healthcare staff training

7. Specialist PSI Exercise Module Falls in women over 1 year Lord 1993

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11. How common are falls? In those aged over 75, falls are the leading cause of death resulting from injury In those aged over 75, falls are the leading cause of death resulting from injury A third of >65s and a half of >80s fall at least once a year A third of >65s and a half of >80s fall at least once a year 10% of all call-outs for London Ambulance Service are for people aged 65+ who have ‘fallen’. 10% of all call-outs for London Ambulance Service are for people aged 65+ who have ‘fallen’. –> 40% are not even taken into Hospital.

12. Specialist PSI Exercise Module Reported falling by age and sex Cambridge City Over 75s Cohort Study, Fleming, 2002

13. Specialist PSI Exercise Module Reported falling by Residence Cambridge City Over 75s Cohort Study, Fleming, 2002

14. Specialist PSI Exercise Module Time and Location of Reported Falls Cambridge City Over 75s Cohort Study, Fleming, 2002

15. Specialist PSI Exercise Module Indoor location of falls Lord 1993

16. Specialist PSI Exercise Module Reported falling by distance of walking ability Cambridge City >75s Cohort, Fleming, 2002 %

17. Specialist PSI Exercise Module Reported falling by need for help with walking Cambridge City Over 75s Cohort Study, Fleming, 2002

18. Specialist PSI Exercise Module Types of Injurious falls One which results in a visit to or by a health professional. One which results in a visit to or by a health professional. 20% of injurious falls result in fractures requiring hospital treatment. 20% of injurious falls result in fractures requiring hospital treatment. Other injuries include: Other injuries include: –Cuts and lacerations, –Deep bruises, –Soft Tissue Injuries, –Dislocations, –Sprains –Increase in joint pain

19. Specialist PSI Exercise Module Types of ‘fallers’ FLOF FLOF FAOP FAOP FBS FBS 3F syndrome 3F syndrome 3G syndrome 3G syndrome 3P syndrome 3P syndrome FNOF FNOF Found Lying On the Floor Medical Falling All Over the Place Intrinsic Fractured Neck Of Femur Fall Back Syndrome Intrinsic Fear of Falling Further Grabbing Great Grandmother Patient with Precocious parking Fear Medical & Intrinsic

20. Specialist PSI Exercise Module Changing incidence of fractures with increasing age 50 to 65 yrs - wrist 55 to 85 yrs - spine 75 to 85 yrs - hip (because of poor reaction, coordination and reflexes)

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22. Consequences of Hip Fracture By Year 2031 = 96,000 hip fractures a year. By Year 2031 = 96,000 hip fractures a year. Risk of a hip # 10x higher for those in residential settings than in own home Risk of a hip # 10x higher for those in residential settings than in own home 50% of individuals will die, move into a nursing home or be in hospital within six months of Hip # 50% of individuals will die, move into a nursing home or be in hospital within six months of Hip # 80% do not regain pre-fracture mobility 80% do not regain pre-fracture mobility underlying medical conditions, poor strength, balance and muscle asymmetry all contribute to poor outcome underlying medical conditions, poor strength, balance and muscle asymmetry all contribute to poor outcome

23. Specialist PSI Exercise Module Consequences of Uninjurious falls A long lie, even without injury, is possible if person unable to get up from floor A long lie, even without injury, is possible if person unable to get up from floor Post fall syndrome – psychological sequelae Post fall syndrome – psychological sequelae Reduction in activity and consequent social isolation Reduction in activity and consequent social isolation Reduction in independence Reduction in independence

24. Specialist PSI Exercise Module Long lies with or without injury Long lies (> 1-2 hours) lead to an increased risk of: Long lies (> 1-2 hours) lead to an increased risk of: –dehydration –hypothermia –pneumonia –pressure sores –kidney failure –depression –post fall syndrome –death (Tinetti 1993, 1994)

25. Specialist PSI Exercise Module Costs to the NHS Fractures cost the NHS £1.7 billion per year Fractures cost the NHS £1.7 billion per year Hip repair £12,000 - Wrist repair £480 Hip repair £12,000 - Wrist repair £480 Hospital spending > £10 billion. Hospital spending > £10 billion. Local authority, residential care > £3 billion Local authority, residential care > £3 billion –Non-residential care > £2 billion. –Half of L.A. social services spent on services for older people Formal and informal ‘care’ Formal and informal ‘care’

26. Specialist PSI Exercise Module Consequences to the individual Falls and instability contribute to 40% of nursing home admissions. Falls and instability contribute to 40% of nursing home admissions. Post-fall syndrome - psychological sequelae Post-fall syndrome - psychological sequelae Reduction in independence and social contact Reduction in independence and social contact Depression Depression Frequent fallers (>3 p.a.) have poor outcomes. Nearly a third admitted to hospital, transferred to nursing home or had died one year later (Lord et al., 1992). Frequent fallers (>3 p.a.) have poor outcomes. Nearly a third admitted to hospital, transferred to nursing home or had died one year later (Lord et al., 1992).

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