PREVENTION

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Welcome to Cardiff
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FALLS PREVENTION
Cost to the Nation 1 billion per year and
rising!
We Can Make A Difference
Ann Gates Head of Medicines Management North
Eastern Derbyshire PCT
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(No Transcript)
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What Is A Fall?
A sudden unintentional change in position causing
an individual to land at a lower level
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For Us The Results Are Dramatic

• There are causes

• There are consequence

• Theres certainly guidance!

• Medicines get some of the blame

• Plenty of advice on prevention

• Surprise . . Projects and Pilots

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What Should We Consider First?
Budgets of Course!

• There are demands on emergency
• services

• Hospital admissions
• -if anyone has a bed!

• Winter pressures-bed blocking

• Primary Care follow-up costs

• Home adaptation rehabilitation

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And It Costs A Lot!
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Start Saving!
Acute Hospital Cost 4,808 Long Stay Social
Costs 7,125 Primary Care Costs 164 Total
Costs 12,124 Annual Costs Per Population
942,000,000 (Dolan, P Tagerson D 1998)
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Thats Not Going To Please Mr Milburn!
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The Individual Isnt Going To Be Very Happy
Either!

• Loss of function

• Loss of mobility independence

• Loss of dignity

• Fear of further falls

• Increased isolation and loneliness

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Time For A Few Statistics
40-60 lead to injuries 30-50 are minor 5 lead
to fractures 5-6 lead to major injuries
Minor Injuries Lacerations Bruises Abrasions Spr
ains
Major Injuries Fractures Dislocations Laceration
s Soft tissue damage
And they hurt!
And they hurt a lot!
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Hospitalisation
Rate / 100,00 Age-specific hospital admission
rates for falls SE
Thames 1991-2 Cryer et al
Age group- years
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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
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Deaths
Causes of injury death in people aged 65 years
Falls Motor Suicide Procs Aspiration Fire
Homicide Poison Other
National Center for Health Statistics USA 1986
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Lifes A Risky Business!
Studies have identified over 400 risk factors

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

• Medical Conditions
• Vision
• Cognitive impairment

• Nutrition
• Ca and vitamin D deficiency

• Medication
• Antidepressants
• Sedatives/hypnotics
• Diuretics

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

Alcohol
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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

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While I Have Been Talking . .
FOUR older people will have been seriously injured
SIX older people will have had another injury
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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

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And . . .

• Lots of drugs increase the risk of falling
• They aggravate problems for those who are already
  fallers

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Can We Help At-Risk Patients?
YES!!!

• Does the patient need the drug?

• Do side effects lead to falls
• -drowsiness?

• Do effects lead to falling
• -anti hypertensives?

• Does poor compliance cause problems

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Drug Problems
Sedative drugs benzodiazepines, tricyclics,
phenothiazines, barbiturates and antihistamines
Cardiovascular drugs diuretics, beta-blockers,
ACE inhibitors, alpha-blockers, calcium channel
blockers and vasodilators
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What Drugs Can Do

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

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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

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Most commonly prescribed drugs that cause falls
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
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As Ever, There Is No Shortage Of Advice
DTI Step Up To Safety
DTI Avoid Slips, Trips, Broken Hips
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The Falls Prevention Services

• Wear appropriate flat shoes

• Wear glasses (if you need them!)

• Have regular eye checks

• Treat cataracts (if youve got them!)

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The Falls Prevention Services

• Make sure home is well-lit

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The Falls Prevention Services

• Adopt a multi disciplinary approach

• Patients Environment
• - heat, stairs

• Local councils
• -Pavements, street lighting

• Local exercise classes
• -tai chi

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Good Practice

• Wycombe PCT community pharmacists

• Greater Derby PCT osteoporosis nurses

• Colchester GH medication reviews, interface
  pharmacist

• Barnet health promotion project

• Cambridgeshire tackling falls

• Government NSF older people

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While Weve Been Here . . .
About 120 older people will have had a minor
injury
About 90 older people will have been seriously
injured
One older person will have died
All as a result of a FALL
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Dont Forget . . .
Falls are very expensive and, as the old saying
goes . . .
A Fall and the Money are Soon Parted