Falls a slippy topic(5)
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Transcript of Falls a slippy topic(5)
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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
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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
•Surprise . . Projects and Pilots
•Plenty of advice on prevention
•Medicines get some of the blame
•There’s certainly guidance!
•There are consequence
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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!
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And It Costs A Lot!
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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)
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That’s Not Going To Please Mr Milburn!
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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
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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!
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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
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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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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
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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
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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?
•Does poor compliance cause problems
• Do effects lead to falling -anti hypertensives?
•Do side effects lead to falls -drowsiness?
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Drug Problems
Sedative drugsbenzodiazepines, tricyclics, phenothiazines, barbiturates and antihistamines
Cardiovascular drugsdiuretics, 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 Parkinson’s 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
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
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As Ever, There Is No Shortage Of Advice
DTI “Avoid Slips, Trips, Broken HipsDTI “Step Up To Safety’’
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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 you’ve got them!)
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The Falls Prevention Services
•Make sure home is well-lit
•Avoid loose rugs
•Wear hip protectors
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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
•Cambridgeshire – tackling falls
•Government NSF – older people
•Barnet – health promotion project
•Colchester GH – medication reviews, interface pharmacist
•Greater Derby PCT – osteoporosis nurses
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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
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Don’t Forget . . .
Falls are very expensive and, as the old saying goes . . .
A Fall and the Money are Soon Parted