For older people, falls can be devastating events. A more co-ordinated national effort is needed to help avoid them, says Emma Stanmore.
As anyone with an ageing parent or relative will know, falls can be extremely serious. They can lead to hip fractures, a premature care home admission, or even fearfulness leading to social isolation.
The statistics are frightening. One in three people aged over 65 have a fall each year, and over a third of those who fracture their hip due to a fall will die within the year. In fact falls are known to be the most common cause of death through injury in the over 65s, costing the NHS over £2.3 billion a year and rising.
Against the backdrop of a rapidly ageing society – and increasing health and social care funding issues – it is no surprise, therefore, that falls among the elderly are gaining more attention than ever.
But what can be done about something that isn’t a condition, but rather a symptom with multiple causes, which is perceived as almost inevitable as we get older?
Well, there is some good news to share at least. Over 30 years of research has shown that falls (over half in some trials) can largely be prevented. And the methods to prevent falls are fairly simple too – home hazard checks, medication reviews, monitoring blood pressure, and eyesight and hearing checks can all lead to reducing the risk. However the very best thing that older people can do, is to exercise regularly and ensure that this exercise incorporates progressive strength and balance training, an approach which has been found to reduce falls by over a third.
So, if we know that falls are a big problem, and know the risk factors and the interventions that are most effective in reducing them, then why are we not doing more to tackle the problem?
The first reason is that there are still not enough services available in falls prevention, or enough people trained to deliver the strength and balance exercises that can help avoid them.
Secondly, older people historically undertake low levels of physical activity which, in turn, increases their risk for functional decline and falls. And thirdly, and perhaps most worryingly, there is a persistent myth – even among some health professionals – that falls are just a normal part of ageing.
Tackling the problem
In Manchester, we have made it our mission to tackle this problem. For instance, one way is to make use of video gaming technologies which are directed at getting the user to exercise during the video game. For the elderly it is not difficult to see how such games can increase exercise adherence and prevent falls, especially as the user is able to play the games from comfort of their home and doesn’t need to go outside.
This was precisely the thinking behind the Exergame project back in 2013 which was based on well-tested physiotherapy exercises using Microsoft Kinect tracking. The project was a collaboration between Central Manchester University Hospitals NHS Foundation Trust, the University of Manchester, and MIRA Rehab Limited, and the full results will be available next year.
Currently 120 older people living in sheltered housing schemes in Manchester and Glasgow are participating in a study to test the effectiveness of the Exergames. Anecdotal feedback so far has been very positive with many feeling more confident in their daily activities and noting physical and mental improvements, while others enjoy the social contact of playing the games in a group setting.
However this is just one approach. What is really needed is a national push to enable a sustained effort from all stakeholders to increase awareness of the issue, disseminate best evidence and support more public health initiatives.
We all need to be more proactive about highlighting the risks from falls, and helping to eliminate or reduce them. If the incidence of injurious falls continues to rise then there is going to be a huge need for further acute hospital beds and care home admissions, as well as huge personal costs to the individuals affected. So urgent action is necessary to ensure that falls prevention becomes a priority.
A national initiative is required to dispel the myths, raise awareness of the best methods to prevent falls, and more resources need to be directed at increasing access and uptake to strength and balance exercise classes in the community.
All acute, community and care home facilities should be able to access falls prevention services to ensure that those at high risk, or with a history of falls, can be holistically assessed and effective strategies put in place to prevent further or more serious falls. Such efforts could lead to great health benefits and reduced overall costs.
As a society the UK will soon have more older people than children and more people over the age of 80 than ever before. By preventing falls we can not only ensure that older people live a healthier and longer life in their own home. We can also help reduce a huge and rising burden on health and social care.
- More information on falls prevention can be found at ProFouND, a EU-funded initiative dedicated to the dissemination of best practice in falls prevention across Europe.