Strengths and Weaknesses of Strengths and Weaknesses of

Falls Prevention Strategies Falls Prevention Strategies

Dr Dawn Skelton,

Reader in Ageing & Health, Glasgow Caledonian University

My presentation will….My presentation will….

�� Very briefly explore the prevalence and Very briefly explore the prevalence and consequences of fallsconsequences of falls

�� Discuss the evidence base in relation to Discuss the evidence base in relation to single interventions and populationsingle interventions and population--based based interventionsinterventions–– Strengths and WeaknessesStrengths and Weaknesses

�� Very briefly explore the gaps in the evidence Very briefly explore the gaps in the evidence base base

�� Be available to downloadBe available to download

Prevention of Falls Network Prevention of Falls Network

Europe (ProFaNE)Europe (ProFaNE)

www.profane.eu.orgwww.profane.eu.org

Discussion BoardDiscussion Board

ResourcesResources

InformationInformation

22--Monthly eMonthly e--newsletternewsletter

Figure 9. Mortality rate (age standardised - per 100,000) due to

falls in the elderly (65+) in the EU25 and EEA, in countries having

less than 10% "Other and unspecified" (Table 1)

164.5

112.2

94.9

89.1

73

66.4

65.3

61.7

57.8

50.3

38.9

35.1

33.1

24.8

14.4

0 20 40 60 80 100 120 140 160 180

Hungary

Czech Republic

Finland

Slovenia

Italy

Poland

Latvia

Ireland

Belgium

Austria

Iceland

Li thuania

Slovakia

Estonia

Greece

European Network on Safety among Elderly (EUNESE)

Priorities for Elderly Safety in Europe 2006

10 fold difference in mortality from falls in different EU countries

Falls in the UKFalls in the UK

�� 11 million people aged > 65 yrs11 million people aged > 65 yrs

�� 28,000 women aged > 90 yrs28,000 women aged > 90 yrs

�� Fractures costs Fractures costs ££1.81.8 billion pabillion pa

�� 1 Hip Fracture every 10 1 Hip Fracture every 10 minsmins

�� 1 Wrist Fracture every 9 1 Wrist Fracture every 9 minsmins

�� 1 Spine Fracture every 3 1 Spine Fracture every 3 minsmins

�� 500 admitted to Hospital every day500 admitted to Hospital every day

�� 3333 never go homenever go homeAnnual European Home and Leisure Accident Surveillance Survey (EHLASS) Report UK 2000

DoH Prevention Package 2009

How common are falls?How common are falls?

�� In In > 75s> 75s, falls are the leading cause , falls are the leading cause of of deathdeath resulting from injuryresulting from injury

�� 7575--80%80% of falls are not reportedof falls are not reported

�� 1 in 3 >65’s1 in 3 >65’s and 1 in 2 >80’s fall p.a.and 1 in 2 >80’s fall p.a.

�� 10%10% of all callof all call--outs for outs for UK UK Ambulance ServiceAmbulance Service are for people are for people aged 65+ who have ‘fallen’ but aged 65+ who have ‘fallen’ but nearly nearly half half are not taken to Hospital.are not taken to Hospital.

Skelton & Todd, WHO 2004, Gillespie 2005, Close 2008

EPIDEMIOLOGY OF FALLING EPIDEMIOLOGY OF FALLING

cont.cont.

�� Falls more common in people with Falls more common in people with multiple medical multiple medical conditionsconditions and with and with poor function and mobilitypoor function and mobility

�� There are There are global variationsglobal variations in fall rates (in fall rates (egeg China 6China 6--20%, 20%, Japan 20%), and few figures are available for developing Japan 20%), and few figures are available for developing worldworld

�� Appear to be Appear to be racial differencesracial differences in likelihood of a fall (white in likelihood of a fall (white Caucasians particularly at risk)Caucasians particularly at risk)

�� WomenWomen are more likely to fall than men, and to suffer are more likely to fall than men, and to suffer nonnon--fatal injuries (higher risk of osteoporosis)fatal injuries (higher risk of osteoporosis)

�� Social deprivationSocial deprivation linked to linked to nocturia nocturia and falls at nightand falls at night(WHO 2007, Booth 2009)(WHO 2007, Booth 2009)

With thanks to Dr David Reid, University of Aberdeen & NOS

Consequences of Hip FractureConsequences of Hip Fracture

�� By Year 2030 expected 100,000 By Year 2030 expected 100,000

hip fractures a year.hip fractures a year.

�� RiskRisk of a hip # of a hip # 10x10x

higher for those in higher for those in residential residential

settingssettings than in than in own homeown home

�� 50%50% of individuals will die, of individuals will die,

move into a nursing home or move into a nursing home or

be in hospital within be in hospital within sixsix months of Hip #months of Hip #

�� 80%80% do not regain predo not regain pre-- fracture mobilityfracture mobilityDoH Prevention

Package 2009

Cost to the IndividualCost to the Individual

�� InjuriesInjuries include: include:

–– Cuts and lacerations, Cuts and lacerations,

–– Deep bruises, Soft Tissue Injuries,Deep bruises, Soft Tissue Injuries,

–– Dislocations, SprainsDislocations, Sprains

–– Increase in joint painIncrease in joint pain

�� Less than Less than 5%5% of all falls result in a of all falls result in a

fracturefracture

�� Long lie’s (floor) & complications Long lie’s (floor) & complications

�� Depression, fear of fallingDepression, fear of falling

�� Avoidance of activitiesAvoidance of activities and social and social

isolationisolation

Skelton & Todd, WHO, 2004

When do we become “fallers” When do we become “fallers”

instead of “trippers”?instead of “trippers”?

Fracture site changes

with age, wrist

fractures more common

in younger people, hip

fractures more common

in older people

Reaction times and gait

speed slows, balance

deteriorates, strength

reduces…..

Functional Ability in older ageFunctional Ability in older age

�� Strength (1 % to 2% p.a.)Strength (1 % to 2% p.a.)

�� Power (3% to 4% p.a.)Power (3% to 4% p.a.)

�� Bone density (Women:1% to 3%, Bone density (Women:1% to 3%, Men:0.4% p.a.)Men:0.4% p.a.)

�� Balance, Coordination and Balance, Coordination and reactionreaction

�� Transfer skillsTransfer skills

�� Maintenance of temperature Maintenance of temperature controlcontrol

�� Vision, hearing and other balance Vision, hearing and other balance sensory inputssensory inputs

EVEN HEALTHY OLDER PEOPLE LOSE...EVEN HEALTHY OLDER PEOPLE LOSE...

SedentarySedentary behaviourbehaviour increases the loss of performance...increases the loss of performance...

Falls Prevention ApproachesFalls Prevention Approaches

�� Individual Approach (high risk patients) Individual Approach (high risk patients)

–– MultiMulti--factorial (factorial (egeg. PROFET . PROFET -- Close et al, 1999Close et al, 1999))

�� 2004 Review 2004 Review -- MultifactorialMultifactorial trials reduce risk (RR 0.82) Chang 2004trials reduce risk (RR 0.82) Chang 2004

�� 2008 Review 2008 Review -- MultifactorialMultifactorial trials ineffective trials ineffective -- Gates 2008Gates 2008

–– UniUni--factorial (factorial (egeg.. FaMEFaME -- Skelton et al, 2005Skelton et al, 2005))

�� Exercise only trials reduce risk (RR 0.86) Chang 2004Exercise only trials reduce risk (RR 0.86) Chang 2004

�� Pacemakers, Cataract Removal, Medication Withdrawal Pacemakers, Cataract Removal, Medication Withdrawal

�� Population based approach (targeting communities)Population based approach (targeting communities)

–– Emerging evidence (Emerging evidence (McClure, 2005McClure, 2005))

–– Most include increasing awareness and Most include increasing awareness and physical activityphysical activity, ,

medication and home hazard reviewsmedication and home hazard reviews

�� Reductions in injuries 6Reductions in injuries 6--33% but no 33% but no RCTsRCTs

Falls ClinicsFalls Clinics

�� Geriatrician, Geriatrician, PhysioPhysio, OT, nurse, OT, nurse

�� StrengthsStrengths: Intensive CGA assessment and onward : Intensive CGA assessment and onward referralreferral–– Intended interventions not always undertakenIntended interventions not always undertaken

–– Not always evidence based interventions Not always evidence based interventions

� Weaknesses: different messages from different professionals, lots of double handling and assessment but little ‘action’, lots of waiting around, concern about institutionalisation….lots of DNAs…

� Reports of attendance suggest that the population reach of fall clinics is low (<3% of the population at risk)

Lamb 2008, Gates 2008

OT InterventionOT Intervention

Cumming et al, JAGS 1999 - 65+ years, 1 year, n= 530, RCT- OT home visit < 3 wks hospital discharge- list of recommendations and telephone call 2 wks later - Subjects with fall(s): 36% vs 45% [p=0.05]

Interactive interventions delivered by professionals involving older people in discussion around falls, behaviour and lifestyle are more

successful with high risk groups

(WHO 2007)

Objective 1: Improve outcomes and improve efficiency of care after hip

fractures – by following the 6 “Blue

Book” standards

Hip

fracture patients

Objective 2: Respond to the first

fracture, prevent the second – through

Fracture Liaison Services in acute and primary care

Non-hip fragility fracture patients

Objective 3: Early intervention to restore

independence – through falls care pathway linking acute and

urgent care services to

secondary falls prevention

Individuals at high risk

of 1st fragility fracture or other injurious falls

Objective 4: Prevent frailty, preserve bone health, reduce accidents –

through preserving physical

activity, healthy lifestyles and reducing environmental hazards

Older people

DH 2009: falls & fracture care & DH 2009: falls & fracture care &

prevention: four key objectivesprevention: four key objectives

–– Consider major modifiable Consider major modifiable risk factorsrisk factors

–– Consider bone health / Consider bone health / risk of fracturerisk of fracture

–– Consider if onward Consider if onward referral necessaryreferral necessary

–– Not be repeated by Not be repeated by everyone that comes into everyone that comes into contact with an older contact with an older person!person!

–– Lead to effective Lead to effective interventionsinterventions

–– Be predictive??Be predictive??

Oliver 2009Oliver 2009

Falls prediction tools in Falls prediction tools in

different settingsdifferent settings

�� Systematic review of tools to predict falls (up to June 2004)Systematic review of tools to predict falls (up to June 2004)

�� Validity and reliabilityValidity and reliability

�� Wide range of tools and settingsWide range of tools and settings

–– Community setting Community setting –– 23 tools (14 studies)23 tools (14 studies)

–– Acute setting Acute setting –– 8 tools (12 studies)8 tools (12 studies)

–– Long term care setting Long term care setting –– 10 tools (6 studies)10 tools (6 studies)

�� Of the 38 tools Of the 38 tools

–– 11 were 11 were multifactorialmultifactorial toolstools

–– 27 were functional mobility assessment tools27 were functional mobility assessment tools

�� Few tools were found that were tested more than once or in more Few tools were found that were tested more than once or in more than one settingthan one setting

�� No single tool can be recommended for use in all settings or forNo single tool can be recommended for use in all settings or for all all subpopulations within each settingsubpopulations within each setting..

Scott V et al. Age Ageing. 2007; 36:Scott V et al. Age Ageing. 2007; 36: 130130--99

Systematic reviews of tools Systematic reviews of tools

that predict risk of a future fallthat predict risk of a future fall

�� Myers H 2003Myers H 2003

�� Oliver D et al 2004Oliver D et al 2004

�� Scott V et al 2007Scott V et al 2007

�� Hill K and Haines T 2008Hill K and Haines T 2008

�� All cast doubt on predictive validity of falls toolsAll cast doubt on predictive validity of falls tools

�� And show up the almost total lack of validated tools And show up the almost total lack of validated tools

in community or nursing home or mental health in community or nursing home or mental health

settingsetting

So what about case So what about case

finding for bone fragility?finding for bone fragility?

Used to determine 10 year fracture risk in community dwelling adults –

then NOGG suggests guidance on treatment

How useful is the fracture Risk How useful is the fracture Risk

Assessment Tool (FRAX) in a falls clinic Assessment Tool (FRAX) in a falls clinic

population?population?

�� NOGG advice (DEXA or treat) followed:NOGG advice (DEXA or treat) followed:

–– 46% (n=6) of those with OP at either spine and/or hip would 46% (n=6) of those with OP at either spine and/or hip would not be treated or advised a DEXAnot be treated or advised a DEXA

–– Of those where DEXA was advised (n=18), 72% did not have Of those where DEXA was advised (n=18), 72% did not have osteoporosis (n=13)osteoporosis (n=13)

–– Treatment advised in 2 patients both of whom had osteoporosis Treatment advised in 2 patients both of whom had osteoporosis on subsequent DEXAon subsequent DEXA

�� McCarthy C, Skelton DA,McCarthy C, Skelton DA, GallacherGallacher S, Mitchell LE S, Mitchell LE �� Abstract presented at 10Abstract presented at 10thth National Conference on Postural Stability and Falls, National Conference on Postural Stability and Falls,

Blackpool, 07/09/09Blackpool, 07/09/09

Tools to target your Tools to target your

intervention intervention egeg. .

Balance and Strength Exercise (group or home) /

Walking aids

Lower Urinary Tract Symptoms Continence training /

Surgical / Medical

Fear of Falling CBT / Counselling /

Exercise / Hip Protectors

Vestibular Function Vestibular Rehabilitation Exercise

Surgery

Postural Hypotension Pre-transfer exercise / Behavioural

Surgical stockings / Medical

Vision Surgery / Glasses / OT

Foot health Chiropody / Insoles / Surgery

……

Different costs to interventionsDavis 2010

Weaknesses in EvidenceWeaknesses in Evidence

�� Falls definitionFalls definition

�� Consensus on outcome measuresConsensus on outcome measures

�� Consensus on reporting intervention detailConsensus on reporting intervention detail

�� ? Fall per unit of activity ? Fall per unit of activity –– exposure to riskexposure to risk

�� Different models of delivery?Different models of delivery?

�� Cost effectiveness and utility reporting rareCost effectiveness and utility reporting rare

�� Poor fidelity at implementation (Poor fidelity at implementation (egeg. 12 week exercise . 12 week exercise

programme programme ��))Lamb 2005, 2008,

Skelton & Todd 2004

Exercise to Prevent FallsExercise to Prevent Falls

Exercise Exercise couldcould help fallers in a number of ways:help fallers in a number of ways:

�� Reducing Falls (or injurious falls) Reducing Falls (or injurious falls)

�� Reducing known Risk Factors for Reducing known Risk Factors for

Falls Falls

�� Reducing Fractures ? (or changing Reducing Fractures ? (or changing

the site of fracture)the site of fracture)

�� Increasing Quality of Life & Social Increasing Quality of Life & Social

ActivitiesActivities

�� Improving bone densityImproving bone density

�� Reducing FearReducing Fear

�� Reducing Long LiesReducing Long Lies

�� Reducing InstitutionalisationReducing Institutionalisation

Sherrington 2008; Skelton & Dinan 1999; NICE 2004

Not all physical activity is Not all physical activity is

safe for fallers!safe for fallers!

�� RCT Increasing physical activity in RCT Increasing physical activity in

people with previous upper arm people with previous upper arm

fracturefracture

�� Intervention: Brisk walkingIntervention: Brisk walking

�� Control: exercise of upper armControl: exercise of upper arm

�� Falls risk Falls risk ↑↑ (Brisk walking > control)(Brisk walking > control)

�� Fracture risk Fracture risk ↑↑ (Brisk walking > (Brisk walking >

control)control)

�� Beware unsafe pavements!Beware unsafe pavements!

Ebrahim et al. (1997)

NICE 2004 do not recommend brisk walking!

Tai Chi Tai Chi –– secondary secondary prevention in younger years ?prevention in younger years ?

-- Community Dwelling older people Community Dwelling older people -- mild deficits of strength/balancemild deficits of strength/balance-- 2x/week for 15 weeks2x/week for 15 weeks–– Cut trip and fall rate byCut trip and fall rate by halfhalf

- Frail older adults aged 70-97- 2 x/week for 48 weeks- no significant reduction in risk of falls

Wolf et al. J Am Wolf et al. J Am Wolf et al. J Am Wolf et al. J Am GeriatGeriatGeriatGeriat Soc 2003; 55: 1693Soc 2003; 55: 1693Soc 2003; 55: 1693Soc 2003; 55: 1693----1701170117011701

Wolf et al. Wolf et al. Wolf et al. Wolf et al. Wolf et al. Wolf et al. Wolf et al. Wolf et al. (1996)(1996)(1996)(1996)(1996)(1996)(1996)(1996)

- Community Dwelling older people aged 70+ Community Dwelling older people aged 70+ Community Dwelling older people aged 70+ Community Dwelling older people aged 70+ - 3 x/week for 24 weeks3 x/week for 24 weeks3 x/week for 24 weeks3 x/week for 24 weeks

- IncreasedIncreasedIncreasedIncreased Falls SelfFalls SelfFalls SelfFalls Self----EfficacyEfficacyEfficacyEfficacy (ABC) and (ABC) and (ABC) and (ABC) and DecreasedDecreasedDecreasedDecreased Fear of FallingFear of FallingFear of FallingFear of Falling (SAFFE) (SAFFE) (SAFFE) (SAFFE) Li et al. J Li et al. J Li et al. J Li et al. J Li et al. J Li et al. J Li et al. J Li et al. J GerontolGerontolGerontolGerontolGerontolGerontolGerontolGerontol B B B B B B B B PsycholPsycholPsycholPsycholPsycholPsycholPsycholPsychol SciSciSciSciSciSciSciSci Soc Soc Soc Soc Soc Soc Soc Soc SciSciSciSciSciSciSciSci 2005; 60:P342005; 60:P342005; 60:P342005; 60:P342005; 60:P342005; 60:P342005; 60:P342005; 60:P34--------4040404040404040

Overall (I-squared = 61.5%, p = 0.000)

Ebrahim, 1997

Barnett, 2003

Woo, Tai Chi, 2007

Luukinen, 2007

Campbell, 2005

Schoenfelder, 2000

Sihvonen, 2004

Lord, 2003

Buchner, 1997

Author,

Nowalk, Tai Chi, 2001

Mulrow, 1994

Day, 2002

Reinsch, 1992

Skelton, 2005

Wolf, Balance, 1996

Woo, Resistance, 2007

Wolf, Tai Chi, 1996

year

McMurdo, 1997

Korpelainen, 2006

Morgan, 2004

Campbell, 1999

Hauer, 2001

Voukelatos, 2007

Faber, Functional walking, 2006

Li, 2005

Lord, 1995

Schnelle, 2003

Steinberg, 2000

Faber, Tai Chi, 2006

Liu-Ambrose, Resistance, 2004

Lin, 2007

Bunout, 2005

Liu-Ambrose, Agility, 2004

Resnick, 2002

Latham, 2003

Madureira, 2007

Carter, 2002

Green, 2002

Toulotte, 2003

Wolf, 2003

Cerny, 1998

Sakamoto, 2006Rubenstein, 2000

Means, 2005

Protas, 2006

Suzuki, 2004

Campbell, 1997

Nowalk, Resist./Endurance, 2001

Robertson, 2001

0.83 (0.75, 0.91)

1.29 (0.90, 1.83)

0.60 (0.36, 0.99)

0.49 (0.24, 0.99)

0.93 (0.80, 1.09)

1.15 (0.82, 1.61)

3.06 (1.61, 5.82)

0.38 (0.17, 0.87)

0.78 (0.62, 0.99)

0.61 (0.40, 0.94)

Effect

0.77 (0.46, 1.28)

1.26 (0.90, 1.76)

0.82 (0.70, 0.97)

1.24 (0.77, 1.98)

0.69 (0.50, 0.96)

0.98 (0.71, 1.34)

0.78 (0.41, 1.48)

0.51 (0.36, 0.72)

size (95% CI)

0.53 (0.28, 0.98)

0.79 (0.59, 1.05)

1.05 (0.66, 1.68)

0.87 (0.36, 2.10)

0.75 (0.46, 1.25)

0.67 (0.46, 0.97)

1.32 (1.03, 1.69)

0.45 (0.33, 0.62)

0.85 (0.57, 1.27)

0.62 (0.38, 1.00)

0.90 (0.79, 1.03)

0.96 (0.76, 1.22)

1.80 (0.67, 4.85)

0.67 (0.32, 1.41)

1.22 (0.70, 2.14)

1.03 (0.36, 2.98)

0.71 (0.04, 11.58)

1.08 (0.87, 1.35)

0.48 (0.25, 0.93)

0.88 (0.32, 2.41)

1.34 (0.87, 2.07)

0.08 (0.00, 1.37)

0.75 (0.52, 1.08)

0.87 (0.17, 4.29)

0.82 (0.64, 1.04)0.90 (0.42, 1.91)

0.41 (0.21, 0.77)

0.62 (0.26, 1.48)

0.35 (0.14, 0.90)

0.68 (0.52, 0.89)

0.96 (0.63, 1.46)

0.54 (0.32, 0.91)

100.00

2.64

1.88

1.22

3.85

2.74

1.40

0.98

3.38

2.21

%

1.88

2.75

3.80

2.04

2.81

2.86

1.41

2.67

Weight

1.48

3.05

2.04

0.88

1.89

2.56

3.31

2.87

2.38

1.98

3.97

3.34

0.72

1.13

1.67

0.65

0.11

3.46

1.34

0.70

2.21

0.10

2.58

0.31

3.341.11

1.40

0.88

0.80

3.13

2.27

1.84

0.83 (0.75, 0.91)

1.29 (0.90, 1.83)

0.60 (0.36, 0.99)

0.49 (0.24, 0.99)

0.93 (0.80, 1.09)

1.15 (0.82, 1.61)

3.06 (1.61, 5.82)

0.38 (0.17, 0.87)

0.78 (0.62, 0.99)

0.61 (0.40, 0.94)

Effect

0.77 (0.46, 1.28)

1.26 (0.90, 1.76)

0.82 (0.70, 0.97)

1.24 (0.77, 1.98)

0.69 (0.50, 0.96)

0.98 (0.71, 1.34)

0.78 (0.41, 1.48)

0.51 (0.36, 0.72)

size (95% CI)

0.53 (0.28, 0.98)

0.79 (0.59, 1.05)

1.05 (0.66, 1.68)

0.87 (0.36, 2.10)

0.75 (0.46, 1.25)

0.67 (0.46, 0.97)

1.32 (1.03, 1.69)

0.45 (0.33, 0.62)

0.85 (0.57, 1.27)

0.62 (0.38, 1.00)

0.90 (0.79, 1.03)

0.96 (0.76, 1.22)

1.80 (0.67, 4.85)

0.67 (0.32, 1.41)

1.22 (0.70, 2.14)

1.03 (0.36, 2.98)

0.71 (0.04, 11.58)

1.08 (0.87, 1.35)

0.48 (0.25, 0.93)

0.88 (0.32, 2.41)

1.34 (0.87, 2.07)

0.08 (0.00, 1.37)

0.75 (0.52, 1.08)

0.87 (0.17, 4.29)

0.82 (0.64, 1.04)0.90 (0.42, 1.91)

0.41 (0.21, 0.77)

0.62 (0.26, 1.48)

0.35 (0.14, 0.90)

0.68 (0.52, 0.89)

0.96 (0.63, 1.46)

0.54 (0.32, 0.91)

100.00

2.64

1.88

1.22

3.85

2.74

1.40

0.98

3.38

2.21

%

1.88

2.75

3.80

2.04

2.81

2.86

1.41

2.67

Weight

1.48

3.05

2.04

0.88

1.89

2.56

3.31

2.87

2.38

1.98

3.97

3.34

0.72

1.13

1.67

0.65

0.11

3.46

1.34

0.70

2.21

0.10

2.58

0.31

3.341.11

1.40

0.88

0.80

3.13

2.27

1.84

Favours exercise Favours control

1.25 .5 1 2 4

RR = 0.8395%CI 0.75-0.91

P<0.001

17%

reduction

in falls

ResultsResults

I² = 62% moderate

heterogeneity

Sherrington et al., JAGS 2008

Highly challenging Balance TrainingHighly challenging Balance Training

�� Exercise in standing involving:Exercise in standing involving:

–– movement of the centre of massmovement of the centre of mass

–– narrowing of the base of supportnarrowing of the base of support

–– minimisingminimising upper limb supportupper limb support

24%

RR 0.76(95%CI =0.62 to 0.93)

Sherrington et al., JAGS 2008

High DoseHigh Dose

�� 50+ hours 50+ hours

–– At least 2 hours a week of exercise At least 2 hours a week of exercise for at least 6 monthsfor at least 6 months

–– Home or groupHome or group--based or a based or a combination of bothcombination of both

20%

RR 0.80(95%CI =0.65 to 0.99)

Sherrington et al., JAGS 2008

No reduction:

RR 0.95 (0.78 to 1.16)

No reduction:

RR 0.96 (0.80 to 1.16)

No reduction:

RR 0.91 (0.79 to 1.05)

Increased risk: RR 1.20 (1.00 to 1.44)

High balanceLow dose

Walking

Low balanceLow dose

Walking

Low balanceLow dose

No walking

Low balance

High doseWalking

Reducing barriersReducing barriers

��Walk from Home Walk from Home

��Keighley Peer MentorsKeighley Peer Mentors

Mary Moffat Mary Moffat -- 9393

–– Referred by physio after a fallReferred by physio after a fall

–– Loss of confidence and fear of Loss of confidence and fear of

fallingfalling

–– Isolated and lonely and Isolated and lonely and

dependent upon others to get dependent upon others to get

outout

Wider Benefits of ExerciseWider Benefits of Exercise

�� PsychologicalPsychological

–– Anxiety, depression, sleep, fear of fallingAnxiety, depression, sleep, fear of falling

�� PhysiologicalPhysiological

–– Maintain bone density, ability to perform everyday Maintain bone density, ability to perform everyday activities, reduce breathlessness, reduce stiffness and activities, reduce breathlessness, reduce stiffness and

chance of injurychance of injury

�� PsychosocialPsychosocial

–– Isolation, social contacts, peer support, playing with Isolation, social contacts, peer support, playing with grandchildren, using the bathgrandchildren, using the bath

�� Even the very frailEven the very frail

–– DVT, constipation, transfer skills DVT, constipation, transfer skills

Gaps in evidence….Gaps in evidence….

� Patient concordance and presentation of information

� Fear of falling and activity avoidance

� Ethnicity and Socioeconomic deprivation

� Reducing falls and injury in stroke, parkinson’s, dementia….

� Different professionals or models of delivery

� Different models of exercise (home vs group, games for health) and

necessary duration / intensity / frequency and type

� Different exercise in different population groups?

� Value of falls prevention on other outcomes (quality of life, depression,

other syndromes of ageing)

� Getting people to USE fall alarms

� Tele-health and technology opportunities

New technologies ?

•• Whole Body Vibration Whole Body Vibration •• 66 mthsmths, 3 x p/w, 3 x p/w

•• postpost--menopausal women menopausal women •• Strength 15%, Balance 20%,Strength 15%, Balance 20%,•• Hip BMD 1%Hip BMD 1%

VerschuerenVerschueren SM et al. 2004SM et al. 2004

Wii-fit (Nintendo) ?

Glasgow SECC Aug 13Glasgow SECC Aug 13--1717thth 20122012

www.wcaa2012.comwww.wcaa2012.com

dawn.dawn.skeltonskelton@@gcalgcal.ac..ac.ukuk