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Falls can be prevented – help your older patients prevent falls and stay independent

Falls are common in older people but they can be prevented. Do your older patients relate to either of the following risk factors?

  • Having had a fall
  • Conditions that impact mobility such as diabetes, stroke, arthritis
  • Dizziness
  • Urge incontinence
  • Unsteadiness when walking or stepping onto a curb
  • Vision impairment
  • Clutter in the home

 

Project Update

The iSOLVE project, a partnership between the University of Sydney, the NSW Clinical Excellence Commission and Sydney North Primary Health Network (SNPHN), aims to establish integrated processes and pathways between general practice, allied health services and programs to identify older people at risk of falls and engage a whole of primary care approach to falls prevention.

Prof Lindy Clemson and a team of multidisciplinary researchers including GPs have developed a clinical decision tool and resources based on the latest research evidence and practice guidelines1-3. We anticipate that these will help GPs and practice nurses identify people at risk of falling and provide tailored management options. GPs are also offered a directory of trained fall prevention service providers in their local area to facilitate patient referral.

The clinical decision tool, resources and referral directory are being offered to GP practices as part of a trial, which is currently ongoing with a final number of 27 GP practices taking part (click here for research protocol paper). Practices are welcome to express interest through SNPHN or to project coordinator, Amy Tan at amy.tan@sydney.edu.au or on 02 9036 7463. See flyer below for further information and resources provided as part of the trial.

SNPHN offered various workshops throughout 2016 to health service providers to facilitate referral pathways and implementation of evidence-based fall prevention interventions. Workshops that have been delivered to date include:

  • Exercise Interventions to Prevent Falls
  • Home Environment Interventions for Preventing Falls
  • Medication Management for Preventing Falls
  • Lifestyle-Integrated Functional Exercise (LiFE) for Preventing Falls
  • Preventing Falls from the Ground Up (Foot and Ankle Interventions)

SNPHN will continue to promote future fall prevention workshops through the Education Events page.

Partners and investigators

Prof Lindy Clemson, University of Sydney (Project leader)
Sydney North Health Network (Partner, contact: Cynthia Stanton)
Clinical Excellence Commission (Partner, contact: Lorraine Lovitt)
Assoc Prof Christopher Roberts, University of Sydney
Prof Dimity Pond, University of Newcastle
Prof Catherine Sherrington, The George Institute for Global Health
Assoc Prof David Peiris, The George Institute for Global Health
Assoc Prof Roslyn Poulos, University of New South Wales
Assoc Prof Lynette Mackenzie, University of Sydney
Prof Karen Willis, Australian Catholic University
Dr Sabrina Pit, University of Sydney
Dr Mary Lam, University of Sydney
Dr Meryl Lovarini, University of Sydney
Assoc Prof Anne Tiedemann, The George Institute for Global Health
Prof Judy Simpson, University of Sydney
Dr Kenneth Chung, University of Sydney

Project aims

  • To establish integrated processes and referral pathways at levels of GP practice and allied health services to identify older people at risk of falls and engage a whole of primary care approach to fall prevention.
  • To form collaborative, information rich, working arrangements with GPs and allied health service providers.
  • To improve access to appropriate fall prevention interventions for older people, ensure ongoing knowledge acquisition and sustainable action by healthcare professionals and organisations, using a multidisciplinary team approach to fall prevention that is integrated and translatable nationally.

Falls and their economic impact

  • Fall-related injuries accounted for the majority of all hospitalised injury cases among people aged 65 and over.4
  • Hospitalisation rates in Northern Sydney have been consistently higher than the NSW average. In 2011-12, the rate of hospitalisations from falls was 5,362 per year per 100,000 population in the Northern Sydney LHD.5
  • The total cost of treatment and health care, associated with falls in persons aged 65 years and older, was estimated at $558.5 million in 2006/07. This was almost five per cent of the NSW health budget in that year.6
  • One in every 10 days spent in hospital by a person aged 65 and older in 2009-10 was directly attributable to an injurious fall, equating to 1.3 million patient days over the year. The average total length of stay per fall injury case was estimated to be 15.5 days.7

Evidence & recommended solutions

  • There is strong evidence that balance and strength exercises, home safety interventions and medication reviews are effective in preventing falls in older people. These are three core effective strategies recommended in the latest Cochrane Database of Systematic Reviews on Fall Prevention Interventions for older people living at home.1
  • A meta-analysis of exercise interventions for fall prevention by Associate Professor Cathie Sherrington found that exercise reduced the risk of falling by 17%.8
  • Professor Lindy Clemson conducted a meta-analysis of randomised trials of environmental interventions and found a significant reduction in the risk of falling of 21%, with higher effects for those frailer or recently hospitalised.9
  • Dr Sabrina Pit led a successful randomised trial which demonstrated the value of medication reviews by GPs who had been updated on fall risks by a trained pharmacist.10

Implementation barriers to fall prevention strategies

  • Older people think that a fall may just be a part of ‘ageing’ and do not think that they can actively do things to prevent a future fall.
  • A lack of engagement of multiple stakeholders in falls prevention.
  • Health providers reported a lack of consultation time, the need to focus on more pressing health issues, and a lack of educational materials.
  • Too few community-based organisations regularly offer evidence-based falls prevention services.
  • There is no clear model for how fall prevention services can be effectively delivered in primary care.11

References

1 Gillespie L, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2012;Issue 9:Art. No.: CD007146. DOI: 10.1002/14651858.CD007146.pub3.

2 Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society. 2011 Jan;59(1):148-57.

3 Guidelines for preventive activities in general practice. 8th Edition  Melbourne: The Royal Australian College of General Practitioners (RACGP); 2012; Available from: The Royal Australian College of General Practitioners.

4 Australian Institute of Health and Welfare. Australia’s health 2012. Australia’s health series no. 13. Cat. no. AUS 156. Canberra: AIHW, 2012.

5 Harvey L, Close, JCT. Trends in fall-related hospitalisations, persons aged 65 years and over, NSW, 1998-99 to 2011-12 Sydney: Falls and Injury Prevention Group, Neuroscience Research Australia; 2013. Available from: Neuroscience Research Australia.

6 Watson W, Clapperton A, Mitchell, R. The incidence and cost of falls injury among older people in New South Wales 2006/07. Sydney: NSW Department of Health, 2010.

7 Bradley C. Hospitalisations due to falls by older people, Australia 2009–10. Injury research and statistics series no. 70. Cat. no. INJCAT 146. Canberra: AIHW, 2013.

8 Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JCT. Effective exercise for the prevention of falls: a systematic review and meta-analysis. Journal of the American Geriatrics Society. 2008;56(12):2234-2243.

9 Clemson L, Mackenzie L, Ballinger C, Close JCT, Cumming RG. Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials. Journal of Aging and Health. 2008;20(8):954-971.

10 Pit S, Byles J, Henry D, Holt L, Hansen V, Bowman D. A Quality Use of Medicines program for general practitioners and older people: a cluster randomised controlled trial. The Medical Journal of Australia. 2007;187(1):23-30.

11 Shubert T, Smith ML, Prizer LP, Ory MG. Complexities of fall prevention in clinical settings: a commentary. The Gerontologist. 2013:doi:10.1093/geront/gnt079.