The Problem
Everyone knows that falling over is a problem. You are left with ruined clothes, bruises and a bit of embarrassment, but it’s almost always immediately forgotten.
However, I’m not talking about stumbling over after one too many down the pub. I am talking about a very real threat to life.
Falls are the leading cause of injury-related death in adults over 65, and even more disturbingly the rate is increasing; in fact it has risen 30% in the last 10 years.
More alarmingly, one third of those over 65 fall at least once per year, rising to 50% for those over 80 (yet they still continue to raise retirement age!). Let me hit you with some more statistics.
Falling can have consequences more severe than embarrassment. Hip fractures, apart from being very painful, have a significant impact on independence and ability to function. The likelihood of dying within a year of a fractured hip is 33% (1 year mortality rate). (Reference)
Falls are estimated to cost the NHS £2.3 BILLION per year, not including the huge cost of social care required afterwards. (Reference)
The ambulance service receives 700,000 calls per year (10% of total calls) from older adults who have suffered a fall. (Reference)
Why is this an issue now? “Its a global pandemic don’t you know?!”
I could write an essay on this but I will try and keep things succinct.:
1) People don’t stop falling because there’s a pandemic
2) Lots of beds are taken up by Covid patients therefore less beds for those who need emergency orthopaedic care
3) Older adults are scared to use the NHS for routine services during this time, meaning they are less likely to seek help for issues such as dizziness, mobility issues, eyesight issues or blood pressure issues until it’s too late
4) Older adults have been locked in their homes for pretty much a year, and less exercise means much higher risk of falls (reference)
5) Organised sport, exercise classes, gyms and pretty much all routine health services are currently not running
6) Mental health is at an all time low, which can lead to poor coping mechanisms such as substance and alcohol abuse, which are intrinsically linked to a higher risk of falls
7) Many older adults do not have the same support network as usual, and are becoming increasingly isolated. Those living alone are far more likely to be adversely effected by a fall due to a “long lie” – being unable to get up off the floor for hours, sometimes days (yes, days).
Falls are not normal or inevitable, and they do not just effect older people.
Falling is, actually, very complicated. It’s complicated because there are many risk factors.
In fact, over 25 different risk factors have been identified from dozens of studies.
These include:
– Medical conditions (Parkinson’s or dementia)
– Certain medications, especially in combination (for example the medications for cardiovascular disease or depression)
– Poor eyesight
– Loss of muscle strength and balance
– Environmental hazards (ill-fitting shoes, poor lighting, slippery surfaces)
– Lifestyle factors (excessive alcohol, physical inactivity).
But while the problem is complex, it’s not inevitable.
Falls are not a “normal” part of ageing and many can be prevented, using interventions that are evidence-based and effective. In fact, there have been over 200 randomised controlled trials of interventions for preventing falls in older people. Unfortunately, people often do not realise the potential consequences of falling until it is too late.
What can we do about it?
Prevention prevention prevention!
Guidelines from the National Institute for Health and Care Excellence (NICE) highlight interventions that are likely to be beneficial. They include a programme of muscle strengthening and balance training, as well as a comprehensive multifactorial risk assessment that includes the factors mentioned above.
Unfortunately, there will be huge secondary healthcare effects of this pandemic; and unfortunately, the devastating effect of falls will be one of them.
So now you are aware: Falls are a HUGE problem – significantly reducing the life expectancy and quality of life for older adults, not to mention the devastating economic impact. I will be continuing the discussion on what we can do to reduce the incidence of falls related issues in my next blog post, so stay tuned!
Thanks again for reading,
Jack Howard