Why is it so difficult to prevent falls? A ProFouND perspective on evidence based fall prevention

Transcription

1 Why is it so difficult to prevent falls? A ProFouND perspective on evidence based fall prevention Chris Todd Professor of Primary Care & Community Health University of Manchester

2 European initiatives Why falls matter Plan of this lecture Falls prevention is efficacious The falls prevention implementation gap ProFouND Making falls a priority Making evidence accessible and implementing best practice

3 European Commission action: European Innovation Partnership on Active & Healthy Ageing Prescription adherence Personalised health management falls prevention Frailty prevention Integrated care Independent living Age friendly environments

4 70+ commitments European Network for FALL Prevention Intervention and Security Lead: Universitat Politechnica de Catalunya 18 partners 21 partners

5

6 Osteoporosis, falls and fractures EVOS/EPOS Group Falls explain betweencenter differences in the incidence of limb fracture across Europe. JBMR 2002 Low BMD is less predictive than risk of falling for future limb fractures in women across Europe. Bone 2005

7 Fatal injuries in the EU amongst older people (65+) by cause and gender EuroSafe/IDB Injuries in the EU (2009)

8 Masud, Morris Age & Ageing 2001; 30-S4 3-7 Rubenstein. Age & Ageing; 2006; 35-S2; ii % community dwelling >65yrs fall in year 40-60% no injury 30-50% minor injury 5-6% major injury (excluding fracture) 5% fractures 1% hip fractures Falls most serious frequent home accident 50% hospital admissions for injury due to fall History of falls a major predictor future fall

9 Masud, Morris Age & Ageing 2001; 30-S4 3-7 Rubenstein. Age & Ageing; 2006; 35-S2; ii % community dwelling >65yrs fall in year 40-60% no injury 30-50% minor injury 5-6% major injury (excluding fracture) 5% fractures 1% hip fractures EU = million population 2012 = 27 million fallers in EU 2030 = 36 million fallers in EU

10 Masud, Morris Age & Ageing 2001; 30-S4 3-7 Rubenstein. Age & Ageing; 2006; 35-S2; ii % community dwelling >65yrs fall in year 40-60% no injury 30-50% minor injury 5-6% major injury (excluding fracture) 5% fractures 1% hip fractures EU = million population Kanis et al Osteo Int 2012; = 27 million fallers in EU 2030 = 36 million fallers in EU

11 Consequences Injury Peripheral fractures Hip fractures Expensive to treat Expensive for patients and families» Money, morbidity, mortality and suffering» 20% die within 90 days» 50% survivors do not regain mobility Psychological and social consequences Disability Admission to long term care Loss of independence Falling most common fear of older people More common than fear of crime or financial fear Leads to activity restriction, medication use

12 Costs of falls Health care expenditure % GDP % per fall victim US$ 2,044-25,955 per fall US$ 1,059-10,913 per fall hospitalisation US$ 5,654-42,840 per inhabitant US$ US$ PPP (purchasing power parity approx x1.25 for ) Heinrich S, Rapp K, Rissmann U Becker C, König H-H. Osteoporos Int :

13 44 trials 9,603 participants Falls can be prevented! Gillespie et al trials participants Multiple-component group exercise RaR 0.71 [ ] RR 0.85 [ ] Multiple-component home-based exercise RaR 0.68 [ ] RR 0.78 [ ] Tai Chi RaR 0.72 [ ] RR 0.71 [ ] Multifactorial intervention individual risk assessment RaR 0.76 [ ] RR 0.93 [ ] Vitamin D RaR 1.00 [ ] RR 0.96 [ ] NB low Vit D Home safety interventions by OT RaR 0.69 [ ] RR 0.79 [ ] RR=0.83 (95%CI ) (High Dose & Challenging RR=0.58 (95%CI ) Sherrington et al JAGS 2008

14 Implementation gap Prevention programmes are efficacious Implementation gap Falls prevention not a priority Older people Professionals Society Services not available Evidence not used or modified Training needs to be challenging, progressive & regular Programmes often too short term High refusal & non-adherence Prevention not effective?

15 Not a priority for older people It s good advice BUT - they wouldn t necessarily act on (all of) it It s all good. I mean its good advice, yes, excellent, I agree. I doesn t mean to say I do it all but I agree. It s good advice - for them - only seen as relevant to elderly Because we re that much fitter -- we don t really take too much notice of it, only for other people, for other disabled or elderly people that we have to watch when we re we always watch older people anyway.

16 Implications for practice Do not present initially to older people in terms of falling prevention (since falling risk denied anyway) Talk in terms of Activity Emphasise/maximise immediate wider Benefits: looking and feeling good; remaining active and independent; taking part in an enjoyable and interesting Communal/social activity Most effective approach is personal invitation from health professional explaining exactly what is involved, benefits. Illness, evidence of increasing Disability provides good opportunity to suggest taking this up. Exercise in terms of everyday activities F word Groups only for some Home based exercise preferred

17

18 Overwhelmed by evidence?

19 Evidence pyramid

20 or

21 What is ProFouND? 21 partners 12 countries (+ 15 associate members) disseminate best practice in falls prevention embed evidence based programmes in at least 10 countries/15 regions by 2015 use internet & ICT to facilitate widespread implementation collate resources library distribute tailored, customised, best practice guidance cascade model e-learning to create cadre of accredited exercise trainers across Europe create PFPApp collect standardised falls data across Europe work with E-NO FALLS to create ICT for Falls Forum work with stakeholders EIP AHA A2 falls prevention

22 1. University of Manchester 2. Glasgow Caledonian University 3. Robert Bosch Gesellschaft für medizinische Forschung 4. Norges Teknisk-Naturvitenskapelige Universitet 5. Later Life Training Ltd 6. EuroSafe European Association for Injury Prevention and Safety Promotion 7. Osteoporosis Betegek Magyarországi Egyesülete 8. Swiss Council for Accident Prevention bfu 9. Instituto de Salud Carlos III 10. Azienda Unità Sanitaria Locale 11 Empoli 11. National Center for Scientific Research "Demokritos" 12. Connected Health Alliance CIC 13. Instituto de Biomecánica de Valencia 14. Fundacio Institut Catala de l'envelliment 15. TEILAM: Technical Educational Institute of Central Greece 16. Johanniter-Unfall-Hilfe in Österreich 17. Istituto Nazionale Riposo e Cura Anziani 18. Regionförbundet i Västerbottens län 19. Jyväskylän Yliopisto 20. Stichting Consument en Veiligheid 21. Achmea B.V.

23 UK Manchester Glasgow Belfast London D Stuttgart NL Amsterdam Leiden FIN Jyväskylä S Umeå I Empoli Ancona E Madrid Barcelona Valencia EL Athens Lamia NO Trondheim CH Zurich Ö Vienna H Budapest

24

25 Downloads for Partners etc.. ProFouND Poster A0 (841 x 1189mm) Flyer (3-fold)

26 Members Profiles

27 EC Stakeholder Organsations

28 Best practice Updated Added by experts in the field Simple search and retrieval «ONE STOP SHOP»

29 Collation of best practice resources

30 English Greek Spanish Norwegian German Dutch Italian Swedish Finnish Hungarian French Polish Turkish

31

32

33

34 Running Falls Awareness Events

35

36 Otago Home Exercise Booklets Translated Evidence based home exercise programme shown to reduce falls with regular use and progression (Campbell & Robertson, 1997, 2001) 7 RCTs in community dwelling older people

37 Postural Stability Home Exercise Booklets Translated Evidence based strength and balance programme shown to reduce falls in frequent fallers and community dwelling older people (Skelton et al. 2005) 2 RCTs, primary and secondary prevention

38 Chair Based Home Exercise Booklets Translated Evidence based strength and flexibility programme shown to improve function in frailer older people (Skelton et al. 1995, 1996) 2 RCTs Preparation for standing balance work

39 Cascade training: train trainers to train older people

40 Training Portal

41 Cascade Training Online

42 ProFouND Falls Prevention App

43 one fall single fall without injury perform up and go test fear of falling good impaired no transfer Provide exercise group or home based program Consider Physiotherapy if yes add CBT Recommend Physical Activity

44 Leaflets are they read?

45 Ability to: App outputs bespoke to suit your setting Nursing home / hospital / community etc Add your logos and contact details Add local information on services and settings

46

47 EU Stakeholder Meeting February 2014 Standing Committee of European Doctors (CPME) European Forum for Primary Care (EFPC) European Federation of National Associations of Orthopaedics and Traumatology European Union Geriatric Medicine Society (EUGMS) Geriatric medicine section UEMS European Association for Directors and Providers of Long-Term Care Services for the Elderly (EDE) European Region of the World Confederation for Physical Therapy (ER-WCPT HEPA Europe (European network for the promotion of health-enhancing physical activity) EuroHealthNet European Public Health Association (EUPHA) European Society for Quality in Health Care European Platform of European Elderly (AGE) Eucomed-Medical Technology Achmea European Commission

48 EU Level Support Group Objectives: Increase visibility and advocacy Empower national member organisations Expand fall awareness

49 Find out more about ProFouND on our website: Follow us on Find us on Facebook and Like our Page to receive updates: profound.eu.com

50

51 WP 1 Chris Todd, Helen Hawley- Hague, (Jo Hobbs) Emma Stanmore, Jane McDermott University of Manchester WP 2 Dawn Skelton, Steve Richardson Glasgow Caledonian University WP 3 Jorunn Helbostad, Kirstin Taraldsen Norwegian National Technical University Trondheim WP 5 Dawn Skelton Later Life Training WP 6 Chris Todd, Helen Hawley- Hague University of Manchester WP 7 Carmel Dickinson Connected Health Alliance WP 8 Wim Rogmans Eurosafe WP 4 Clemens Becker, Karin Kame Robert Bosch Krankenhaus

52 Studies and collaborators L Yardley, F Bishop, University of Southampton, UK N Beyer, Copenhagen University Hospital, Denmark K Hauer, Robert-Bosch-Krankenhaus, Stuttgart & Bethanien- Krankenhaus, University of Heidelberg, Germany G Kempen, R Zijlstra Maastricht University, The Netherlands C Piot-Ziegler, T Cuttelod, University of Lausanne, Switzerland Y Ben-Shlomo, R Gilbert University of Bristol, UK E, Boulton, H Hawley-Hague, M Horne, D Skelton, S Whitehead University of Manchester, UK Older people s views of advice about falls prevention: A qualitative study. Health Education Research (4); Attitudes and beliefs that predict older people s intention to undertake strength and balance training. Journals of Gerontology Series B- Psychological Sciences & Social Sciences. 2007; 62(2): , Encouraging positive attitudes to falls prevention in later life. London: Help the Aged 2005 Older people s views of falls prevention interventions in Six European countries. The Gerontologist (5) Recommendations for promoting the engagement of older people in activities to prevent falls. Quality and Safety in Health Care How likely are older people to take up different falls prevention activities? Preventive Medicine Socio-demographic factors predict the likelihood of not returning home after hospital admission following a fall Journal of Public Health 2010 Are the attitudes of exercise instructors who work with older adults influenced by training and personal characteristics? Journal of Ageing and Physical Activity 2012: The role of the exercise instructor in older adults uptake and adherence to exercise classes Promoting physical activity amongst older people: What if we ask them?

53 Intention to carry.09 out Strength &.87 Balance Training Threat appraisal Fear of falling (FES-I) Perceived vulnerability - risk of falling Perceived severity - consequences of falling Perceived causes of falling Coping appraisal Expected benefits of SBT Expected attitudes of others Expected ability to carry out SBT Identity right to do SBT