Identify frailty by identifying falls- what next?

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1 Identify frailty by identifying falls- what next? Dr Shelagh O Riordan Clinical lead for falls- Royal College of Physicians Consultant Community Geriatrician

2 Frailty

3 Falls can be bad

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5 Describe the fall What is a mechanical fall?

6 I must have tripped. I stood up and next thing I knew I was on the floor. Postural hypotension Slow pulse Carotid sinus hypersensitivity Commoner in dementia Always investigate or refer if suspected Don t miss blackouts

7 Falls prevention in frailty It s complicated It s hard to find the time Not sure how to do it? Does it really make a difference?

8 Evidence behind fall prevention Falls may have multiple causes Need to look for each different cause in each patient Not many things done on their own prevent falls MFRA- multifactorial falls risk assessment Checklist of causes and suggested interventions Not just for specialists! Gait and balance exercises- tailored to the patient is the best intervention

9 Gait and balance exercise classes Falls prevention exercises in one RCT reduced fractures by 60%- better than drugs?

10 How does this all link to management of frailty? Medication r/v Postural hypotension Vision assessment and referrals Continence assessments Cognition assessments OT interventions Physiotherapy Mental health review Social interventions

11 CGA v MFRA

12 #drugswelovetostop Amitryptyline 10mg at night (or any dose!) Tamsulosin in patients with a long term catheter (or not) Bisphosphonates in patient s who have been on them for 10 years or have less than a year to live or who are immobile Diuretics for non-heart failure leg oedema Doxazosin for hypertension Benzos/zopiclone (started in 1987 for insomnia after the cat died)

13 In summary Identify falls as a marker of frailty Preventing falls is possible Preventing falls prevents serious injuries Describe the fall! Not mechanical! Don t forget blackouts Gait and balance interventions mainstay of falls prevention Good falls prevention is good frailty care

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15 NHS England Frailty Webinar Daniel MacIntyre, Population Health Services Manager, PHE

16 Falls and fracture consensus National Falls Prevention Coordination Group Falls and fracture consensus statement - commissioner focussed (but useful to all!) details key interventions, approaches to commissioning plus national commitments for support Falls and fracture consensus statement resource pack comprehensive set of resources and tools to support commissioning and delivery 16

17 Consensus whole system interventions Life course risk factor reduction Case finding and risk assessment Strength and balance exercise programmes Healthy homes High-risk care environments Fracture liaison services Collaborative care for severe injury 17

18 Key points Links between frailty and falling High risk multifactorial intervention Low to moderate risk strength and balance exercise programmes Do NOT use falls risk prediction tools Not all high risk patients are frail Don t lose sight of low to moderate risk patients tomorrow s frail Links between falls and fractures Integrated governance for frailty, falls and fracture 18

19 Case finding Case finding for frailty efi Case finding for falls - falls history (NICE CG161, QS86) - falls injuries, gait and balance deficits - support self-referral - don t mention the F word Case finding for fractures - NICE recommendations large numbers! - FRAX, Qfracture + DXA - fracture liaison services 19

20 Consensus statement resource pack Links to comprehensive collection of resources and tools for all key interventions Extra technical information, evidence of clinical and cost-effectiveness Range of documents - commissioning support resources, relevant clinical guidance and quality standards, research and policy documents and patient information Suites of indicators for local collection Commissioners checklist Extra section on frailty 20