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14/Nov/2019

Fall Prevention Awareness Week – September 24th – 30th 2018

Nothing in life is more inevitable than the fact that one day we will all be old or in need.  When we think of those at falls risk we visualise very frail elderly relatives shuffling around their homes on their own but the reality is that falls impact a much wider population.  30% of all people older than 65 and 50% of all people older than 80 have a fall at least once a year.1

Falls are estimated to cost the NHS over £2.3 billion each year.1 Not only do falls cause pain, immobility and distress to the patient but they also impact on that person’s carer and wider family, which very often are other vulnerable or elderly people.

So, who is at risk?

Risk factors are separated into intrinsic factors, those which are inherent to the person and extrinsic, those which are related to the environment. Intrinsic factors include old age, chronic conditions such as diabetes, dementia and arthritis, previous falls and poor vision or balance. There is very little that can be done about many of the intrinsic factors; good medicine management, correct sight wear and regular testing will all improve someone’s risk of a fall. The extrinsic factors can often be much easier to manage. They include lack of handrails, dim lighting, obstacles or trip hazards and slippery or uneven surfaces. However, is it that simple for a person at falls risk to get handrails fitted or improve the lighting in their home? We all have that odd job that we need to complete at home but very few of us get around to doing it. And how receptive are people at receiving the advice and acting on it. Research suggests many at risk believe it doesn’t apply to them yet or that falling is a part of getting older. Often advice about hazard perception is considered patronising and assumes the person is senile.

The challenge is bigger than first anticipated. So how do we really reduce the risk?

  1. One of the main elements that must be tacked to reduce the risks associate with falls is balance and exercise. This advice is well received by patients and is most effective when incorporated into every day activity or routines. As well as Tai Chi, Otago and LiFE there are a number of tailored exercise programmes that people can follow which if all over 65’s followed would prevent 7,000 unnecessary deaths a year – from hip fractures alone.1
  2. Medication review and regular check-ups are vital for reducing risk. Any recent falls should be recorded and the nature and cause discussed. Medication which cause drowsiness, dizziness, low blood pressure or blurred vision should be identified and if possible taken at a time of day that has the least impact.
  3. Regular sight and hearing tests are simple or organise can both reduce the risk of falls as well as ensuring people can keep their independence and aren’t missing vital information oral and aural.
  4. Those with a good support network of family are friends are also less at risk as they can share their concerns and ask for help when it is needed. People who are more isolated will take partake in more risky behaviours as they try to manage on their own.
  5. The final and most obvious activity that reduces risk is to safe check the home. Removing uneven flooring, rugs and trip hazards and fixing hand rails. Good footwear is also essential to ensure a steady footing.

If these 5 elements were tackled the impact would be substantial not only on the wellbeing of those over 65 but also the cost savings for the NHS through reducing the 4 million hospital bed stays each year in England alone. As healthcare professionals, it is our responsibility to educate those at risk of falls and move our attention to prevention rather than treatment.

References

  1. Age concern – Stop falling
  2. NICE Clinical guideline [CG161]
  3. Age concern- Don’t mention the F-word – 2012

14/Nov/2019

An excuse to do less, or a reason to do more?


We’ll often hear from those living with arthritis…or “suffering” as they will more likely describe it…about what they can no longer do. The pain and stiffness is now a limiting factor and our body’s way of telling us to slow down.

Nitin Makadia


And with new stories always telling us that painkillers are either ineffective, bad for our heart or addictive, it’s understandable we will want to avoid them…but perhaps not tell the doctor!

Sometimes though, I hear the opposite. Someone who will take the full dose (& sometimes more!) of all of their pain medicines just so they can keep going with their busy life…fighting through the pain…it’s not going to defeat them!

Arthritis Research UK are taking a pro-active approach with their ‘Share your Everyday’ campaign, enabling those living with arthritis to share their experiences to allow people to learn from each other: ShareYourEveryday

Just one example of something that can make a huge difference is pacing…doing things steadily over the day and taking time to relax in between.

  • Doing as much as possible as quickly as possible before the pain becomes unbearable will mean getting less done overall, with a heavy reliance on painkillers that should be kept aside for occasional breakthrough pain
  • Putting the brakes on life and doing as little as possible to remain as pain-free as possible will further stiffen the joints, is bad for overall health and the weight gain from inactivity will put more pressure on the back and joints, not to mention leading to a poorer quality of life

But pacing is just one piece of advice out of many. Every individual is different, and of course there are many forms of arthritis that need a tailored approach.

Pharmacists have the most frequent contact with their patients and are therefore perfectly placed to make brief interventions each time. This can be initiated whilst conducting Medicines Use Reviews when there would be the perfect opportunity to open up a conversation, dispelling myths around treatments, addressing concerns around opioid analgesic dependence (& referring where appropriate) and offering lifestyle advice after first listening and understanding…particularly important otherwise we risk giving the right solution to the wrong problem by being efficient instead of effective.

And pharmacists themselves need support…education in the non-medical interventions they can suggest…time to have the conversations…tools to support those conversations. A service I was involved with demonstrated the significant improvement in quality of life that can be achieved…but it needs vision and leadership…and of course funding from commissioners or Pharma partners. But the reward in what we can achieve for our patients reminds us why we are in healthcare.

Those living with arthritis are not looking for an excuse to do less, but without support they won’t know they can, and should, do more.


Evolve Health Solutions can support pharmacists to engage with their pain customers, with appropriate training, support materials, tools and outcome measures. Contact us for more information at hello@evolvehealthsolutions.co.uk


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