Falls in the older adult

Hello!

Todays blog is focusing on the falls in the older adult. The following statistics have come from the CSP’s Physiotherapy Works: Falls a community approach 2019 (1).

  • Fear of falling affects ~50% of older adults who have fallen and up to 50% who have never fallen
  • 1/3 of over 65’s fall at least once a year. This increases to 50% for those over 80
  • Falls with injury = leading cause of mortality
  • Following a fall, 50% of older adults have mobility impairments and there is a 10% probability of dying within a year

This is a shocking figure!

Economically:

  • The cost of falls to the NHS in England due to hazards in the home environment is £435 million (1). 
  • The cost to the NHS is thought to be more than £2.3 billion per year (1).

Effects of lockdown

Lockdown has no doubt lead to increased falls due to reduced mobility and social activities. Ultimately this will lead to more deaths. A hidden killer in COVID times.

A study by UCL (2) has shown that elderly people who live alone and have limited social contact are more likely to fall. They had 13,061 participants with data collection over a period of several years. Those living alone had an 18% greater risk of reporting a fall than those living with a friend or relative. Older adults with the least social contact were 24% more likely to report a fall . During lockdown elderly have been more isolated so this could translate to there being more falls. Studies have shown that mechanical unloading of muscles resulting from periods of inactivity may lead to a transient exacerbation of age‐related muscle waste, increasing the progression of sarcopenia and the development of comorbidities (3) (4) (5). Interestingly an analysis of data from FitBit has shown that there has been a reduction in steps ranging from 7%-38% in European countries during the week ending 22nd March 2020 (5)(6). Lockdown has definitely resulted in reduced activity for all. Although its too soon to learn the real cost of COVID on the elderly in relation to falls, its clear that it could be high.

What can we do?

We know that Physiotherapy can help:

  • Physio can result in a 24% reduction in falls with a multi-factorial falls assessment
  • Providing an exercise programme can result in a 34% reduction in falls
  • This can reduce fear of falls and improve function + mobility. (1)

Its important we act now to intervene and help reduce this probable hidden killer of COVID.

References

  1. https://www.csp.org.uk/publications/physiotherapy-works-falls-community-approach
  2. A longitudinal analysis of loneliness, social isolation and falls amongst older people in England. F,Bu et al. Scientific Reports volume 10, Article number: 20064 (2020) 
  3. Hartley P, Costello P, Fenner R, et al. Change in skeletal muscle associated with unplanned hospital admissions in adult patients: a systematic review and meta‐analysis. PLoS One. 2019; 14:e0210186
  4. Bell KE, Von Allmen MT, Devries MC, Phillips SM. Muscle disuse as a pivotal problem in sarcopenia‐related muscle loss and dysfunction. J Frailty Aging. 2016; 5: 33‐ 4110 
  5. Blog FITBIT. FITBIT News: The Impact of Coronavirus on Global Activity [Internet]. https://blog.fitbit.com/covid-19-global-activity/. Accessed 13/1/2021
  6. Risk of Increased Physical Inactivity During COVID‐19 Outbreak in Older People: A Call for Actions. Hamilton Roschel PhDGuilherme G. Artioli PhDBruno Gualano PhD First published: 11 May 2020 https://doi.org/10.1111/jgs.16550 Accessed 13/1/2021

Welcome to 2021

Happy New Year!

I have been wondering what to write in my first blog of 2021, and eventually settled on the idea of a summary of 2020 and plans for this year.

2020 started off well, until COVID came along. Like many others, COVID dictated my everyday life. Working in an Acute NHS trust and based in Respiratory Medicine I saw the start of what was to come. At first there was very limited information from all angles, but quickly came to realise this was like no other disease we has seen before.

Wards quickly became full of very sick patients. What was scary was the fact that it didn’t discriminate. People of all ages were admitted; from young adults to the elderly. It was making young people, with no other health issues incredibly sick. We saw a lot of patients being admitted to intensive care, aware that mortality at that point was around 50%.

For those patients that were not for intensive care intervention, for various reasons, we saw die. They were not able to be with family members until the end, and even then, who could visit was restricted for risk of further disease spread. For myself and others as health professionals, it was incredibly hard to watch and at times felt helpless.

When patients arrived back on the ward from their intensive care admission, many were vey deconditioned. Some not able to move themselves in bed, take a drink for themselves, walk. Even something as simple as scratching an itch was impossible for some. Alongside this some were showing symptoms of severe anxiety and even post traumatic stress syndrome. The rehabilitation process was extensive.

There was also fear of bringing COVID home to my family. The risk of spreading this disease and knowing the implications of this were very real. I tried to avoid the news as much as possible to limit how much COVID was intruding on my life. Its fair to say that my anxiety felt horrific at times.

Having suffered from anxiety and depression for many years, my symptoms were increasing as the year went on. This along with other reasons made me come to the decision to leave my job in the NHS, one I had been in for nearly 15 years. It wasn’t an easy decision to make.

Following this, I decided to start up my own private physiotherapy business. Being a Physio is something i love and has taken up such a large portion of my life, in a good way! I really enjoy meeting the variety of patients i treat and being able to help them improve their symptoms and reach their goals. There are so many people needing physiotherapy input at the moment, and this has been exaggerated by the pausing of many NHS services. So, that is what I am going to do; improve the quality and timely intervention of Physiotherapy to people in the community.

Bring on 2021!