Pride comes before a fall Dr Raj Thakkar

Pride comes before a fall Dr Raj Thakkar BSc (Hons) MBBS MRCGP MRCP Clinical Commissioning Director – Chiltern and Aylesbury Vale CCGs Thames Valley Cardiac Lead for HF and AF, Oxford AHSN, NHS England NHS Aylesbury Vale Clinical Commissioning Group NHS Chiltern Clinical Commissioning Group

This presentation is designed to reduce your risk of falls. It is important to consider your own risk of falling and do something about it – it may save your life. Feel free to share this with as many people as possible.

What are your risks of falling? 30% of those over age 65 will fall at least once per year 50% of those over age 80 will fall at least once per year A significant number of falls are preventable Falls: assessment and prevention of falls in older people, NICE CG 161, 2013

What are your risks of falling? Have you fallen in the past? What did it feel like? What would happen if you fell and couldn’t get up?

What are the effects of falling? National • Annual NHS cost £ 2. 3 billion • >4 million beds days (England) • Doubles the hospital length of stay • 70, 000 hip fractures • Unsustainable for health economy • Vast social care bill Patient • Personal injury e. g. osteoporotic fracture • 30 -73% left with loss of confidence/independence • Mortality (10% annual, 14000 deaths/year) • Leading injurious cause of death in elderly Family/Carers • Huge Pressure

Why do people fall? Falls is not a diagnosis, it is a symptom Cause often not considered or misdiagnosed Detailed history and assessment required May be multifactorial

Why do people fall? Environmental Muscular Neurological (1 in 3 falls) • Muscle weakness • Arthritis • Spinal disease • Contractures • Pain • Use of walking aids • Stroke • Epilepsy • Parkinson’s disease • Dementia • Neuropathy • Depression • Anxiety • • • Rugs Doormats Slippery stairs Loose slippers Wet floors Slippery baths Wires Lighting Living alone Alcohol

Why do people fall? Cardiac Systemic Medication • Low blood pressure • Faint • heart failure • abnormal heart rhythm • valve disorders • carotid hypersensitivity • Infection • Vitamin D deficiency • Anaemia • Poor fitness • Low sugar • Thyroid disease • Stopping steroids suddenly • Four or more drugs – 30% increased risk of falls (if live in the community)

Keep moving for a balanced life Ageing can affect your balance, muscles and joints This is made worse if we spend long periods sitting down The more active you are, the more you can offset the effects of ageing What can I do? • Gardening • Housework • Walking to the shops • Exercise classes • Yoga or Tai Chi https: //www. ageing-better. org. uk/our-work/area/keeping-physically-active/ Click on the above link, to watch a video on how exercise has benefited people’s strength and balance

Keep moving for a balanced life If you feel unsteady or have weak legs exercise can often help. If you have already had a fall targeted strength and balance training works best Get advice from a physiotherapist or postural stability instructor or discuss this with your GP

Sit to Stand Exercise • Sit tall near the front of your chair • Place your feet slightly behind your knees • Lean slightly forward • Stand up (using your hands as support if needed) • Progress to no hands after time • Step back until your legs touch the chair, bend your knees and slowly lower your bottom back into the chair • Repeat 10 times Age UK, Preventing Falls, Strength and balance exercises for healthy ageing

Active Bucks – Move more, feel great! Programme to get more Bucks residents regularly active – particularly those who are inactive/sedentary people www. activebucks. co. uk holds over 2500 activities to search through – including those to improve your strength & balance such as Tai Chi and Dance Why not download a voucher and get your first session free? Email: activebucks@buckscc. gov. uk

What to do if you are unable to get up Getting Help • If you are unable to get up, you may need to consider phoning 999 • Make sure you are warm and comfortable • It is not a good idea for family members/friends/passers-by to lift you from the floor. This can cause injury to the person who has fallen, and also to the person assisting Be Prepared • Consider what you would do in the event of a fall and were unable to get up • Have a pendant alarm or a mobile phone, or ensure that phones are low down and accessible

Getting up safely after a fall 1. Ease yourself up onto your elbows 4. Facing the chair ease yourself to a standing position 2. Move onto your hands and knees 3. Hold onto a firm surface to support yourself Bucks Integrated Falls and Bone Health Service, I’ve had a Fall 5. Turn yourself gently and sit on a firm surface

What are we doing in Bucks? • Public campaign – Hiya Bucks (www. goo. gl/x 5 QMDp) – Posters • Education • Screening our patients • Medication reviews

What can you do to reduce your risk? If you’re concerned keep a falls diary and ask for help Assess your home for dangers – don’t delay Think about falls when out and about Look after those at risk Age UK, Top tips for staying steady