WHILE’S WORDS
Minimising the cost of falls Alison While Emeritus Professor of Community Nursing, King’s College London, Florence Nightingale School of Nursing and Midwifery and Fellow of the QNI
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Napoli N, Shah K,Waters DL, Sinacore DR, Qualls C,Villareal DT (2014) Effect of weight loss, exercise, or both on cognition and quality of life in obese older adults. Am J Clin Nutr. doi: 10.3945/ajcn.113.082883 National Institute for Health and Care Excellence (2013) Falls: Assessment and Prevention of Falls in Older People. http:// tinyurl.com/nzmp4h5 (accessed 1 July 2014) Rezende LFM, Rey-Lopez JP, Matsudo VKR, Luiz OC (2014) Sedentary behaviour and health outcomes among older adults: a systematic review. BMC Public Health 14: 333. doi:10.1186/1471-2458-14-333
414
‘If health-care resources are to be maximised, individuals of all ages need to be encouraged to become less sedentary so that they age healthily and have the best possible quality of life.’
Alison While
© 2014 MA Healthcare Ltd
alls and associated injuries are a major problem for older people, with about half of those older than 80 years of age falling at least once a year compared with about a third of those over 65 years of age (National Institute for Health and Care Excellence (NICE), 2013). The prevention of falls in older people has many benefits at both the individual and societal levels. At the individual level, some falls can cause serious injury and mortality, while others may cause less serious injuries with associated pain and distress, but all will impact upon levels of confidence and associated functional independence. Indeed, loss of confidence may undermine an older person’s social engagement and quality of life as they no longer feel able to mobilise safely. At the societal level, the cost of falls to the NHS is estimated to be more than £2 billion each year (NICE, 2013), and this is in addition to the loss of older people’s participation in society and in their local communities. While it may not be possible to prevent all falls, the NICE (2013) guideline, if implemented, could help improve the current rates of falls. The guideline recommends that older people should be asked routinely whether they have fallen and the context, frequency and characteristics of the fall(s) as part of a multifactorial assessment as a precursor to an individualised multifactorial intervention. Falls prevention programmes that incorporate strength and balance training may particularly benefit those who report recurrent falls, although it is important to respond to differing preferences. However, the most important issue is helping older people maintain their functional independence through rebuilding their confidence and their mobility as far as possible. Interestingly, a recent systematic review (Rezende et al, 2014) has highlighted that sedentary behaviour in older people is associated with poorer health outcomes related to metabolic syndrome and obesity, and increased all-cause mortality. They were unable to draw any firm conclusions regarding the relationship between sedentary behaviour, mental health and falls due to insufficient data. However, in a trial involving 107 obese, frail older people, Napoli et al (2014) found that weight loss and exercise improved both cognitive function and health-related quality of life challenging the sometimes pervasive wisdom that obese, frail older people should not be offered weight management support and that the promotion of physical activity should be age restricted. Clearly physical activity should be appropriate and reflect capabilities, but if health-care resources are to be maximised, individuals of all ages need to be encouraged to become less sedentary so that they age healthily and have the best possible quality of life. This means that older people who have a fall need to be helped to return BJCN to as active life as possible.
British Journal of Community Nursing August 2014 Vol 19, No 8
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 18, 2015. For personal use only. No other uses without permission. . All rights re
Minimising the cost of falls Alison While Emeritus Professor of Community Nursing, King’s College London, Florence Nightingale School of Nursing and Midwifery and Fellow of the QNI
F
Napoli N, Shah K,Waters DL, Sinacore DR, Qualls C,Villareal DT (2014) Effect of weight loss, exercise, or both on cognition and quality of life in obese older adults. Am J Clin Nutr. doi: 10.3945/ajcn.113.082883 National Institute for Health and Care Excellence (2013) Falls: Assessment and Prevention of Falls in Older People. http:// tinyurl.com/nzmp4h5 (accessed 1 July 2014) Rezende LFM, Rey-Lopez JP, Matsudo VKR, Luiz OC (2014) Sedentary behaviour and health outcomes among older adults: a systematic review. BMC Public Health 14: 333. doi:10.1186/1471-2458-14-333
414
‘If health-care resources are to be maximised, individuals of all ages need to be encouraged to become less sedentary so that they age healthily and have the best possible quality of life.’
Alison While
© 2014 MA Healthcare Ltd
alls and associated injuries are a major problem for older people, with about half of those older than 80 years of age falling at least once a year compared with about a third of those over 65 years of age (National Institute for Health and Care Excellence (NICE), 2013). The prevention of falls in older people has many benefits at both the individual and societal levels. At the individual level, some falls can cause serious injury and mortality, while others may cause less serious injuries with associated pain and distress, but all will impact upon levels of confidence and associated functional independence. Indeed, loss of confidence may undermine an older person’s social engagement and quality of life as they no longer feel able to mobilise safely. At the societal level, the cost of falls to the NHS is estimated to be more than £2 billion each year (NICE, 2013), and this is in addition to the loss of older people’s participation in society and in their local communities. While it may not be possible to prevent all falls, the NICE (2013) guideline, if implemented, could help improve the current rates of falls. The guideline recommends that older people should be asked routinely whether they have fallen and the context, frequency and characteristics of the fall(s) as part of a multifactorial assessment as a precursor to an individualised multifactorial intervention. Falls prevention programmes that incorporate strength and balance training may particularly benefit those who report recurrent falls, although it is important to respond to differing preferences. However, the most important issue is helping older people maintain their functional independence through rebuilding their confidence and their mobility as far as possible. Interestingly, a recent systematic review (Rezende et al, 2014) has highlighted that sedentary behaviour in older people is associated with poorer health outcomes related to metabolic syndrome and obesity, and increased all-cause mortality. They were unable to draw any firm conclusions regarding the relationship between sedentary behaviour, mental health and falls due to insufficient data. However, in a trial involving 107 obese, frail older people, Napoli et al (2014) found that weight loss and exercise improved both cognitive function and health-related quality of life challenging the sometimes pervasive wisdom that obese, frail older people should not be offered weight management support and that the promotion of physical activity should be age restricted. Clearly physical activity should be appropriate and reflect capabilities, but if health-care resources are to be maximised, individuals of all ages need to be encouraged to become less sedentary so that they age healthily and have the best possible quality of life. This means that older people who have a fall need to be helped to return BJCN to as active life as possible.
British Journal of Community Nursing August 2014 Vol 19, No 8
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 18, 2015. For personal use only. No other uses without permission. . All rights re
