falls and fragility fractures the public health england view daniel macintyre - population health...
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Falls and Fragility Fractures The Public Health England View
Daniel MacIntyre - Population Health Services Manager
Epidemiology• 11.1 million people aged 65+ (17.4%)
• 35% aged 65+ fall at least once, 45% aged 80+
• 10-15% of falls result in fracture
• Higher rates in women, care and nursing homes
2 Falls and Fragility Fractures: the Public Health England View
Risk factors Intrinsic factors Extrinsic factors Behavioural factors
• Previous falls, fractures, stumbles and trips• Muscle weakness• Impaired balance/gait,restricted mobility• Medical history ofParkinsons, stroke,arthritis, cardiacabnormalities• Fear of falling• Medication (e.g.polypharmacy,psychotropicmedication)• Acute illness• Dizziness
• Stairs and steps• Clutter and trippinghazards (e.g. rugs,flexes)• Floor coverings• Poor lighting, glare,shadows• Lack of appropriateadaptations (e.g. grabrails,stair rails)• Low furniture• No access to telephoneor alarm system• Poor heating• Thresholds, doors
• Limited physical activity / exercise• Poor nutrition/fluidintake• Alcohol intake• Carrying, reaching,bending, risk-takingbehaviour (e.g. climbingon chairs or ladders)• Footwear• Clothing• Inappropriate use of/refusal to use assistiveDevices
Source: College of Occupational Therapists, 2015
3Falls and Fragility Fractures: the Public Health England View
Service complexity Private landlords – Social housing providers - Private,
VCS and LA physical activity services – General
practitioners - District nurses – Pharmacists –
Physiotherapists - Occupational therapists –
Residential nursing and care homes - Ambulance Trusts –
Falls services - LA Public health teams – Fracture Liason
Services – Trauma and Orthopaedics Departments –
Emergency Departments – Public Health England –
inpatient care – Opticians –Geriatric Medicine Departments
4Falls and Fragility Fractures: the Public Health England View
What needs to be covered
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Falls prevention: the evidence base Intervention Evidence base Examples
Muscle strengthening and balance retraining
RR 0.80 (95% C.I. 0.66-0.98)
National physical activity strategy Be Active, Be Healthy
Home hazard assessment and modification
RR 0.66 (95% C.I. 0.54-0.81)
Liverpool Healthy homes, Hertfordshire Fire service home safety checks service
Multidisciplinary, multifactorial risk factor screening and intervention
History of falls: RR 0.86 (95% CI 0.76-0.0.98); Care home: RR 0.60 (95% CI 0.50-0.73)
NHS falls prevention and bone health service, Hertfordshire Emergency Care Practitioner & Social Worker service
+ Fracture Liaison Services
Primary falls prevention Falls and Fragility Fractures: the Public Health England View
PHE activity • Physical activity – Everybody Active Every Day
• Primary falls prevention – screening tools, social marketing
• Allied Health Professionals – Fire and Rescue Service
• Secondary falls prevention - Sir Muir Gray’s question
7Falls and Fragility Fractures: the Public Health England View
Developing the evidence base • Ways of delivering what works
• Fracture liaison services
• Primary falls prevention
8Falls and Fragility Fractures: the Public Health England View
Next steps Working together to develop the evidence
base around falls and fragility fractures…
Daniel MacIntyre – [email protected] 020 8654 48472
9 Falls and Fragility Fractures: the Public Health England View