Counting The Heavy Cost Of Falls
1 February 2010
Dr Jonathan Bayly (right) talks to a delegate at a University osteoporosis national conference in 2007.
What is encouraging is that following the study, many GPs in the area have agreed to review the recommendations made and consider appropriate changes in prescribing practice in more than 1,239 of 2,622 patients.
”Dr Jonathan Bayly
A survey of almost 4,000 vulnerable people in residential and nursing care homes has found that more than four out of ten of them suffered a fall in a 12 month period, according to new University of Derby research.
Research from this news release has already been reported in The Times, on the BBC and in the Nursing Times and Community Care magazine.
Residents in residential and nursing care homes are historically more vulnerable to falls than those in the community as they are more frail, have balance disorders, muscle wasting, loss of confidence and movement disorders.
Research was carried out by Derby's osteoporosis experts in collaboration with Gloucestershire Primary Care Trust to assess the recent health of more than 3,700 elderly residents - three quarters of Gloucestershire's residential care home population.
The study found that 42 per cent of 3,730 patients in elderly care (1,566 people) had fallen in a twelve month period. Of this figure, 1,077 (68.8 per cent) of people had suffered multiple falls - some having a fall every day.
Yet just a quarter of the residents (834 people) were being given regular doses of calcium and vitamin D - a treatment that can improve muscle strength, co-ordination and strengthen bones, and prevent falls and hip fractures.
Now GPs representing more than 1,200 of the patients in the survey have agreed to consider changing practice, including considering prescribing patients calcium and vitamin D, in light of the research.
Academics wanted to assess the level of falls risk facing those living in residential and nursing care homes after previously published national research suggested falls and fractures were three to four times higher in this group compared to those living in the community.
Dr Jonathan Bayly, a Visiting Fellow at the University of Derby, said: "4.5 per cent of the UK population over age 65 live in residential care, yet 20 per cent of the people who suffer a fracture from a fall come from this setting, making them the highest risk group of patients when it comes to falls.
"The study mirrors what is happening elsewhere in the country. It also highlighted that many residents were not being prescribed calcium and vitamin D and many opportunities existed to modify treatments to reduce falls risk.
"What is encouraging is that following the study, many GPs in the area have agreed to review the recommendations made and consider appropriate changes in prescribing practice in more than 1,239 of 2,622 patients."
The study, led by Nikki Mayes, from Gloucestershire Care Services is entitled: Evaluating and Improving Clinical Standards in the Management of Falls and Fracture Risk in Older Patients in Residential and Nursing Care Home Setting, also found that 594 (37.9 per cent) required medical attention from primary or secondary care to treat injuries sustained in the fall.
Dr Bayly says it costs just £5 extra for a patient to undergo an enhanced Medicines Use Review programme to identify changes needed in their medication yet a patient suffering a hip fracture as a result of a fall may face £10,000 hospital costs.
He said: "We have a tendency to place elderly people into residential homes and hope it will be all right - but is it always the case? It may be that much more could be done to help reduce the risk of falls and fractures and an outlay of funding now could help save the NHS millions further down the line in after care as a result of a fall."
In another study co-authored with fellow Derby academic Paul Mitchell, Dr Bayly questions why more expensive second-line therapies for heart attacks and strokes outlined in the NICE Technology Appraisals are permitted, when cheaper more cost-effective preparations are not suitable for patients. Yet more expensive second line therapies for osteoporosis are restricted until bone health has deteriorated or the patient is older or sicker.
They state in their study: "This inconsistency of recommendations in the two disease areas is surprising given the volume and costs incurred by the prescribing of non-generic statins by the NHS in England are eight times higher when compared to those for osteoporosis treatments."
Dr Bayly and Mr Mitchell's comparative analysis of non generic prescribing in cardiovascular disease and osteoporosis, has been invited for submission to the International Osteoporosis Federation Conference in Florence in May 2010.
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