The Public Health England View Daniel MacIntyre Population Health S ervices Manager Epidemiology 111 million people aged 65 174 35 aged 65 fall at least once 45 aged 80 1015 of falls result in fracture ID: 289508
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Falls and Fragility Fractures The Public Health England View
Daniel MacIntyre - Population Health
S
ervices Manager Slide2
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 fractureHigher rates in women, care and nursing homes
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Falls and Fragility Fractures: the Public Health England View Slide3
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• DizzinessStairs 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, doorsLimited 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 assistiveDevicesSource: College of Occupational Therapists, 2015
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Falls and Fragility Fractures: the Public Health England View Slide4
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
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Falls and Fragility Fractures: the Public Health England View Slide5
What needs to be covered
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Falls and Fragility Fractures: the Public Health England View Slide6
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 HealthyHome hazard assessment and modification RR 0.66 (95% C.I. 0.54-0.81)Liverpool Healthy homes, Hertfordshire Fire service home safety checks serviceMultidisciplinary, multifactorial risk factor screening and interventionHistory 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 Slide7
PHE activity
Physical activity – Everybody Active Every Day
Primary falls
prevention – screening tools, social marketingAllied Health Professionals – Fire and Rescue Service
Secondary falls prevention - Sir Muir Gray’s question
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Falls and Fragility Fractures: the Public Health England View Slide8
Developing the evidence base
Ways of
d
elivering what worksFracture liaison services Primary falls prevention
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Falls and Fragility Fractures: the Public Health England View Slide9
Next steps
Working together to develop the evidence
base around falls and fragility fractures…
Daniel MacIntyre – daniel.macintyre@phe.gov.uk 020 8654 48472
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Falls
and Fragility Fractures: the Public Health England View