Falls Awareness week is on its way; this year’s theme is ‘Boost your Bones’. If you’re thinking of taking part, the action pack will give you all the information you need to organise and run an event, as well as details of how to order promotional resources such as posters, flyers, balloons and banners. To download a copy, visit www.ageuk.org.uk/fallsweek, or request hardcopies by e-mailing falls@ageuk.org.uk.

This year, Age UK will also be producing participant evaluation forms, an interactive quiz on bone health and a template press release for your event.

Professionals running events are also invited to join the Boost your Bones webinar on falls and bone health, which will take place on Monday 11th June at 3pm. Click for more details and to register for the Falls and Bone Health Webinar.

Call for case studies
Age UK is still looking for case studies of older people who have fallen, and particularly those that have fractured a bone, to highlight the importance of falls prevention services and interventions during Falls Awareness Week.

If you know anyone who fits within one or more of these categories that would be happy to share their story with us, and potentially help others to reduce their risk of falls, please contact falls@ageuk.org.uk or call 0203 033 1354.

Different formats of Otago Exercises now available

The evidence behind the cost-effectiveness of the Otago Home Exercise programme in reduction of falls is very strong. However, not all people find reading these exercises, from a booklet or photocopied sheets, easy. For example, many older people have a visual impairment such that reading from a printed format is difficult and therefore their adherence to doing the exercises might be reduced. The VIP trial, by Campbell and Robertson, showed that adherence to the Otago exercises was reduced in this population. Working closely with the original Otago authors, Later Life Training have rolled out a National Training Qualification in the UK for those wishing to deliver the Otago home exercise programme. A number of the instructors had asked different formats such as audio files that people may be able to play on their CD/MP3 player or iPod if they use such technologies. Later Life Training have now provided this for their instructors and they are available for others to download.

Presented by a professional qualified Otago Exercise Programme Leader these audio guides take you through each and every exercise with .mp3 playlists for different levels of ability. The idea is to either buy a CD or download the files, then you get all files individually and also four playlists. You can burn the individual playlists (beginners, intermediate and making progress and advanced) to CDs as required so that your clients/patients get one set of exercises on their CD – tailored to suit their needs at that time. As they progress with their exercises, a new CD can be given to them so that they continue the progress. At present the audio files are only in the English Language.

Full information about the audio files, can be found on the Later Life Training Otago Audio Files web page. They can be used in conjunction with the freely downloadable Otago home exercise booklet that Later Life Training provide as well.

Article written for ProFaNE.co by Dr Helen Hawley, University of Manchester, UK.

Despite all of the known health benefits of exercise, inactivity increases with ageing and only 30% of those aged 65+ report any regular exercise (Skelton et al, 1999; Heath et al, 2002; Department of Health, 2010; Department of Health, 2011). Even when older adults initiate exercise they will often discontinue their involvement within the first 6 months (Robison & Rogers, 1994; Jancey et al 2007). Encouraging older adults who have experienced a major health issue (Stroke, Coronary Heart Disease, and a fall) to maintain exercise after rehabilitation is equally as difficult. It is not only national research that shows maintenance of exercise to be difficult but also compliance to exercise on a local service level. Community based falls rehabilitation projects in Rotherham (North of England) have shown that patients followed up in the community six months after falls rehabilitation, deteriorate almost back to their pre-rehabilitation state (Hawley, 2009). Therefore what does the evidence tell us are the key factors relating to older adults uptake and adherence to exercise classes and what can we do about it in practice? Recent work carried out as part of a PhD study working with both exercise instructors, their classes and participants and a Systematic Review of the literature suggests the following factors as important:
To continue reading you must be a registered member. Click here to register now.

Last week the Royal College of Physicians published a new audit on exercise provision in falls services across the UK. Some of the findings were, unfortunately, not unexpected!

This survey was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit (CEEU). It follows on from concerns raised in an earlier programme of work looking at older people’s experiences of falls prevention services in general and complements the findings from the recent report of the national audit of falls and bone health audit in older people 2010. The aim of the project was to obtain patients’ experiences of NHS run therapeutic exercise programmes to reduce falls. The patient questionnaire was supplemented by a survey of staff involved in the delivery of therapeutic exercise.

First, the good news!

• Over 1,700 older people who had attended an NHS-run exercise programme to reduce falls shows that 96% felt the exercises were either beneficial or quite beneficial, and 95% were either satisfied or very satisfied with their exercise programme.

Now, the not so good news!

The implementation of evidence-based exercise interventions by healthcare providers is incomplete and varies widely. Overall, the types of exercises prescribed appear appropriate however, the frequency, intensity and duration of most programmes are low and do not appear to meet recommended guidance:

• 86% of staff report low frequency of their exercise classes (once per week), well below recommended guidance.
• Only 29% of patients returning questionnaires used ankle weights for targeted resistance training to reduce falls.
• Only 52% of patients felt their exercise programme had been progressed.
• 81% of patients attending a class indicated that this had lasted 12 weeks or less.
• 73% of patients supervised at home indicated that their programme lasted for 3 months or less.

Not all staff delivering the exercise programmes to reduce falls are appropriately trained. Only 54% of sites had staff who had completed Postural Stability Instructor training and 41% of sites had staff who have completed Otago training.

Evidence shows older people are more likely to continue exercising in a class than on their own at home. However, responses from staff show there is lack of long term follow-up classes in the community that patients can attend. 9% of participating sites had no classes they could encourage patients to attend at the end of their NHS-run exercise programme and only 53% had two or more classes and many of these were not evidence based.

Key recommendations

• Commissioners need to commission a local, integrated exercise continuum across health and local authorities/voluntary sector to ensure long term provision of evidence-based exercise programmes for reducing falls run by appropriately qualified staff.

• The quality of training and delivery of exercise programmes for reducing falls needs to be monitored locally and nationally against the evidence base for delivering effective exercise programmes to reduce falls.

Dr Jonathan Treml, Consultant Geriatrician, University Hospitals Birmingham and RCP Associate Director for the National Audit of Falls and Bone Health said:

‘The right type of exercise is the single most effective way of reducing the risk of falls in older people. It is concerning that many local NHS services appear to provide exercise programmes that are of insufficient duration or intensity to assure benefit to this vulnerable group.’

So, even though we have had many guideline documents on the need for evidence based exercise, progression of the intensity or challenge of exercises and the need for effective delivery, we are still in a position where half those who are delivering exercise have not had up to date evidence based training and most are not being referred onto community based exercise to ensure effective duration. What are your thoughts?

Dear colleague,

We have launched a consensus process to develop a sedentary behaviour taxonomy. The purpose is to develop a classification system and nomenclature as universal as possible to allow research across the life span, be as inclusive as possible and that is meaningful to and understood by all field of research and the general public.

Therefore we seek you opinion in identifying domains and a structure for the classification that will allows refinement to increase specificity for special populations and settings. We have set up a website to facilitate this process online.

We would be most grateful if you could spare a few moments to register with “SIT: Sedentary behaviour International Taxonomy” to take part in this consensus. This consensus survey follows a Delphi protocol (all the details are on the website) and runs concurrently to the development of a folksonomy (layman classification) of sedentary behaviour.

We are collecting opinion from all people involved in sedentary behaviour research from measurement scientist to those involved in interventions. So please pass this email onto colleagues who might be interested or whose opinion needs to be heard.

Could you also forward the link to the folksonomy to as many people as possible? – http://tinyurl.com/cba3yt8

Thank you for your interest.

Seb Chastin
Senior Research Fellow – Behaviour Dynamics – Active Living Research Group
School of Health and Life Sciences
Glasgow Caledonian University

Dawn Skelton
Professor of Ageing & Health – Later Life Research Group
Institute of Applied Health Research
School of Health & Life Sciences
Glasgow Caledonian University

The effects of medications on falls has been a topic of much discussion, both in research and practice.

For a while we have known that certain medications increase the risk of falls, but people may need to be on these medications which makes it difficult to consider withdrawal, although there may be a chance to discuss medication timing and dosage.

We have also known for a while that being on four or more medications increases the risk of falling, although there is some debate over whether it is the potential interactions between medications or whether four or more medications is really just an indicator of multiple medical conditions and hence risk of falls could be more related to the effects of the medical conditions than the medications themselves.

The following articles provide an overview of the issues involved by reviewing a selection of research publications, exploring interventions in practice and finally providing a list of online resources that may help in your falls prevention practice.

1) Key Publications (research) on Medications, Polypharmacy and Falls Prevention

2) Medications, Polypharmacy and Falls Prevention in Practice

3) Online Resources on Medications, Older People and Falls

This article provides an overview of research publications that consider some aspects of Medications, Polypharmacy and Falls Prevention. Seeking to answer questions such as “is it taking multiple medications or just the number of comorbidities that increases falls risk?” and clarifying which medications always have an associated increased risk of falls; this is essential reading for anyone who comes into contact with older people, in any environment, who are at risk of falling and take any medications.
To continue reading you must be a registered member. Click here to register now.

Following on from our previous post, Key Publications (research) on Medications, Polypharmacy and Falls Prevention, this article looks at several interventions in practice that reportedly have very positive results and raises the converse issue that not taking prescribed medications may also be a risk factor for falls. Also, important questions are raised with regards effective implementation of such interventions and more generally are we really doing everything we can?
To continue reading you must be a registered member. Click here to register now.

If you are working on the front line then the following collection of resources will be helpful in your management of medications and falls risk with older people. Including an overview of all potentially risk inducing or harmful medications for older people, a screening tool for use with older persons, in-house training for all professionals who are required to be well informed about medication risks and falls and finally, an excellent selection of very useful resources suitable for use by older adults themselves.
To continue reading you must be a registered member. Click here to register now.

One of the most common questions asked in falls prevention is what actually constitutes a fall. At first it may be tempting to think that it the dictionary definition is enough, however, in research and in practice the reality is often more complicated than this. The following article highlights some of the different approaches and definitions that have been used in the literature and raises some important questions about reporting standards.
To continue reading you must be a registered member. Click here to register now.