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Catching older people of falls-risk post-discharge

RDNS Institute Research Fellow Dr Claudia Meyer
Photo: RDNS Institute Research Fellow Dr Claudia Meyer
A home-based intervention that catches older people returning home after a hospitalisation for a fall could reduce their potential risk of future falls.

The RDNS Institute aims to further examine the use of a home-based intervention, including an individualised balance exercise program, medication review and education, after a soon-to-be published pilot study showed promising results.

Dr Claudia Meyer, a Research Fellow at the RDNS Institute with a background in clinical physiotherapy, says a gap exists for older people transitioning to home after hospitalisation for a fall - when care is often, and understandably, focused on the person’s injury or illness as a priority over their heightened falls risk.

Dr Meyer says the study found older people returning home either failed to receive any information about falls prevention or were possibly unable to recall whether they received falls prevention information while in hospital.
“That’s quite striking because they’re in hospital as a result of a fall but it was almost like the fall didn’t matter,” she says.

“So, for example, somebody had a fall, they were transported to hospital in an ambulance, they did some tests on the person and found she had had, coincidentally, a silent heart attack – but not the cause of the fall.

“But then they addressed that problem as the priority, which is totally understandable, but the fact that she had fallen - first - wasn’t considered as part of the equation.”

Statistics show falls account for 70 per cent of hospitalisations resulting in injury to people aged 65 years and older, and 87 per cent for people aged 85 years and older.

Dr Meyer says a person living with dementia has a 50 to 80 per cent chance of having a fall, a person with Parkinson’s disease has up to an 80 to 90 per cent chance of a fall, and a stroke survivor has a 60 per cent chance of experiencing a fall, over the course of one year.

Falls also result in substantial injuries for five to 10 per cent of older people, with 92 per cent of hip fractures attributed to falls.

Dr Meyer says older people face an increased risk of falls post-discharge - up to 40 per cent fall within six months of discharge, while 34 per cent fall within three months of discharge from aged care inpatient rehabilitation.

“Also from a psychological point of view, there’s a potential to develop a fear of falling, so people who have this fear of falling can get into a spiral where they reduce or stop activity because they are essentially afraid of moving.

“That potentially leads to muscle weakness and functional decline, which can predispose them to more falls - so this fear of falling can be quite a vicious cycle.”

The RDNS pilot study aimed to improve the health-related quality of life of participants, reduce rate and risk of falls, improve balance and physical function, and review medications to identify and potentially change medications known to increase the risk of falls.

It also aimed to increase knowledge about participants’ individual risk factors and implement management strategies, and develop hospital discharge strategies targeted to older people hospitalised for falls.

Ten people aged over 65, who had been discharged home from an acute or rehabilitative hospital in Melbourne, and were an existing or new RDNS client, participated in the six-month study.

Five participants were randomly assigned to receive the home-based intervention, comprising exercise such as balance and strength exercises over four sessions with an exercise physiologist, education, and a Home Medicines Review with a pharmacist, while five participants received usual RDNS care.

After six months, half of the participants who were initially deemed frail, at a high or intermediate level, had returned to a level of intermediate or non-frailty.

The study resulted in an overall improvement in participants’ quality of life, reduced falls risk, a slight increase in fear of falling, and a substantial increase in physical activity levels.

“We had very low numbers in the study so it was difficult to get any kind of real conclusions out of it but what we did work out was that when people come back home - that is actually the perfect time to talk to them about falls, rather than in the hospital setting,” Dr Meyer says.

“That’s because it’s just too busy in the hospital - it’s too overwhelming for them.

“We’re hoping to extend that project at some point, and work with our liaison nurses, and catch people when they first come back home, when it’s still on their mind, before they get back into their normal routine and begin to not worry about falls any more.”

Dr Meyer says it’s important older people being discharged from hospital are assessed for falls risk.

“Often they are not even assessed for falls risk and that should be considered part of routine assessments,” she says.

“From there, the big gap is actually putting some strategies in place and that requires a coordinated service and follow up.”

Dr Meyer, who has researched falls prevention in older adults with diabetes and those living with dementia, says it’s important to give older people choice in deciding which falls prevention risk factors they would like to address.

She says a long list of recommendations can be overwhelming for older people while targeting one or a few risk factors, that they want to tackle, may be more effective.

“As a physiotherapist, I can come in and insist on exercise but that might be what they don’t want to do - they might hate exercising or they’d rather address another risk factor instead,” Dr Meyer says.

“And by addressing any of the risk factors they are reducing their overall risk.

“It’s about giving people choices in falls prevention but also making them aware it’s not the end of the road - there’s lot of things that can be done, there’s lots of strategies, and it’s about convincing them that those strategies may be helpful.”


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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords