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'G' Forces & Fracture - Falls
- Arunachalam Kumar, Jairaj Kumar C (21 July 2005)
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Effective Falls Prevention into Practice
- Dawn A Skelton, Steve Iliffe, Susie Dinan, and Sharon See Tai (Primary Care and Population Sciences, University College London School of Medicine, London, NW3 2PF) (25 July 2005)
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Arunachalam Kumar, professor of anatomy Kasturba Medical College, Mangalore 575001, India, Jairaj Kumar C
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The remarkable association between fractures in the elderly and the locale of accident, has for too long been neglected. In a random survey among the older age groups, we found most accidental falls occured 'in the bathroom'. The overwhelming statistical significance between frequency of fracture and the constancy of the locale wherein it was acquired in, requires analysis and assessment. Our preliminary inferences embolden us to postulate that the sudden change of posture, from astride or asquat the toilet seat, to an erect one,is of some bearing on the causes of accidental falls. The sudden downward shift in the garvitational 'G' forces within cranially directed arterial columns, due to a rapid change of positiopn from sitting to standing, can engender transient alteration and imbalance in blood pressure.The situation is akin to the physiological stress suffered by the astronaut during the upward thrust during space launch. The odds of this transient "black-out" increases with vascular and circulatory physiological compromizes, concurrant and common with advances in age. It would worth delving a bit deeper into this nebulous areas of science. The biophysics of gravity, and its effects on posture, stance, balance, sex and age, may well provide a key to better undertanding of the problem of fracture-falls in the elderly, and hopefully also provide clues to preventive measures. Competing interests: None declared |
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Dawn A Skelton, Scientific Co-ordinator of Prevention of Falls Network Europe (ProFaNE) School of Nursing, Midwifery and Social Work, University of Manchester, M13 9PL, Steve Iliffe, Susie Dinan, and Sharon See Tai (Primary Care and Population Sciences, University College London School of Medicine, London, NW3 2PF)
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The Editorial by Oliver et al. (1) brings to our attention that falls and fracture assessment and prevention is often not done in tandem, despite there being a fairly strong evidence base for both and a strong causal association between falls and fractures. Services in the UK, although backed by high grade evidence based guidelines (2,3,4), are still often lacking individualized, tailored, falls prevention specific exercise in their provision. A recent British Geriatric Society Survey on Falls Services was disappointing with only 69% suggesting a formal exercise programme was part of their service and with 41% of exercise programmes reporting no strength or balance training (the two key components of a successful exercise programme for fallers)(5). The problem, as we are all aware, is that any Falls Service will be swamped if professionals referred all people at risk of falling. For many, tailored, specific exercise will provide important benefits to both balance and bone health. Correctly tailored and progressed exercise can significantly reduce risk of falls even in those with a history of frequent falls (6). Weight resisted exercise is effective for bone health as well as strengthening muscles and stabilizing joints for efficient movement. Even older patients with established osteoporosis can reduce their falls risk (7). Yet, money is still invested in single interventions (eg. sloppy slipper exchanges) rather than exercise services which are evidence based. Health services must acknowledge that physical activity and group exercise has many additional benefits to older people, including reducing fear and isolation, improving independence, reducing depression and improving other health outcomes (8). With all this evidence, why is it that even those services in the UK which claim to be “comprehensive and integrated” often have no exercise provision within their falls care pathways? Where there is some provision, it is often only for a very brief duration, with no formal mechanism for monitoring and supporting exercise adherence and progression, or for ongoing referral into a community based programme. Yet, a community, evidence based, interdisciplinary falls exercise service, of appropriate duration and intensity is known to be effective in engaging older people with a high risk of falls (9). It is time for Commissioners and Health Service Managers to invest in an intervention that is known to both prevent and manage falls in the same way they have effectively invested in Phase IV cardiac rehabilitation. References 1. Oliver D, McMurdo MET, Patel S. Secondary prevention of falls and osteoporotic fractures in older people. BMJ 2005; 331:123-124 2. NICE Guidelines. Falls: the assessment and prevention of falls in older people. 2004. National Institute of Clinical Evidence, London. 3. American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guidelines for the prevention of falls in older persons. J Am Geriat Soc 2001; 49: 664- 672. 4. All Party Parliamentary Osteoporosis Group (APPOG) 2004. Falling short; Delivering Integrated Falls and Osteoporosis Services in England. 5. Ali A, Morris RO, Skelton DA, Masud T. Falls Services in the UK – A Survey of UK Geriatricians. 5th National Conference on Falls and Postural Stability. Manchester, 2004. 6. Skelton DA, Dinan SM, Campbell M, Rutherford OM. FaME (Falls Management Exercise): An RCT on the Effects of a 9-month Group Exercise Programme in Frequently Falling Community Dwelling Women age 65 and over . Journal of Aging and Physical Activity 12 (3); 457-458 (In Press, Age and Ageing) 7. Liu-Ambrose T, Khan KM, Eng JJ, Janssen PA, Lord SR, McKay HA. Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. J Am Geriatr Soc. 2004; 52: 657-65. 8. Department of Health. National Service Framework for Older People: Modern Standards and Service Models. 2001: London, Her Majesty’s Stationary Office. Standards 3,5,6 and 8. 9. Dinan S, et al. Camden & Islington PCT Falls Exercise Service (FES). Poster accepted for the 6th National Conference on Falls and Postural Stability, Manchester, Sept, 2005. Competing interests: None declared |
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