Category Archives: Ageing Well: Falls

Anything relating to the Ageing Well: Falls course on FutureLearn.

Ageing Well: Falls starts 5 September

Ageing Well: Falls is a four week (2 hours a week) free online course, which starts on 5 September 2016. Previous learners really valued this engaging course which is having a real effect on people’s lives.

This course was excellent, it gave a lot of good information and dispelled many myths about “only old folks have falls”, as well as giving resources to check when problems arise.

Photo of Dr James Frith.
Dr James Frith, Lead Educator, Ageing Well: Falls

As we make the finishing touches to the course before it starts, we asked Dr James Frith, Lead Educator, a few questions which come up regularly:

Are falls really that dangerous?

James: Yes. Falls are hugely common and as we get older our bodies are less robust and are more likely to be injured during a fall. Serious injuries include broken bones and head injuries or serious bleeding. A broken hip can be devastating for some people. But for some people the loss of confidence following a fall can be just as disabling as a physical injury. Fortunately we can reduce the risk of falling and the associated injuries.

What is the most common story you hear from your patients?

James: Falls are complex and are rarely caused by a single factor. in each person who falls there are a mix of factors which contribute, so there is not really a typical type of fall.  However, common things which I come across are:

  1. Falling on the bus as people get up from their seats before it has stopped.
  2. Putting out the bins in wet or windy weather.
  3. Getting up too quickly to answer the telephone or the door.
  4. Slipping in the bath or shower.

What can increase a person’s risk of falls?

James: Researchers have identified hundreds of risk factors for falls, so we tend to stick to the ones that we can do something about. The main risks are having a poor gait or balance, poor eye sight, dizziness, some medications, and hazards in the home or on the street, but there are many more.

What can a person do to reduce the risk of falls?

James: Sometimes it can come down to common sense, such as keeping stairs free from clutter, turning on the lights and reporting dizziness to the doctor. But there are other simple ways too, such as keeping the legs active and strong through gentle exercise, having a medication review with a doctor or pharmacist, avoiding dehydration and having walking sticks measured by a professional.

What is the best way to recover from a fall?

James: If someone is prone to falls they should consider wearing a call alarm or keeping a mobile phone in their pocket, just in case they need to call for help. Some people can learn techniques to help them stand following a fall – usually from a physiotherapist or occupational therapist. In the longer term anyone who has fallen or is at risk of falls should seek help from a health professional to try to prevent future falls. Sometimes falls can be due to medical conditions which can easily be treated.

Everyone knows someone who has fallen. Why not join our friendly team of falls specialists and thousands of people like you to find out what you can do to help yourself, your family, friends or people you care for?

The lead educators were warm and engaging, and they were generous with their knowledge and expertise.

I liked the interaction between participants. It makes you feel you are not alone in your experiences.

Sign up now at www.futurelearn.com/courses/falls

We believe in lifelong learning

This September sees an opportunity to take part in our Ageing Well: Falls course, the third time we have delivered the course on FutureLearn.

FALLS_300x250 Starts 5 Sept Box

Looking back at our previous two courses, it is a real pleasure to see how engaged and enthusiastic our learners were with the course materials.  Learners worked together as a community and participated in discussions, activities and quizzes, creating an active and supportive learning environment.

Should this be a surprise?  Well not really, we know that FutureLearn have been working hard to “pioneer the best social learning experiences for everyone” and our course shows that this still holds with an older audience.

In the UK, only 9% of people aged over 65 and 36% of those aged 55-64 used a computer on a daily basis when surveyed in 2006. But by August 2014, these figures had risen to 42% and 74% respectively. Of particular relevance to our Ageing Well: Falls course, is that when older people use the Internet, one of the main reasons is to seek health information. 1, 2

Data from our course also helps to show that older people engage with online learning. The graph below shows the age distribution of 412 people who volunteered their age during one of our activities.  The oldest learner completing this activity was 87, showing that you are never too old to learn!

fallsgraph

As before the course will be facilitated by Dr James Frith, and colleagues from the Newcastle Falls and Syncope service. You can sign up at www.futurelearn.com/courses/falls

  1. Office for National Statistics. Internet Access – Households and Individuals: Statistical Bulletin; 2014.
  2. Morrell RW, Mayhorn CB, Bennett J. A survey of World Wide Web use in middle-aged and older adults. Hum Factors 2000;42(2):175-82.

 

Ageing Well: Falls live event tomorrow (Friday) at 10am GMT

There is a live discussion online as part of the Ageing Well: Falls course on FutureLearn.

The event is open to anyone – so please pass on the link to anyone you think will be interested. You can tune in live tomorrow (Friday 5 December) at 10am GMT on YouTube. Don’t worry if you miss it, you can watch the recording afterwards at the same link or, if you prefer, read the transcript.

In this live event:

  • Dr James Frith, Clinical Lecturer and falls researcher
  • Professor Julia Newton, Consultant Physician, Falls Specialist and falls researcher
  • Dr Chris Elliott, Advanced Occupational Therapist

will answer your questions from Week 2 of Ageing Well Falls.

An important day for recognising excellence in ageing research, and an honorary award for Angela Rippon

Lead Educator for Ageing Well: Falls, Professor Julia Newton has had a busy couple of days, and you can read why here:

JuliaToday saw two important announcements for Newcastle and our ageing research.

The Newcastle University Institute for Ageing was launched at the Great North Museum here in Newcastle by the wonderful TV presenter Angela Rippon OBE. Angela was also awarded an Honorary Doctorate in Civil Law for her work highlighting the importance of Alzheimers, dementia and ensuring the patient voice is heard. Angela delivered a fantastic speech at the graduation ceremony to the audience of over 130 Newcastle University graduands where she described her career and how her father would have been particularly proud of her award (being from County Durham down the road from Newcastle).
The second came in the Chancellors Autumn statement (p88 !) delivered in the House of Commons when a £20million investment in a National Institute for Ageing which will be based in Newcastle was announced.
Wonderful recognition of the important research that is being carried out in Newcastle and how working collaboratively can lead to important advances in our understanding of how we age and strategies to improve quality of life.
Julia Newton
Dean of Clinical Medicine & Professor of Ageing and Medicine Clinical Academic Office The Medical School Newcastle University

You can watch Angela receive her award (45 minutes and 8 seconds) and see her speech (45 minutes 50 seconds) in the congregation video at: https://nuvision.ncl.ac.uk/Play/3084 See if you can spot Julia who was there in the second row behind where Angela was sitting.

Medication. Is four the magic number?

We know that medication which lowers the blood pressure can cause falls.  This would typically occur on standing up from sitting, with a sudden drop in blood pressure causing a fall.  We also know that medication which affects the brain, such as sleeping tablets or antidepressants can cause falls.  This seems logical as they may cloud the full function of the brain, nerves and blood pressure.

What seems less obvious is the result of a large research study which found that taking four or more medications was a risk factor for falling.  To understand this a bit more, I will explain the study itself.  Approximately 1280 older people were followed over the course of a year.  At the beginning of the study period, various observations were made, including details of the medications and other medical problems.  Different measurements were taken over the course of the year.  At the end of the study the researchers explored the data to see if they could find any way to predict who was more likely to fall.  They found that people who were taking four or more medication were more likely to fall.

This study is over 10 years old now and the types of medication we take now are very different.  The study is not able to tell us why it is the particular number 4.  But let’s not fixate on why it is 4 and not 3 or 5 or 10.  Let’s use this information to help people.  We can see who is more likely to have a fall and therefore who would benefit from a falls assessment.

Some people have questioned whether being on four medications is a sign of frailty and whether it is the underlying medical problems that are causing the falls.  This is a fine theory.  But other studies have proven that reviewing medication and stopping anything that is unnecessary can prevent falls, which implies (but does not prove) that it is the medication and not the underlying condition contributing to the falls.

 

As we have learnt in week one, even just agreeing on a definition of a fall has been challenging.  So you can imagine all the other difficulties we face in trying to perform research into falls.  For example, falls are under-reported, several risk factors contribute to falls and people often have a complex mix of underlying conditions and medications.  So where we do not have the proof from large, well-conducted studies, we must draw upon the evidence from smaller studies, clinical experience and expert opinion.

The issue is not about reducing a person’s medications to less than four, it is about using the information to recognise and help those at risk.

Tromp AM et al.  Fall-risk screening test: A prospective study on predictors for falls in community-dwelling elderly.  J Clin Epidemiol 2001; 54: 837-844 – abstract available

Leipzig, Cumming and Tinetti Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999; 47(1):40-50.

Vari- and bi-focal lenses – a risk factor for falling?

Frank C. Müller [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
In vari-focals, the lower part of the glass contains the lens for reading and the upper part contains the lens for long distance.  In vari-focals the two lenses merge across the glass without the distinct line which we see in bi-focals.

The problem arises when we are up on our feet and need to look down to the ground, the best example is when going down the stairs.  As we look down, our vision looks through the lens for near vision/reading.  This distorts our depth perception and the judgement of where we place our feet, increasing our risk of falls.

As we have seen from the discussions, many people use vari-focals with no problems at all, but other people have difficulty adjusting to them.  We are not asking everyone to stop using their vari- or bi-focals if they like to use them.  What we hope for, is that people can be aware of the risk.  For people who are comfortable using their vari-focals, have an awareness that if falls do become troublesome in the future you could consider changing to single lenses.  The biggest risk is for people who use them outdoors.  For people who are considering using vari-focals, feel confident enough to ask your optician what all of your options are.

Vari- and bi-focal lenses are a well recognised risk for falls among experts. This is based on the results of well conducted clinical trials, small observational studies, clinical experience and expert opinion.  But it remains up to each and every individual to decide for themselves whether to use them, or use separate glasses for distance and near vision.

If you would like to read more about this and make up your own mind, you may find the following links interesting:

The college of optometrists report on falls  

The British Geriatrics Society guide about falls and vision  

A paper from the British Medical Journal looking at falls:  BMJ 2010; 340 doi:  (Published 25 May 2010, accessed 3 December 2014)

How embarrassment may protect us from falls

Why do we feel embarrassed when we fall?

Embarrassment may actually serve us and protect us

For a moment, it seems as though all the eyes in the world are focussed on us, just as we are feeling particularly vulnerable, lying on the ground.  Given that almost everyone who has ever walked on the earth will have experienced a fall at some point in their life, why is it so embarrassing to fall in public?  In fact, we can all probably empathise with someone in this position, having been through it ourselves.

That intense emotional feeling of discomfort which appears immediately on hitting the ground can stay with us for days or even weeks.  In the immediate moments of embarrassment we may try to divert attention away from ourselves by laughing and turning the situation into a humorous one.  Or, we may become angry and to place blame, shifting the focus of attention, and the uncomfortable feeling, away from ourselves.

There is a theory that the feeling of embarrassment is protective in some ways.  It gives us feedback, in a similar way to pain, that the situation is bad for us.  This could make us change our behaviour in order to prevent being in the same situation again.  If we fall in a particular place outdoors, do we change our behaviour at that spot? And if so, do we change in order to prevent injury, or is it to prevent embarrassment?

Previous research has shown that people, who do not experience the emotion of embarrassment, tend to partake in more antisocial behaviour.  So embarrassment may actually serve us and protect us from risky behaviour or putting our heads above the parapet.

Blushing is just one of the physical characteristics of embarrassment.  It is an uncontrollable reflex that makes us very visible to those around us.  Charles Darwin found it fascinating and even wrote a whole book chapter about blushing, describing it as

“…the most peculiar and most human of all expressions”

Blushing arises because the blood vessels in our cheeks react differently to blood vessels in other parts of our body when under stress.  So while our hands might go pale and clammy, our cheeks may turn ruddy.  However, this effect wears off with advancing age and is usually limited to younger people.

Some psychologists believe that blushing is a very useful tool to have in social situations.  It provides an immediately recognisable signal that we know the situation is awkward, that we are able to react emotionally to social situations and that we are not prone to antisocial behaviour.

Will understanding these theories make falling in public any less embarrassing?  Probably not.  But maybe we can accept that sometimes embarrassment may be useful, it may help protect against falls and we shouldn’t be embarrassed by being embarrassed!