After the fall

When we think of medical breakthroughs, we tend to picture a eureka moment in a laboratory, or a pioneering operation.Some important breakthroughs, however, are much less dramatic – and considerably less glamorous.

Take, for example, the recent cultural change in the NHS towards the issue of falls in older people. This is a serious problem: falls are the most common cause of accidental death in the over 75s, and even when not fatal, they create enormous damage. Nine per cent of women over 70 who have this type of accident sustain a fracture, and if the fracture is to the hip, it can hasten death. In an older person prone to osteoporosis or with slightly less sharp reflexes, a nasty tumble can quickly compromise independence.

But there is good news. The NHS and the National Institute for Clinical Excellence are now taking falls seriously. This involves careful detective work to ascertain the reason for the fall, and thorough application of basic clinical skills to ensure that it does not happen again. By employing the skills of a multidisciplinary team – from physiotherapist to community matron to geriatrician and GP – the cause of the patient’s fall is identified accurately. The right course of action is then taken.

There are myriad reasons for falls, from heart irregularities to seizures to poor eyesight. A recent study in the British Medical Journal noted that older people wearing multifocal glasses can reduce the risk of falling during outdoor activity by switching to single-lens specs.

There are still gaps in knowledge, but based on randomised controlled trials we do know what is most likely to reduce the risk of future falls. Top of the list is a tailored programme of exercise – from tai chi to balance training – to improve the patient’s core strength. Stopping or reducing certain medications, such as sedatives, can also be effective. Blood pressure pills may cause dizziness – and thus unscheduled meetings with the floor.

There is something else, though, that studies don’t often mention: confidence. When an older person falls, they often lose their confidence, too. I dread seeing this because it so often is the harbinger of independence being threatened. Once confidence is lost, it is a short step to isolation, anxiety and fear. Getting that confidence back through the “falls team” is invaluable, and we need more research on this service. Falls are not always avoidable in old age, but we should be pleased that the NHS is at least improving the way we treat them.

Margaret McCartney is a GP in Glasgow

margaret.mccartney@ft.com

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