Falls (health and wellbeing needs in South Tyneside)

COVID-19 related resources:

• CQC. Updates for health professionals: COVID-19, 6 May 2020 and COVID-19, 7 May 2020.
• DHSC and NHIR: COVID-19 technology for strength and balance. Delivery of strength and balance exercises for falls prevention amongst older people using digital technologies to replace face-to-face contact during COVID-19 home isolation and physical distancing. 
• Keep on Keep up app. This app help reduce the high risk of falls and physical decline in older people self-isolating during the COVID-19 Lockdown.
• Public Health England Active at home. A guide to being active at home during the coronavirus outbreak.

NICE guidance:

• NICE (2019) Surveillance of falls in older people: assessing risk and prevention (NICE guideline CG161).
• NICE (2017) Falls in older people. This updated quality standard covers assessment after a fall and preventing further falls (secondary prevention) in older people living in the community and during a hospital stay.
• NICE (2017) Falls in older people pathway. This pathway covers the assessment and prevention of falls in older people both in the community and during a hospital stay.

Wider publications and toolkits:

• NHS Improvement. Patient Safety Collaboratives - Making care safer for all. Supporting trusts to  reduce falls is a priority for NHS Improvement. Case study - Safety huddles reduce falls by as much as 60 per cent (page 10)
• NIHR. Falls Management Exercise (FaME) Implementation Toolkit. This toolkit provides a suite of resources that commissioners can use to plan, implement and monitor the FaME programme.
• Public Health England. Falls: applying All Our Health. Updated information on preventing falls and fractures. See also: e-LfH - Falls and fractures prevention e-learning module.
• Public Health England and Centre for Ageing Better (2018) Muscle and bone strengthening and balance activities for general health benefits in adults and older adults. Summary of a rapid evidence review for the UK Chief Medical Officers' update of the physical activity guidelines.
• Public Health England. Falls prevention: cost-effective commissioning. The return on investment tool pulls together evidence on the effectiveness and associated costs for interventions aimed at preventing falls in older people living in the community.
• Royal College of Physicians. Falls and Fragility Fracture Audit Programme (FFFAP). The Falls and Fragility Fracture Audit Programme is a national clinical audit designed to audit the care that patients with fragility fractures and inpatient falls receive in hospital and to facilitate quality improvement initiatives.
• Royal College of Physicians (2017) Bedside vision check for falls prevention: assessment tool. The National Audit of Inpatient Falls (NAIF) has collaborated with partners to produce a new vision assessment tool which enables ward staff to quickly assess a patient's eyesight in order to help prevent them falling or tripping while in hospital.
• Royal College of Physicians (2017) National Audit of Inpatient Falls Audit report 2017. Although prevention of inpatient falls across hospitals in England and Wales has improved slightly many patients are not receiving the required assessments which can help prevent falls in hospitals.
• Royal College of Physicians (2016) Falls Prevention in Hospital: a Guide for Patients, their Families and Carers. This guide is designed to help prevent serious injury and unnecessary cost to the NHS caused by older people tripping or falling when they are in hospital.
• Royal College of Physicians (2015) FallSafe resources. FallSafe was a quality improvement project that helped frontline staff to deliver evidence-based falls prevention.
• World Falls Guidelines for Prevention and Management of Falls in Older Adults (2022). Full recommendations of the working and ad hoc groups from the World Falls guidelines with their detailed justifications, practical tips and research priorities.

Peer Reviewed Evidence:

• Barmentloo, Lotte & Olij, Branko & Erasmus, Vicki & Smilde, Dini & Schoon, Yvonne & Polinder, Suzanne. (2020). Personal preferences of participation in fall prevention programmes: A descriptive study. BMC Geriatrics. 20. 10.1186/s12877-020-01586-9.
• Delbaere K, Valenzuela T, Lord SR, Clemson L, Zijlstra GAR, Close JCT, Lung T, Woodbury A, Chow J, McInerney G, Miles L, Toson B, Briggs N, van Schooten KS. E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. BMJ. 2021 Apr 6;373:n740. doi: 10.1136/bmj.n740. Erratum in: BMJ. 2021 Aug 17;374:n1908. PMID: 33824131; PMCID: PMC8022322.
• Goldberg EM, Resnik L, Marks SJ, Merchant RC. GAPcare: the Geriatric Acute and Post-acute Fall Prevention Intervention-a pilot investigation of an emergency department-based fall prevention program for community-dwelling older adults. Pilot Feasibility Stud. 2019 Aug 27;5:106. doi: 10.1186/s40814-019-0491-9. PMID: 31463079; PMCID: PMC6710862.
• Hentschke C, Halle M, Geilhof B, Landendoerfer P, Blank W, Sieber CC, Siegrist M, Freiberger E. 24-Months Cluster-Randomized Intervention Trial of a Targeted Fall Prevention Program in a Primary Care Setting. J Gen Intern Med. 2021 Jul 8. doi: 10.1007/s11606-021-06944-w. Epub ahead of print. PMID: 34240282.
• NHS England,  Public Health England, National Osteoporosis Society. RightCare: Falls and Fragility Fractures Pathway.   NHS RightCare » Falls and Fragility Fractures Pathway (england.nhs.uk) accessed August 2022
• Tsuda, Takayuki MD, PhD Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature, Current Orthopaedic Practice: November/December 2017 - Volume 28 - Issue 6 - p 580-585

Alcohol Misuse and Fall Risks:

• Derek D. Satre, Matthew E. Hirschtritt, Michael J. Silverberg, Stacy A. Sterling, Addressing Problems With Alcohol and Other Substances Among Older Adults During the COVID-19 Pandemic, The American Journal of Geriatric Psychiatry, Volume 28, Issue 7, 2020, Pages 780-783, ISSN 1064-7481
• Iju Shakya, Gwen Bergen, Yara K. Haddad, Ramakrishna Kakara, Briana L. Moreland, Fall-related emergency department visits involving alcohol among older adults, Journal of Safety Research, Volume 74, 2020, Pages 125-131, ISSN 0022-4375
• Bye EK, Bogstrand ST, Rossow I. The importance of alcohol in elderly's hospital admissions for fall injuries: a population case-control study. Nordic Studies on Alcohol and Drugs. May 2021. doi:10.1177/14550725211015836

Meta-analysis:

• Active multifactorial interventions had positive effects on fall rates and the number of people experiencing falls. Thus, healthcare workers, including nurses, should be involved in planning fall prevention programs so that older adults can be provided with optimal care; multifactorial interventions that include exercise and environmental modification are particularly effective in reducing falls
• STRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient wellbeing
• MFI and exercise appear to be effective to reduce falls among older adults, and should be considered first as service delivery options. Further investigation is necessary to verify effectiveness and suitableness of the strategies to at-risk populations
• Multifactorial interventions (most of which include exercise prescription) may reduce the rate of falls and slightly reduce risk of older people sustaining one or more falls and recurrent falls (defined as two or more falls within a specified time period)
• There is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required

Dizziness and Falls:

• Furman JM, Raz Y, Whitney SL. Geriatric vestibulopathy assessment and management. Curr Opin Otolaryngol Head Neck Surg. 2010 Oct;18(5):386-91. doi: 10.1097/MOO.0b013e32833ce5a6. PMID: 20613528; PMCID: PMC4879828.
• Lawson, J., & Bamiou, D. (2005). Dizziness in the older person. Reviews in Clinical Gerontology, 15(3-4), 187-206. doi:10.1017/S0959259806001791
• Cohen, Helen S. et al. 'International Guidelines for Education in Vestibular Rehabilitation Therapy'. 1 Jan. 2011 : 243 - 250.
• Strupp M, Dlugaiczyk J, Ertl-Wagner BB, Rujescu D, Westhofen M, Dieterich M: Vestibular disorders—diagnosis, new classification and treatment. Dtsch Arztebl Int 2020; 117: 300-10. DOI: 10.3238/arztebl.2020.0300
• Whitney, S.L., Alghadir, A.H. & Anwer, S. Recent Evidence About the Effectiveness of Vestibular Rehabilitation. Curr Treat Options Neurol 18, 13 (2016).
• Pothula, V., Chew, F., Lesser, T. and Sharma, A. (2004), Falls and vestibular impairment. Clinical Otolaryngology & Allied Sciences, 29: 179-182. 
• Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg. 2000 May;122(5):630-4. doi: 10.1067/mhn.2000.105415. PMID: 10793337.
• Casani , A.P., Gufoni, M. & Capobianco, S. Current Insights into Treating Vertigo in Older Adults. Drugs Aging (2021).