Oral Presentation-Abstract No 1
Development and validation of a falls-related impulsive behavior scale for residential
care.
J.C. Whitney (1), J.C.T Close (2,3), S.H.D. Jackson (1), S.R. Lord (2)
1. Kings Health Partners, Kings College Hospital, London, UK 2. Neuroscience Research Australia, University
of New South Wales, Sydney, Australia 3. Department of Geriatric Medicine, Prince of Wales Clinical
School, University of New South Wales, Sydney, Australia.
_____________________________________________________________________
Introduction
There are many causes of falls in older people with cognitive impairment. Impulsivity is a possible risk
factor but has yet to be defined clearly in this context. We have designed a scale to measure falls related
impulsive behaviors and the objective of this study was to evaluate the psychometric properties of the
falls-related impulsive behavior scale for residential care (FIBS).
Methods
One hundred and nine residential aged care residents (84.5 ±8.3 years) were assessed on the FIBS and a
range of behavioral, physical and neuropsychological measures. Participants were also followed up for
falls in the subsequent 6 months.
Results
The internal reliability (Cronbach’ s α = 0.77) and test-retest reliability (intra-class correlation coefficient =
0.93) of the FIBS were both good. Construct validity was supported by significant correlations between
the FIBS and the neuropsychiatric inventory (r=0.43, P<0.001), wandering (r=0.33, P=0.001) and cognition
(r=-0.2, P=0.04). Those with a FIBS score of ≥1 were more likely to fall in the following 6 months AOR=
2.92 (95%CI 1.03-8.29).
Conclusion
The findings indicate the FIBS is a simple, valid and reliable scale for assessing falls related impulsivity in
residential aged care residents. The FIBS can therefore be recommended for use in this group for both
research and clinical purposes.
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Oral Presentation-Abstract No 2
Bed rail use in acute medical wards: Exploring the human - technology interface
S. Hignett G. Sands, M. Fray, P. Xanthoupoulou, F. Healey, P. Griffiths
Loughborough Design School, Loughborough University, UK National Patient Safety Agency, 4-8 Maple
Street, UK School of Sports, Exercise and Health Sciences, Loughborough University, UK.
____________________________________________________________________________
Background
The design and use of rails has been contentious since the 1950s with benefits identified for safety,
protection, mobility support and access to bed controls and disadvantages associated with entrapment
and restraint.
Objective
To explore the use of bed rails on medical wards with respect to bed and mattress types, visibility of the
patient and patient characteristics (mobility, cognitive status and age).
Method
Medical wards at 18 UK hospitals were audited for overnight use of rails between 23.00-06.00 between
July 2010 and February 2011 by collecting observational data for each bed and individual patient
information from nurses. Relationships were explored using the Chi-Square test with a significance level
of p<0.05.
Results
Data were collected on 2,219 beds, of which 1,799 were occupied. 86% had rails attached, of which 89%
were single or ¾ length. 52% had raised rails, with 42% having both rails raised. 81% of beds were electric
profiling, with 17% manual height adjustable hydraulic beds. Where rails were attached, they were
significantly more likely to be used on electric profiling beds. There were significant associations between
all rails raised and confusion, and all rails raised for patients who needed help to mobilise or who were
bedbound / immobile.
Conclusion
There seems to be an increase in rail use (52%) compared with previous audits (26%), particularly for
people described as confused and electric profiling beds. The mobility benefits from rails are probably not
being realised in the UK due to the use of single or ¾ length rails. There was evidence from the reasons
given by nurses to suggest that bedrails were being used to restrict independent mobility and wandering.
The use of rails illustrates a dichotomy in the care of older people between safety (and possible restraint)
and supporting mobility and autonomy, including risk taking.
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Oral Presentation-Abstract No 3
Reducing serious fall-related injuries in acute hospitals: are low-low beds a critical
success factor?
A L Barker J A Kamar K D Hill
Center of Research Excellence in Patient Safety, Monash University, Melbourne, Australia
__________________________________________________________________________________
Introduction
A nine-year evaluation at The Northern Hospital (TNH) found a significant reduction in fall-related injuries
after the 6-PACK program was implemented. Low-low beds are a key component of the 6-PACK that aim
to decrease serious fall-related injuries. Low-low beds have been increasingly implemented in hospitals
despite little evidence to support their effectiveness. To address this evidence-practice gap, this study
investigated changes in serious fall-related injuries and associations with implementation of low-low beds
over 11 years at TNH.
Methodology
The main elements of the 6-PACK program, except the number of available low-low beds, have remained
essentially the same from 2002 until present. The TNH low-low beds are similar to standard hospital beds
but can be lowered to floor level and raised to a height of 70cm. The low-low beds were located on the
high falls risk wards which were medical and surgical units. A retrospective audit of inpatients admitted
between 1999-2009 was undertaken. Changes in serious fall-related injuries throughout the period and
associations with available low-low beds were analysed using Poisson regression.
Results
During the observation of 356,158 inpatients, there were 3,946 falls and 1,005 fall-related injuries of
which 60 (5.9%) were serious (55 fractures and five subdural haematomas). The rate of falls injuries
(IRR=0.90; 95%CI:0.88-0.92; p<0.001) and serious fall-related injuries (IRR=0.88, 95%CI:0.82-0.96,
p=0.003) both declined significantly throughout the period. When there was one low-low bed to nine or
more standard beds there was no significant decrease in serious fall-related injuries. A significant
reduction only occurred when there was one low-low bed to three standard beds.
Conclusion
There appears to be an association between serious fall-related injuries and the number of available of
low-low beds. Threshold numbers of these beds may be required to achieve optimal usability and
effectiveness. A randomised controlled trial is required to provide further evidence for use of low-low
beds for injury prevention in hospitals.
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Oral Presentation-Abstract No 4
Which factors are independently associated with fear of falling in older people?
A Kumar1, H Carpenter1, R Morris2, S Iliffe2, D Kendrick1.
1. School of Community Health Sciences, University Of Nottingham, 2. Research Department of Primary
Care and Population Health, University College London.
______________________________________________________________________________________
Introduction
Determining the relationship between fear of falling and socio-functional characteristics of older people
will help identify those most at risk and aid development of interventions to
prevent falls and reduce fear of falling.
Methodology
Socio-demographic characteristics fall associated risk factors, and functional measures were recorded
from community dwelling older people aged 65 and over recruited from general practices in London,
Nottingham and Derby. Measurements included fear of falling (Short FES-I), physical activity (CHAMPS),
falls risk (FRAT), psychosocial variables (SF-12, LSNS, MSPSS) and functional ability (Timed Up and Go,
Functional Reach, and Sit to Stands). Participants with a Short FES-I score of ≥ 11 were
classified as having a high fear of falling. Multivariable logistic regression models were used to determine
factors independently associated with fear of falling.
Results
Of the 1088 participants included for analysis (62.9% female; mean age 72.9), 19.2% reported a high fear
of falling. Fear of falling was significantly (P<0.05) associated with a timed
up and go time ≥ 13.5 seconds (odds ratio (OR) 3.55, 95% confidence intervals (CI) 1.96-6.45), use of a
walking aid (OR 3.28, CI 1.70-6.31), non-white ethnicity (OR 2.48, CI1.42-4.34), poor mental health (OR
2.31, CI 1.04-5.11), a greater number of comorbidities (OR 1.18, CI 1.04-1.33), higher BMI (OR 1.03, CI
1.00-1.07). The odds of having a fear of falling were significantly lower among those with higher annual
household income (OR 0.19, CI 0.05-0.76), better self-reported physical function (OR 0.35, CI 0.16-0.77),
aged 75-79 (OR 0.45, CI 0.24-0.84), ability to do ≥ 11 sit to stands (OR 0.46, CI 0.28-0.76), and greater
functional reach (OR 0.95, CI 0.92-0.99).
Conclusions
A range of factors identify those with greater fear of falling and could be used clinically for this purpose.
Developing interventions to address modifiable factors may help reduce fear of falling.
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Oral Presentation-Abstract No 5
A complex bi-modal spatial multi-task alters postural prioritisation in healthy older
adults
M B Liston1, J H Bergmann 2, N Keating 3, D A Green1, M Pavlou1
1 Centre of Human and Aerospace Physiological Sciences, King’s College London. London UK. 2 Medical
Engineering Solutions in Osteoarthritis Centre of Excellence, Imperial College. London UK. 3 Academic
Department of Physiotherapy, King’s College London, London UK.
_____________________________________________________________________________
Background
Many daily activities require appropriate allocation of attention between postural and cognitive tasks (i.e.
dual-tasking) to be carried out effectively. Processing multiple streams of spatial information is important
for everyday tasks such as road crossing. However, the effect of complex bimodal spatial multi-tasks on
postural prioritisation has not been investigated.
Methods
Fifteen community-dwelling healthy older (mean age=78.3,male=1) and twenty younger adults (mean
age=25.3,male=6) completed this novel bimodal spatial multi-processing test. The paradigm provides
contextually similar spatial information via separate sensory modalities. Two tasks, a temporally random
visually-coded spatial step navigation task (VS) and a regular auditory-coded spatial congruency task (AS)
were performed independently (Single task) and in combination (Multi-task). Response time, accuracy
and dual-task costs (DTC’s) were determined.
Results
A significant 3-way interaction between task type (VS vs. AS), complexity (single vs. multi) and age group
was observed for both response time (p<.01) and response accuracy (p<.05) with older adults performing
significantly worse than younger adults. DTC’s were significantly greater for older compared to younger
adults in the VS step task for both response time (p<.01) and accuracy (p<.05) indicating prioritisation of
the AS over the VS stepping task in older adults. Younger adults display greater AS task response time DTC
compared to older adults (p<.05) indicating VS task prioritisation in agreement with the posture first
strategy.
Conclusion
This novel test displays alterations in postural prioritisation not previously described in older adults. These
findings may have clinical implications for falls assessment and rehabilitation.
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Oral Presentation-Abstract No 6
Vitamin D Deficiency in patients attending a Geriatric Day Hospital in South West
London
E C Heitz., N Hashemi, J A Coles
St George's Healthcare NHS trust
____________________________________________________________________________
Introduction
The prevalence of vitamin D insufficiency of UK adults has been previously documented to be 50%, 16%
being severely deficient during the winter and spring. Limited data are available for the geriatric day
hospital population.
Aim
To record all patients attending the day hospital over a year, prospectively collecting data including
vitamin D levels to evaluate prevalence and associations.
Methodology
All patients attending the St John’s Therapy Centre Day Hospital, St George’s Healthcare NHS trust, were
prospectively included from April 1 2010 to April 1 2011(n=227) . Patients were referred from a variety of
sources including general practitioners, secondary care and therapists. Routine blood tests were offered
including vitamin D (<75nmol/L=suboptimal <50nmol/L=insufficient <25nmol/L= deficient).
Results
227 patients attended, 220 patients had vitamin D measured; 7 patients refused venepuncture. The
average age was 82(61-98) of which 34%(n=75) were male. 97%(n=214) had an eGFR of >30. The main
reason for referral was assessment and treatment of falls/decreased mobility 97%(n=213).
Normal vitamin D levels were present in 11%(n=25 ) of patients, 15%(n=34) were suboptimal. 39%(n=85)
of patients had insufficient levels and 35%(n=76) were deficient. 57%(n=126) of patients who attended
without previous supplementation were insufficient with 50%(n=63) of those being deficient. 54%(n=51)
of patients who were previously taking supplementation (n=94) were insufficient, 10%(n=9) were
deficient. No significant difference was found in vitamin D levels for season, ethnicity, age or sex.
Conclusion
A higher than UK average percentage of patients attending the Geriatric Day Hospital had vitamin D
deficiency requiring treatment. Unexpectedly no difference in vitamin D deficiency was found with
ethnicity or season. A high proportion of patients remained deficient despite receiving supplementation.
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Poster Presentation-Abstract no 7
In-Patient Falls: What can we learn from incident reports?
S. Hignett, G. Sands, P. Griffiths
Loughborough Design School, Loughborough University, UK School of Sports, Exercise and Health Sciences,
Loughborough University, UK
_____________________________________________________________________________
Background
In 2008 Healey et al reported an analysis of 12 months data from the National Reporting and Learning
System. This offered useful insights but was limited due to the small dataset of free text analysis (n=400).
A subsequent pilot study (n=4,571 reports) found an apparent difference in the contributory factors for
the cognitive (confused) and physical impairment (frail) groups.
Objective
To analyse 3 years national incident data (2005-2008) to further explore the contributory factors of inpatient falls and address limitations of previous research.
Method
20,036 reports (15% sample) were analysed by coding the free text data using the taxonomy from the
pilot study. The contributory risk factors were compared with the whole sample and explored with the
Chi-squared and Fisher’s exact tests.
Results
Data were reported about the degree of harm (100% of reports), (un)witnessed status of fall (78%),
location (47%), patient activity at the time of the fall (27%), frailty (9.5%) and confusion (9.2%). Less than
0.1% of reports provided data about dizziness, illness, vision/hearing, and medicines. Overall, patients
were less likely to be harmed from a fall in the bed space, when transferring, and if falling from a chair
when not intending to leave the chair. They were more likely to be harmed when away from the bed
space, mobilising/walking and by falling from the bed when not intending to leave the bed. Differences
were found again for contributory factors in the cognitive (confused) and physical (frail) impairment
groups.
Conclusion
This analysis explored incident reports at a level of detail not previously achieved. It identifies significant
contributory factors for fall locations and activities associated with physical and cognitive characteristics.
Although this analysis offers a more detailed description of falls, empirical data collected directly from
patients are needed to fully explore contributory factors.
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Poster Presentation-Abstract no 8
Does a six week balance course improve physical, psychological and quality of life
measurements in a community-dwelling falls population?
I Marinescu 1, A D Kerr 2, S Skevington 1
1. University of Bath, Department of Psychology, 2. Falls clinic, St Martin’s Hospital, Bath
____________________________________________________________________________
Introduction
This study investigated the effect of a 6 week balance course on physical, psychological and quality of life
measurements in a falls’ population.
Methods
Community-dwelling participants were recruited from a Falls Clinic who had fallen in the previous year.
Questionnaires were completed before and after a 6 week (twice a week) balance course assessing their
fear of falling (Short FES-I), and health-related quality of life (SF12-v2). This was matched with their
functional mobility (Timed up & Go test), balance (Berg Balance) and balance confidence
(CONFbal).
Results
There were 13 participants (8 female and 5 male) with a mean age of 79.8 yrs who had a mean number of
co-morbidities of 5 and were taking on average 6 medications. Paired sample statistical comparisons were
made between each of the before and after results. There were significant improvements in Timed up &
Go (p=0.002), Berg Balance (p=0.006), CONFbal (p=0.035), short FES-I (p=0.022) and the physical
component of SF12-v2 (p=0.001). There was no significant improvement in the mental component of SF
12-v2 (p=0.156) although on further sub-section analysis, there was a significant improvement in social
functioning (p=0.004). It was also found that people who live with someone have a greater tolerance to
bodily pain than people who live alone (p=0.006).
Conclusions
There are physical, psychological and health related quality of life (physical component) benefits
of a six week, twice a week balance course in a community falls’ population. There are also added benefits
of improved social functioning as a result of attending the course. The lack of improvement in the other
sub-sections of the mental component of quality of life suggests a possible role for psychologists working
alongside therapists in a falls clinic
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Poster Presentation-Abstract no 9
Delivering Optimum Orthogeriatric Care to Frail Elderly Patients
Ashraf Nasim, Katy Davies
St Georges Hospital, Tooting
_____________________________________________________________________________
Introduction
Hip fractures are the commonest cause of morbidity and mortality among elderly patients, causing
considerable health care expenditure. Old age increases risk of hip fracture. Dementia is under-diagnosed
in fracture hip patients (1). Dementia Patients with a hip fracture are more expensive to treat (2), more
likely to be institutionalised (3) and less likely to recover function (4) compared with patients without
dementia or cognitive impairment.
Methodology
N: 71 pts, Average age- 84yrs, over 6months, all pt had AMTS/MMSE on admission. Investigations: S
Albumin, Vit D levels on admission. All pt had ‘MUST’ score calculated during stay. Also included was any
Hx previous bone protection intake:
Results
N: 71; 75% were females/ 25% were males. 40(56%) had Intra-capsular hip# 31(44%) extra-capsular # (5).
59(84.5%) had 3 or more co-morbidities (6). 49(69%)signs of dementia (MMSE) on admission. Average
LOS for normal cognition was 21 days (median ‘17’; range 6---72). Dementia group had longer LOS of 25
days. 35(50%) had low Vit D; 18(66%) had background dementia. Dementia & low Vit D group overstayed
by 4 days. 50(70%) had low Albumin levels on admission. Group with ‘MUST’ score of 3 overstayed by 3
days.13(19%) taking bone protection on admission. 52(73%) had orthogeriatric review within 24 hrs with
average LOS of 16.75days, compared to 31.11days (Reviewed anytime after 48 hrs).
Conclusion
1. Rising UK old age population will increase hip # load on NHS. 2. Co-morbidities (3 or>3) predicts
increase LOS, dependency and poor rehab outcome. 3. Dementia is an important risk factor for hip #.4.
Malnutrition/ low MUST score predicts increase LOS, institutionalization. 5.Orthogeriatric input on
admission significantly reduced LOS. 6.Dementia & malnutrition increase frailty, poor surgical and rehab
outcome, institutionalization and death.
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Poster Presentation-Abstract no 10
The effect of the OTAGO falls exercise program with and without additional multisensory balance exercises on falls risk, gait, and balance confidence in older adult
fallers: A pilot randomised control trial.
M B Liston 1, L Alushi 1, Doris-Eva Bamiou, 2,3, F C Martin, 4, A Hopper 4, M Pavlou 1
1.Centre of Human and Aerospace Physiological Sciences, King’s College London, London, UK; 2.
Department of Neuro-Otology, National Hospital for Neurology and Neurosurgery, London, UK. 3. Ear
Institute, UCL, London, UK; 4 Department of Elderly Care Medicine, Guys and St Thomas’ NHS Foundation
Trust, London UK.
____________________________________________________________________________________
Objective
To compare the effect of the OTAGO falls exercise prog falls risk measures, and perceived balance
confidence. Ram with and without additional multisensory balance exercises on functional gait,
physiological
Methodology
Community-dwelling older adults (n=21) experiencing >2 unexplained falls during previous 12 months
were recruited into this single-blinded randomised control trial. Participants undertook an Otago exercise
class supplemented with either a supervised home-based multisensory (Group M) or control stretching
exercise program (Group S). The group exercise classes and supervised sessions each occurred twiceweekly for 8-weeks. The primary outcome measure was the Functional Gait Assessment (FGA) Secondary
outcomes were the Physiological Profile Assessment (PPA), computerized Rod and Disc test for subjective
visual vertical, and questionnaires for symptoms, symptom triggers, balance confidence, and psychological
state.
Results
Multi-factorial PPA falls risk (p<.05), FGA (p<.01), and vestibular symptom (i.e. giddiness, unsteadiness,
p<.05) scores improved significantly only for Group M with an identical significant effect size (r) for each
measure (T=0, p<.05, r=-0.63). For Group S significant improvements were noted only for balance
confidence (p<.01); falls risk did not reduce on any measure. Drop-out rate was similar for both groups
(~30%).
Conclusions
Functional gait, multi-factorial falls risk, and vestibular symptoms improve only when customised multisensory exercises designed to promote utilisation of vestibular cues and sensory reweighting are included
within the falls rehabilitation program. Findings suggest multisensory balance exercises are beneficial and
should be incorporated into falls rehabilitation programs.
______________________________________________________________________________________
Poster Presentation-Abstract no 11
Community Falls Clinic innovation
C Heaton S Doyle
Bridgewater Community Health care NHS Trust
___________________________________________________________________________
Introduction
Community based Falls Clinic that meets Nice Guidelines and RCP Audit criteria, delivered by
an Extended Scope Practitioner, Occupational Therapist, Physiotherapist, Nurse and admin. It
delivers a quality service with increased capacity, from 4 clinic slots in previous provision to 18
per week with the flexibility to expand if demand requires it. Follow up appointments are done
at home if possible.
All patients are seen at home 1-2 weeks before initial attendance by the Nurse who undertakes
triage, including medication review, Lying and standing BP, blood tests, coping strategies and
health promotion. This has been shown to reduce DNA rates, and identify patients who would not
be suitable to attend and can be seen at home.
At the clinic the Extended Scope Practitioner undertakes focused medical assessment
investigation and diagnosis, full medicine review, osteoporosis risk assessment and bone
replacement therapy with counselling. Also the Specialist Physiotherapy undertakes a full
assessment at clinic and plans treatment. Following this the Occupational Therapist will
undertake a Home fast environmental assessment.
Results and Outcomes
Waiting time’s approx 6 weeks greatly reduced from previous provision when initiative clinics had
to be held to manage demand. DNA rates reduced from over 37% with previous provision to less
than 8 %.
Excellent outcomes, 80% of patients are discharged from the clinic or are referred to the Falls
Prevention Exercise programme, with only 14% going on to see a Consultant in secondary care–
8% Falls, 6% other e.g. Cardiac, elderly care, ENT.

Thus also delivering on the QIPP agenda with efficient use of the consultant time.

Patient satisfaction 100% very satisfied or satisfied

Patient information leaflets pre clinic (created with the patient user group) and information
of the outcome given to patients before leaving the clinic.
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Poster Presentation-Abstract no 12
Falls and bone health in patients with Parkinson's disease at the Royal Devon and
Exeter Hospital
Shvaita Ralhan Caroline Ostrowski Lindsay Ronan Ray Sheridan Gill Fenwick Vaughan Pearce
Royal Devon and Exeter NHS Foundation Trust
_______________________________________________________________________
Introduction
In accordance with NICE guidance on falls, all older people in contact with healthcare professionals should
be routinely assessed for falls and osteoporotic risk. Falls increase fractures and are the leading cause of
admission to hospital in Parkinson’s Disease (PD) patients. Research has shown an association between
low bone mineral density and PD. Furthermore, the QFracture algorithm has recently incorporated
Parkinson’s disease as part of its calculation for osteoporosis risk. We therefore audited our practice with
respect to falls and osteoporosis assessment and management in this group of patients against NICE and
RCP guidelines.
Methodology
We audited 25 PD outpatients from clinic in May 2012. We looked at our performance to assess and
manage falls and osteoporosis using patient and retrospective case note questionnaires.
Results
The average age of our patients was 74 years. 52% (13) of patients had fallen in the last 6 months. 96%
(24) of patients received a falls assessment within the last year. 64 % (16) of patients were considered at
high risk of falls or fracture (fall in last 6 months, postural hypotension, previous fragility fracture or comorbidities/medication predisposing to osteoporosis). Of these high risk patients only 54% were on any
bone protection. Only 1 of these patients had undergone a DEXA scan. Only 1 patient in our audited
group was on a Bisphosphonate, the remainder of bone protection was in the form of calcium and vitamin
D. We were unable to get sufficient information from the notes to calculate FRAX scores in our patient
group.
Conclusion(s)
We are good at assessing falls in our PD patients. However, we are poor at subsequently assessing and
managing osteoporosis. We hope to introduce an annual nurse led falls and osteoporosis risk assessment
tool to attempt to improve osteoporosis assessment in the future.
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Poster Presentation-Abstract no 13
Development of a Complex Multifactorial Falls Prevention (MFFP) Intervention
Package for Implementation Within Primary Care
S Ralhan, J Bruce ,C Bridle, E J Withers, R Lall, N Walker, R Sheridan, F C Martin and S E
Lamb on behalf of PreFIT Study Group.
Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
_____________________________________________________________________________
Introduction
Falls commonly cause injury, disability and dependence among older people. The NHS commits £34million
annually to MFFP programmes. However, uncertainty exists about the effectiveness of MFFP; particularly
for reducing injurious falls. We have developed an MFFP programme for a multicentre cluster randomised
controlled trial testing alternative approaches to falls prevention (Prevention of Falls Injury Trial: PreFIT).
PreFIT will determine the comparative clinical and cost-effectiveness of three primary care fall prevention
strategies on fractures (primary outcome), falls and quality of life, among 9000 community-dwelling older
people. Development and content of this MFFP intervention for delivery by primary care staff is
described.
Methodology
A literature search identified components commonly targeted within MFFP programmes. Recent national
and international guidance informed selection of risk factors and development of linked treatment
pathways. Experts in falls prevention, primary care and rehabilitation medicine contributed to its content.
Results
The Tinetti (1994) MFFP programme was selected and modified according to recent guidance. Seven risk
factors were selected for assessment: (1)falls history with potential ‘red flags’; (2)gait and balance (Timed
Up and Go Test); (3)postural hypotension; (4)medication review; (5)vision; (6)feet and footwear; and
(7)environmental hazards. Each risk factor is linked to a recommended treatment and referral pathway. A
detailed MFFP intervention manual, supplemented with practical visual aids with screening and treatment
algorithms, has been piloted in primary care.
Conclusion
We have developed a complex MFFP intervention for delivery within primary care.
Training has been successfully delivered to GP surgeries participating in the pilot phase of PreFIT.
_____________________________________________________________________________
Poster Presentation-Abstract no 14
Working with older adults to develop a public friendly version of the national falls and
bone health audit.
J Riglin,J Husk, J Treml, and N Vasilakis
Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London
_____________________________________________________________________________
Introduction/Background
The national falls and bone health audit, commissioned by Healthcare Quality Improvement Partnership,
and delivered by CEEU has been reporting national audit results since 2005. Previous reports were written
for a professional audience. In 2011, it was decided to produce a report that was public-friendly.
Methodology
The aim was to raise public awareness regarding falls and fracture care, and of recommendations from
national audit reports, in an easily understood format. The draft executive summary from the May 2011
report was used as a basis to talk to a volunteer focus group comprising representatives from Age UK/Age
Concern Oldham, the local council, and NHS Oldham. Many of the group had experiences of falling and
had ideas about what was needed. There were face to face meetings at the beginning and towards to end
of the project. Most of the work was done by email or by post. Work started in April 2011 and was
completed in November 2011.
Results
Terminology was changed where possible and where not, explanations were added to a glossary. As
neither the four objectives in the DH Prevention Package, nor the key messages and recommendations in
the full report, were clear to the group members, these were re-written. Reports were sent to key
organisations, distributed to libraries and to Age UK outlets. It can be downloaded from:
www.rcplondon.ac.uk/projects/national-audit-falls-and-bone-health-older-people
Conclusions
The report will be useful both to the public and, potentially, as an easy-read summary for those working in
healthcare. Working with members of the public is a challenge and time consuming. However it is
worthwhile to get a report with messages that are meaningful to patients and the public.
_______________________________________________________________________
Poster Presentation-Abstract no 15
ANALYSIS OF PARAMETERS INFLUENCING THE ASSESSMENT OF GAIT AND FALL RISK
IN ELDERLY PATIENTS WITH AND WITHOUT A HISTORY OF FALLS.
A P Coutinho; C Fragata; I Vivas; M Gonçalves; D Andrade
_____________________________________________________________________________
Introduction
The aim of this study was to compare parameters that may influence gait (strength, balance, fear of
falling, Root Mean Square on the maximal voluntary contraction, Foot Minimum Clearance, stride length,
speed and leg support time) and check whether a relationship exists between these parameters and the
risk of falling.
Methodology
The sample comprised a total of 30 patients who fulfilled the inclusion and exclusion criteria. These were
divided by the group with no history of falls (n=15) and the group with a history of falls (n=15). The
strength evaluation was performed using the Biodex Isokinetic Dynamometer System; balance using the
Berg Scale, the fear of falling through Falls Eficacy Scale, and the Root Mean Square on the maximum
voluntary contraction using the surface electromyography, the Foot Minimum Clearance, and stride
length, speed and leg support time were assessed by kinematic analysis. To assess the risk of falling was
applied Timed Up and Go Test, Performance Oriented Mobility Assessment and Berg Balance Scale.
Results
Significant differences in relation to an equilibrium with p=0.000 and the Performance Oriented Mobility
Assessment with p=0.001. The remaining parameters were not found statistically significant differences
between groups (p>0.05).
Conclusion
We conclude that for the group with a history of falls strength, balance and Foot Minimum Clearance and
support time left is smaller and the fear of falling, Root Mean Square on the maximal voluntary
contraction, velocity and time to support law is superior compared to group with no history of falls.
____________________________________________________________________________
Poster Presentation-Abstract no 16
DO THE TRIGGERS THE COMMUNITY FALLS PREVENTION PROGRAMME (CFPP) USE GET
THE RIGHT PATIENTS TO SPECIALIST FALLS CLINIC
Rachel Stewart (1), Oona Lucie (2), Lara Mitchell (3), Lynsey Simpson (4)
1.Department of Medicine for the Elderly, Gartnavel General Hospital, GG&C 2.Department of Medicine
for the Elderly, Gartnavel General Hospital, GG&C 3.Department of Medicine for the Elderly, Southern
General Hospital, GG&C 4.Department of Medicine for the Elderly, Glasgow Royal Infirmary, GG&C.
_____________________________________________________________________________
Introduction
CFPP assess patients at home after a fall. Onwards referral to a variety of services for individualised and
multifactorial intervention then takes place dependent on a variety of triggers. The following triggers are
used to refer to specialist falls clinic:
·
> 3 falls in 12 months or 2 in 6 months
·
walking limited by feeling faint or dizzy
·
reason for fall
o
don’t know (plus one of dizzy, off balance, faint, sick)
o
just went down
We wanted to know if these triggers were selecting appropriate patients for the specialist falls clinic.
Methods
Data was collected from five specialist falls clinics with in GG&C over a 4 week period. The data
included;
·
demographics
·
cognitive function, (Abbreviated Mental Test)
·
number of falls
·
injuries sustained
·
trigger for referral
·
documented causes of fall(s)
·
Suitability for Specialist Falls Clinic, Geriatric Day Hospital (GDH) or CFPP as
determined by the consultant at clinic.
Results
There were 56 patients in total. 37 women (mean 80.4 years), 19 men (mean 72.7 years). 12 (21%) were
felt to be inappropriate for falls clinic review. Of these, 8 patients were more suitable for GDH. They were
all felt to require AHP review. Some had been recently investigated either at previous falls clinic or as inpatients.Others attended multiple clinics for chronic health problems. 4 could have remained under the
care of CFPP. The cause of their falls were all related to lack of confidence or environmental factors.
Conclusions
CFPP is an excellent interface between community and secondary care. The current triggers in use are
mostly deemed to be appropriate. Some recommendations have been made for those patients who
would be best seen in GDH.
___________________________________________________________
Poster Presentation-Abstract no 17
Falls Partnership Vehicle
Dr Viveca Kirthisingha, Phil Lumbard, Annami Palmer, Abi Aitkenhead, Cara Lawrence
Falls Partnership Vehicle, Cambridge
__________________________________________________________________________
The Falls Partnership Vehicle (FPV) is an innovative service which involves an Emergency Care Practitioner
(ECP) and an Occupational Therapist delivering an immediate falls response to people over 65 who have
fallen at home. The primary objective is to avoid inappropriate acute admissions of patients who would
normally have accessed A & E via the Ambulance service. Following a comprehensive assessment,
interventions are provided to enable the patient to remain safely at home.
The ECP provides immediate medical assessments and seeks to establish the cause of the fall. The
therapist completes a functional and environmental assessment and has immediate access to equipment
to enable independence. With the ability to investigate, diagnose and treat, the team works
collaboratively to formulate management plans, liaising with the GP as appropriate.
A weekly virtual ward round with the Consultant Community Geriatrician provides the opportunity to
discuss the treatment plans initiated during the previous week. This aspect of the service provides clinical
governance and has proved to be invaluable in ensuring the team expedite robust clinical reasoning and
deliver a high quality service.
Referral pathways into community and voluntary services are well established, such as referrals to the
Balance and Strength programmes, ensuring that an ongoing falls prevention element remains
paramount. Additionally, if care is required to support our patients at home, effective pathways are in
place.
A whole system approach is aimed at, to ensure the integration of services provide seamless interventions
with the patient’s goals being paramount. A recent patient experience survey demonstrated that the
service does indeed exceed the expectations of our patients.
This pilot project provides a holistic patient centered approach in the right setting, first time and has
proved to be cost effective. It is has now been commissioned to provide a permanent service in
Cambridge.
_____________________________________________________________________________
Poster Presentation-Abstract no 18
Effects of an 18-week strength and balance exercise intervention: physiological,
biomechanical and psychological changes in older adult fallers
Fiona Higgs (1); Samantha Winter (1); Hugh Chadderton (2); Joanne Thatcher (1)
1. Aberystwyth University Department of Sport and Exercise Science Carwyn James Building Aberystwyth
University Penglais Campus Aberystwyth Ceredigion SY23 3FD 2. Cardiff Bay Clinic Dunleavy Drive Cardiff
CF11 0SN.
_____________________________________________________________________________
INTRODUCTION
The aims were to investigate effects of an 18-week PSI intervention on muscle mass, balance, exercise
motivation (EM), well-being (WB) and falls incidence.
METHOD
A sample of twenty-two patient volunteers (age 77.14 ± 7.2 years) were referred onto the PSI intervention
from a local falls clinic service.
Clinic-based tests (e.g. Timed-Up and Go (TUGT), Romberg Balance (ROM), Falls Efficacy ScaleInternational) were administered by the PSI instructor before first PSI class attendance (T0) and after 6 PSI
classes (T1). At T0, T1 and after attending a further twelve community-based weekly PSI classes (T2),
laboratory-based balance assessments were conducted using force plate data; and well-being and
exercise motivation by questionnaires. Whole body composition was measured using a DXA scanner at T0
and T2. Monthly falls incidence was recorded via telephone interview for six months following T2.
RESULTS
There were no significant changes (P >0.05) in EM, WB, or in lean, fat or bone mass, (T0-T2).
Significant reductions (P<0.05) were found between T0-T2 in the laboratory-based balance assessments
for medio-lateral (ML; T0 9.58 ± 4.32; T2 8.69 ± 5.05) and antero-posterior (AP; T0 3.59 ± 4.93; T2 2.80 ±
1.83) sway and elliptical area (T0 479.50 ± 1064.17; T2 263.90 ± 331.50). Significant improvements were
found in performance of all clinic-based tests – except for TUGT (T0-1), but were not replicated in the
laboratory-based tests (T0-1). In the first month after the PSI intervention 13.4% of participants fell one
or more times, this increased to 46.2% 6 months after the intervention
CONCLUSION
Clinic-based tests showed significant improvements in performance (T0-1); that were not replicated in
objective laboratory-based tests. Taken together the results suggest that changes in neural control were
the cause of improved functional test scores. Short PSI interventions do not replicate the long-term
reduction in falls seen after 48 week PSI programmes.
_____________________________________________________________________________
Poster Presentation-Abstract no 19
Assessment of Falls in the Medical Assessment Unit; How we Compare to NICE
Guidelines
P Sarkar,W Tan
Department of Elderly Care, Croydon University Hospital
__________________________________________________________________________
Introduction
We generated an audit of falls risk assessment undertaken during medical admission, using NICE
guidelines (2004) as our gold standard.
Methods
The audit was undertaken between July - October 2011. Improvement strategies included increasing
awareness amongst medical on-calls, and piloting a multi-disciplinary “falls assessment proforma”. A reaudit was performed after 9 months to complete the loop.
Results
55 patients were reviewed from July-October 2011, and 42 from April-June 2012. In the first audit, only
38% had risk factors contributory to falls identified; in the second audit the rate improved to 71%, with
UTI the predominant documented cause (23%).
A significant low rate of visual assessment (20%), gait assessment (5%), and medication review (11%) was
noted in the first audit, with much improvement observed (62% had visual assessment, 9% gait
assessment and 26% medication review) in the second audit.
Cardiovascular examination (84% in July 2011, and 91% in July 2012) and cognitive assessments (81% in
July 2011, and 88% in July 2012) performed well. ECG (85% in July 2011, and 88% in July 2012) and urine
dipstick assessment (65% in July 2011, and 71% in July 2012) also performed well. There is still a low
proportion of postural blood pressure performed (50% in July 2011, and 46% in July 2012).
Conclusion
In the first audit, the initial steps of falls assessment in the Medical Assessment Unit was investigated and
we found that multifactorial assessment as outlined by NICE guidelines was poor.
In the second audit, there is an overall improvement in various risk factors being considered, in particular
visual impairment. UTI was often labelled as the main cause of fall; although this maybe contributory, a
comprehensive assessment of risk factors was not completed.
Recommendation
Future action involves further training focusing on comprehensive assessment of multiple risk factors
(independent of UTI).
______________________________________________________________________________________
Poster Presentation-Abstract no 20
ALCOHOL USE AMONGST OLDER PATIENTS WHO FALL IN A COMMUNITY SETTING,
AND HOW WE SHOULD APPROACH IT.
Elizabeth Davies, Claire Dinsdale
Swansea Community Resource Team, Gorseinon Hospital,Swansea. Abertawe Bro Morgannwg University
Health Board.
_____________________________________________________________________________
Introduction
Trials have shown that falls in older adults are often multifactorial.
There is evidence that alcohol use is one of these factors,consequently alcohol use enquiry forms part of
the NICE falls checklist. We studied alcohol use within our population of older people falling at
home.These patients are not conveyed to hospital, but assessed by the ambulance service and passed to
our Community Resource Team for multidisciplinary assessment and intervention.We wanted to ascertain
how extensively alcohol is used in this population, and whether we should be doing more about it.
Methods
We analysed the NICE based CRT falls proforma for patients assessed by the service, with respect to
alcohol use; patients were asked whether they drank 1 or more units of alcohol/day.
We asked the nurses completing the assessments what written and verbal advice they gave to patients
drinking this amount.
Results
There were 202 referrals to the pathway in 2011, and 65 for the first 5 months of 2012. 92/202 (45.5%)
and 29/65 (44.6%) admitted to drinking 1 or more units of alcohol per day and therefore received advice.
This tended to include advice about safe alcohol limits and general advice about staying steady. Patients
with drink problems threatening their safety were referred to social services with consent. A
falls information sheet produced locally,which contained no reference to alcohol, was the only written
advice given.
Conclusions
Published research identifies alcohol as a risk factor in up to 11% of older falls patients attending A&E.The
prevalence of drinking more than one unit of alcohol per day in our population is high at nearly 50% of
referred patients. There is a need to give more specific, detailed verbal advice.Additionally,our written
advice now contains a section on falls and alcohol use, which encourages patients to consider the
relationship of alcohol to their falls.
____________________________________________________________________________
Poster Presentation-Abstract no 21
Observational study to explore whether risk of hospital admission is elevated in
patients with a positive tilt table test and examining syncope guideline adherence.
JAH Foster, OM Jeffreys
Royal Devon and Exeter NHS Foundation Trust
_____________________________________________________________________________
Introduction
Tilt testing reproduces the neurally mediated reflex and is included in European
and NICE syncope guidelines.
Aims
Do investigations prior to tilt referral comply with NICE guidelines?
Are patients with a diagnostic tilt more likely to have hospital admissions?
In cases with documented loss of consciousness(LOC) is driving status documented?
Methods
Retrospective observational study of 100 consecutive patients undergoing tilt testing +/- carotid sinus
massage(CSM) at a single NHS Trust from 1/1/11. Data collected from case note analysis.
Results
65% female, 35% male; mean age of 66. 67% were referred by elderly care (39% by the syncope lead) and
32% from other specialists (14% neurology, 6 % cardiology). 2 were paediatric cases.
67% had documented LOC, of which 87% had a 12-lead ECG, 66% had a 24-hour ECG and 50% had
postural blood pressures documented prior to tilt test referral. 35% of those with LOC of driving age had a
documented driving status.
44% of sessions were diagnostic of 95 cases with outcome data. 23 cases showed neurocardiogenic
syncope, 5 cases carotid sinus hypersensitivity, 5 cases orthostatic hypotension, 4 had mixed pathology
and 5 had an alternative diagnosis.
26% were admitted in preceding 12 months: 40% falls, 60% syncope.
12 % were admitted in the 12 months post-tilt: 23 % falls, 40 % syncope, 40% other.
There was no significant difference in admissions pre-tilt (p=0.77) or post-tilt (p=0.54) according to
whether the tilt was diagnostic or not.
Conclusion
Investigations prior to tilt clinic did not reach 100% compliance with NICE guidelines. A more uniformed
approach could be achieved through a single-entry service.
Risk of hospital admission in the year either side of the tilt was not increased in those with a positive tilt
test.
In patients with documented LOC, changes are required to improve documentation of driving status and
advice.
_____________________________________________________________________________
Poster Presentation-Abstract no 22
The Best Practice Tariff for Hip Fractures: A time to concentrate on patients’ needs
rather than their age?
C M Sin Chan and L Thangaraj
Watford General Hospital, Road, Watford, Herts, WD18 0HB
_____________________________________________________________________________
Introduction
The Best Practice Tariff (BPT) has provided financial incentives to improve the care of patients who suffer
fragility hip fractures. Streamlining services has improved collaboration between the geriatric,
orthopaedic, anaesthetic and therapy teams; with the ultimate goal to provide safer and cost effective
care. However, with the current BPT criteria, those under 60 years old can inadvertently be neglected and
miss out on timely multidisciplinary intervention. Fragility fractures in this group are unusual and may
indicate underlying complex medical problems, which would benefit from early medical intervention.
Method
The number of hip fractures admitted to Watford General Hospital was gathered over 1-year commencing
April 2010. From the 459 adults admitted; those over 60 years old were excluded, as were high impact
fractures. We identified 14 fragility hip fracture patients under 60 years old.
Results
Four patients had complex medical issues that required extensive orthogeriatric input. Medical conditions
ranged from alcoholic liver disease, delirium, uncontrolled diabetes and encephalopathy. Ten patients
were less complex, but still required medical intervention, with eight receiving ‘Best Practice’ care.
Conclusion
The under 60s account for a small percentage of fragility hip fractures; 3% in our case. These numbers are
unlikely to impact significantly on resources as orthogeriatric units have become established. Additionally,
such patients often have complex medical conditions, which are best managed by an orthogeriatrician.
Many units may already provide multidisciplinary input to these patients despite additional funding not
being available.
Whilst this is only a small sample, other hospitals with orthogeriatric units may have similar scenarios; a
low percentage of younger patients where ‘Best Practice’ care is provided without reimbursement. Our
recommendation is that the BPT criteria should be needs-related rather than age-related. Removing the
age criteria would be more inclusive and ensure complex medical patients, regardless of age, receive early
orthogeriatric input.
_____________________________________________________________________________
Poster Presentation-Abstract no 23
A re-audit of inpatient falls prevention assessment
S Z Chaudhry, C Manning, T Chattopadhyay
Stepping Hill Hospital, Stockport, Cheshire
_____________________________________________________________________________
Introduction
Inpatient falls are common, with an estimated 282,000 falls recorded in NHS hospitals in 2010 (National
Patient Safety Agency) and are associated with significant morbidity and mortality. Aetiology is often
multifactorial and risk factors can be anticipated. This has led to the development of inpatient falls
prevention programmes. In 2011, an audit cycle was completed at our hospital to assess falls prevention
management. This demonstrated high achievement in the basic falls prevention principles and a 46%
reduction in inpatient falls.
Methodology
A prospective re-audit of inpatient falls prevention assessment was performed. All patients, a total of 51,
on our care of the elderly ward were included over a one week period. The standards used were taken
from the American Geriatric Society/British Geriatric Society Guidelines of 2010 and comprised
assessment of four falls prevention principles; falls history, medication review, footwear assessment and
ease of access to call bell. The audit was modified this year to include a confusion screen and assessment
for postural hypotension in all patients with a history of falls.
Results
The audit results compared with 2011 demonstrated reduced attainment in each of the four principle
areas. 66% of patients had all four principles compared with 92% in 2011. In those with a history of falls,
a confusion screen was performed in 47% and assessment for postural hypotension in 39% of patients.
Including the new standards, all standards were met in 63% of cases. The number of falls increased by
4%.
Conclusion
The 2011 audit demonstrates that falls prevention assessment reduces inpatient falls. The results of the
re-audit this year shows that the importance of falls prevention and assessment requires regular and longterm reinforcement. This can be achieved by a cohesive multidisciplinary approach, staff education,
developing a falls prevention pathway, regular assessments during hospital stay and re-auditing.
_____________________________________________________________________________
Poster Presentation-Abstract no 24
Readmissions up to 1 year after admission with fractured neck of femur
A Folwell, R Humphreys, O D'Souza
Scarborough District General Hospital
______________________________________________________________________________
Introduction
Reducing readmissions is a national priority. Some are preventable whilst others are necessary and
unavoidable. Frail elderly patients with multiple co-morbidities who are most likely to have had a
fractured neck of femur are at increased risk of readmission. A systematic review found on average 27%
of readmissions were preventablei[i].
Methods
We aimed to calculate the incidence of readmissions at 30 days and 12 months following an admission
with a fractured neck of femur, and whether any of these were avoidable. If so, were there any patterns
of deficiencies in care which could be identified to improve practice.
Case notes of patients admitted from November 2009 to October 2010, identified from the National Hip
Fracture Database and followed up for 1 year, were independently and retrospectively reviewed by 2
people.
Results
281 patients were admitted with a fractured neck of femur, 64 of whom were readmitted over 1 year. We
were able to access 44 patients’ notes.
·
60% were only admitted once
·
70% were after 30 days post discharge.
·
6 readmissions (14%) were avoidable.
o
4 with a fall but an incomplete falls assessment prior to initial discharge.
o
2 with pneumonia but signs of infection prior to discharge.
·
3 readmissions for recognised surgical complications.
·
7 with a fall despite adequate falls assessment
·
28 (64%) with an unrelated problem.
Readmission was associated with increased discharge to nursing homes and mortality.
Conclusions
Emergency readmissions to acute hospitals are due to a complex interplay of patient, hospital and
community characteristics. We had fewer than expected readmissions in this frail patient population, and
the majority were with a new and unavoidable problem. With increased senior input and completed falls
assessment some could have been avoided. Input by orthogeriatricians has subsequently been increased,
resolving these issues.
_____________________________________________________________________________
Poster Presentation-Abstract no 25
Polypharmacy and Falls: which pill is the culprit?
Khalifa Boukadida
Falls prevention clinic. St Woolos Hospital, Newport. Gwent.
_______________________________________________________________________
Introduction
Although falls are multifactorial, medications are key risk factor which can be modified.
Objective
To assess whether medications review helped to reduce the frequency of falls and falls related injuries.
Methods
In a retrospective study, we randomly selected 50 patients attended the falls prevention clinic
between January 2011 and January 2012.
Results
The average age was 73 years. 86% of subjects were on four or more medications mainly cardiovascular
and psychotropic drugs. 32% of patients were on antidepressants, 12% were on benzodiazepines,one in
four of patients were taking ACE-Inhibitors, one in three were on beta-blocker, one in four were on
diuretics and 24% of patients were on Calcium channel blockers. Interestingly, medication induced
dizziness was documented in 62% of cases and postural hypotension was confirmed in 42% of cases. more
than two third of patients had their medication modified. Among patients on antidepressants , the dose
was lowered in 25% of cases. one third of patients on ACE-inhibitors had the timing of their medications
changed. 19% of patients on diuretics had their medications stopped. The initial modification
of medications was communicated to general practitioner and we recommended Blood pressure
monitoring and reviewing the long-term need of medication.
Conclusion
Our experience showed that withholding or lowering the dose of high risk drugs along with introducing
blood pressure and medication review diary were key tools in our intervention.
However,we need a larger prospective study in view to provide clearer guidance as regards safer
prescribing in older fallers.
_________________________________________________________________________
Poster Presentation-Abstract no 26
BALANCE UNFRIENDLY DRUGS IN PATIENTS WITH FALLS
A Michael, PJ Teo
Russells Hall Hospital, Dudley, West Midlands, DY1 2HQ, UK
__________________________________________________________________________________
Introduction
Falls are usually multifactorial and one of the common factors is “Drugs”. Some drug classes affect the
balance and increase the risk of falling. There are several mechanisms by which the suspect drugs can
predispose to falls, including postural hypotension, electrolyte imbalance, cerebral hypo perfusion,
sedation, delayed reaction time and extrapyramidal side effects.
Aim
To study the use of some common drugs that may impair balance and increase the risk of falling in
patients with falls or poor balance.
Methods
Retrospective analysis of the electronic records of consecutive patients attending the falls clinic in a 12
months period in a UK teaching hospital. The use of antihypertensives, diuretics, antidepressants,
hypnotics and antipsychotics was reviewed.
Results
142 patients were reviewed; some data were unavailable for 32 patients. 110 were included; 65 %
(72/110) females and 35 % (38/110) males with an average age of 79.6 and 81.7 years respectively.
16% (18/110) patients had no falls in the previous six months, 37 % (41/110) patients had one to two falls,
41 % (45/110) patients had three to ten falls and 6 % (6/110) patients had more than 10 falls.
71% (78/ 110) patients were on antihypertensive medications. 34 % (37/110) were on diuretics. 17 %
(19/110) were on antidepressants.
7 % (8/110) patients were on hypnotics.
Conclusion
 Use of drugs that increase the risk of falling is not uncommon in patients who had falls or poor
balance.
 Physicians should try, as much as clinically feasible, to avoid prescribing drugs that increase the risk of
falling to those patients who had falls or have poor balance, and omit those drugs which are not
clinically indicated anymore.
_____________________________________________________________________________
Poster Presentation-Abstract no 27
Audit into staff awareness of the safe administration of bisphosphonates
R Attoti, J Richards, S Woods, A Rehman
Great Western Hospitals NHSFT
______________________________________________________________
Aim
To assess awareness of manufacturers guidelines on the safe administration
of bisphosphonates, which in turn have large implications on the compliance of
these medications long term.
Subsequently to commence an educational intervention (via training
tracker) if indicated and reassess awareness to assess if this has improved.
Standards
NICE TAG161 (sec3.6): Bisphosphonates have complex instructions for administration.
Alendronate and risedronate must be taken with 200 ml and 120 ml of water,
respectively. Before and immediately after administration patients should not
eat or drink, and must remain upright for stipulated time periods.
Methodology
The nursing staff working in the area with most contact with the post
fracture patients will be identified. An anonymous questionnaire will be
administered to the nurses on the ward by the ward sister, with four questions
related to specific aspects of the drug administration. The responses will be grouped into similar
responses for analysis.
Observations
The questionnaire findings confirm concerns of significant shortcomings in the knowledge of the complex
instructions for bisphosphonate administration amongst frontline nursing staff
charged with the duty of the initial advice. With respect to positioning, only 5% of nurses were unaware
of any requirements, but only 14% were aware of the need to stay upright for 30
minutes. With respect to timing of the dose, 43% were aware of the correct
instructions, with the remainder being either unaware, or incorrect about the
instruction. Fifty seven percent of patients were aware of the appropriate instruction with the remainder
being either unaware or incorrect.
Discussion and recommendations
The shortcomings highlighted above
show significant room for improvement. Possible interventions include:
1. A separate professional group providing advice (eg pharmacists, doctors)
2. Patient advice leaflet
3. Nursing staff education.
We propose an education programme within an already existing electronic managed learning
environment within the trust, and re-auditing to measure effectiveness.
____________________________________________________________________________
Poster Presentation-Abstract no 28
Polymyalgia Rheumatica(PMR) - Unusual cause of decrease mobility and function in
elderly
M. Bhutta, K. Musarrat, N. Vijayakumar, A. Miodrag
Leicester Royal Infirmary
____________________________________________________________________________
Introduction
A relatively common inflammatory disease of unknown aetiology that occurs in patients over the age of
50. The median age at diagnosis is 72 years. It is characterized by proximal myalgia of the hip and shoulder
girdles with accompanying morning stiffness that lasts for more than 1 hour. Giant cell arteritis is seen in
at least 30% of patients. It is a clinical diagnosis, although ESR, CRP are almost always raised at disease
onset. It is treated with glucocorticosteroids, and symptoms should improve dramatically. We present a
case of this incapacitating disorder that lead to falls, impaired ambulation, decrease functional status and
dependency.
Case Report
A 72 – year old lady admitted with fall, decrease mobility, stiffness in shoulder girdles, inability to lift arms
above head and dependency on her husband. She had stiffness lasting for more than an hour in the
morning which leads to her low mood and avoiding physiotherapy. She ended up having hoist transfer on
the ward. Examination revealed no focal neurology. Her plasma viscosity was high 2.48. She was given
prednisolone 15mg OD. She showed a dramatic improvement and described it as she was unlocked. She
started mobilising with physiotherapist in a week, was subsequently discharged home with care package.
Discussion
PMR is among the most common reasons for long-term steroid prescription. Treated patients have an
excellent prognosis. Relapse is common. Long-term complications of corticosteroid therapy must be
monitored and measures should be taken to prevent and manage them. Bisphosphonates are
recommended to prevent osteoporosis.
_____________________________________________________________________________
Poster Presentation-Abstract no 29
John Pathy Day Hospital Falls Prevention Programme
M Maharaj, A Willoughby, J John, J Murrison
John Pathy Day Hospital, Rookwood Hospital, Cardiff
___________________________________________________________________
Background
John Pathy Day Hospital has been developing Falls Prevention Programmes since 2008 and joined the
NLIAH 1000+ Falls Collaborative in 2011.
Included in the Programmes are: Medical and Nursing review including postural blood pressure checks,
culprit medication review, osteoporosis risk, continence status, visual and cognitive assessment ,the
evidence based ‘OTAGO’ strength and balance exercises and ‘Home Hazard’ awareness sessions.
All patients who had attended the programmes were reviewed eight weeks after discharge.
Innovation
The programmes incorporate a multi factorial assessment and intervention based on the NICE and RCP
guidelines using validated outcome measures.
All patients referred to the Day Hospital were screened by the Multi Disciplinary Team and included if
they met the criteria: Previous falls and/or fear of falling; and Ability to participate in the group
Two parallel programmes were developed, one specifically catering for the frail elderly.
Evaluation
Issues identified as follows:
Postural drop 36%, Continence issues 48%, Cardiovascular problems 75%, Neurological problems 24%.
Medication changes were made in 43% of the group, of which 60% were culprit medications.
At eight week review, patients reported the number of falls had reduced by over 2/3rds compared to the
reported falls eight weeks prior to attendance at the programmes.
Conclusion
Since joining the Collaborative we have extended our Data collection and recognised the need to include
the Frailty index to improve and support our evaluation.
We are also collecting data regarding A+E admissions due to falls and aim to establish a central falls
register to improve communication between services and to avoid duplication.
Our programme has now expanded to include follow up via the OTAGO programme for a year following
attendance. This has improved links with Community based projects.
We have improved communication with GPs by sending more detailed discharge letters to include specific
falls data.
_____________________________________________________________________________
Poster Presentation-Abstract no 30
Chronic diseases in patients with falls and poor balance
Atef Michael, Pei J Teo
Russells Hall Hospital, Dudley West Midlands, UK DY1 2HQ
________________________________________________________________________
Introduction
Falls are an age related syndrome. Most falls are due to a combination of several factors. They are a
marker of poor health and impairment of many systems. Dysfunction at any point of either the sensory
system, central nervous system or the musculoskeletal system may result in falls. Mobility is vulnerable to
diseases of the heart, lungs, muscles, joints, bones, and eyes; and to darkness, weather and fear (Prof. B
Isaac)
Aim
To study the prevalence of chronic diseases in patients with falls or poor balance
Methods
Retrospective analysis of electronic data of patients attending the falls clinic in a UK teaching hospital in a
12 months period. Patients with falls or poor balance were included.
Results
142 patients were reviewed; 140 patients were included; 64 % females and 36 % males; the average age
was 80 and 80.7 years respectively. Many patients have more than one chronic disease.
53 % patients are hypertensive, 19 % have ischaemic heart disease and12 % heart failure.
10 % have a diagnosis of chronic kidney disease (less than expected) and 9 % have chronic obstructive
airway disease.
20 % were diabetic and 14 % have hypothyroidism.
12 % have cerebrovascular disease, 9 % had stroke and 8 % had transient ishaemic attacks.
13 % have depression, 8 % have dementia and 4 % Parkinson’s disease.
36 % have osteoarthritis and 3 % have rheumatoid arthritis.
16 % had previous joint replacement. 10 % have a diagnosis of osteoporosis (less than expected) and 14
%had previous fractures.
13 % have cataract, 9 % have glaucoma and 9 % have age related macular degeneration.
Conclusion
Patients with falls have multiple comorbidities and chronic diseases /conditions, which could be partly
due to the aging process however may be predisposing to and increasing the risk of falls.
Assessment of falls should include thorough examination of all body systems.
Poster Presentation-Abstract no 31
Acute Precipitant of Falls in the Elderly Patient Presenting to a District General
Hospital
S Roberts, S M Drysdale
Airedale Hospital
Background
Falls are one of the most common reasons for elderly patients to be admitted to hospital acutely. The
aetiology of a fall is usually multifactorial. Understanding why a patient has fallen is one of the more
difficult challenges faced by junior doctors on the acute take. Recognising the common reversible causes
of a fall can aid in diagnosis and management of these patients.
Method
We conducted a retrospective study of the case notes of 115 patients in care of the elderly
wards admitted acutely to hospital. For those presenting with a fall, we looked at the main diagnosis given
after review by a specialist in elderly medicine.
Results
Of 115 notes examined, 32 (27%) had presented with a collapse or fall. Of those, multiple factors were
found to be contributory in most cases however there was a single acute diagnosis in over 75%. Acute
infection was found to be the predominant cause in 12 (38%). Medication was found to be the main
precipitant in 5 cases (16%). In 2 cases (6%), a myocardial infarction had precipitated the fall and 2 further
patients were found to have suffered a stroke around the time of admission. Postural hypotension was
felt to be the major precipitant in 2 patients and constipation was the main diagnosis in another 2.
Discussion
It is well recognised that falls are usually multifactoral, however we found that most patients admitted to
hospital had a clear major precipitant. Although the study population was small, we found a short list of
easily diagnosed conditions underlying the fall in the majority of cases examined. We proposed at local
teaching that juniors admitting patients presenting with falls bear in mind the pneumonic S.I.M.P.L.E
(Stroke, Infection, Medication, Per rectal exam, Lying/standing blood pressure and ECG) in order to aid
the diagnosis of common treatable medical problems underlying the majority of falls.