30 T R A I N I N G M A T T E R S NOVEMBER 2016 www.tmmagazine.co.uk

These include: A lack of, or poorly

positioned, hand rails Uneven or slippery fl ooring Poorly fi tted rugs and mats Poor lighting Badly fi tting footwear.

Often, a combination of these factors leads to falls, so a multifactorial risk assessment should be carried out to assess an individual’s potential risk. Several different solutions might need to be adopted – for example, disease and medication management, changes to the physical home environment, or surgery for cataracts.

OsteoporosisMany people who are at risk of falling also have osteoporosis, a chronic condition that weakens bones and makes fractures more likely in the event of a fall. In young people, bone formation exceeds bone resorption (the breakdown and weakening of bones), but by the time someone is in their 30s, there is a gradual loss of bone mass. Osteoporosis is

As people get older, they may fall more often. Falls can obviously result in physical injury, which can be serious (e.g. fracture or head injury), but they can also have psychological effects, such as a fear of falling and a loss of confi dence that can lead to a self-restricted reduction in physical activity and social interactions.

Falls are costly to the individual and to society because they lead to additional GP visits, ambulance call outs, A&E attendance, hospital stays and increased social care costs. Falls cost the NHS more than £2 billion a year and there can be additional costs due to caring time and absence from work. As the number of older people in society increases, the impact of falls will grow. Preventing falls is therefore enormously important for individuals and for society.

What causes falls in older people?Falls are not a normal part of ageing and there are many causes. These include: The side effects of medicines The effects of diseases (such as

arthritis, stroke and Parkinson’s disease) on a person’s ability to stand up and move around Sight, hearing or cognitive

impairment Poor mobility, balance and

co-ordination due to a lack of activity.

Certain situations that commonly occur in the home can also make falls more likely.

therefore usually an age-related disease.

Around two per cent of people

aged 50 have osteoporosis. This increases to 25 per cent in people

aged 80. The condition can affect

men and women, but women are at greater risk because the decrease

in oestrogen production after the menopause accelerates bone loss.

The following groups of people are more prone to developing osteoporosis:

All women aged 65 years and over, and all men aged 75 years and over

Younger men and women with major risk factors, such as taking oral steroid medication, smoking, high alcohol intake, premature menopause.

Some people with osteoporosis are considered to have a high enough risk of having a fracture to benefi t from being prescribed bone-

strengthening drugs. Treatment is usually with alendronate or risedronate, which belong to a group of drugs called the bisphosphonates. These can be complicated to take. For example, some are taken weekly, which might be diffi cult to remember, and they can cause gastric side effects, so need to be taken in a particular way to avoid irritation to the oesophagus (food pipe) after swallowing. This means taking them with plenty of water, and remaining upright for at least 30 minutes afterwards.

Reducing the risk There are several things that people can do to help reduce the chance of osteoporosis developing or worsening: Stop smoking Avoid excessive alcohol

consumption (keep to less than two units a day) Do regular weight-bearing

exercise (e.g. 20 minutes of walking every day or 30 minutes fi ve times a week) Avoid immobility Pre-menopausal women

should avoid excessive dieting and exercise resulting in

Contributing author: Andrea Tarr, BPharm, MSc, MRPharmS, clinical and medical writer.

C P D M O D U L E

Welcome to our CPD module series for community pharmacy

technicians. Written in conjunction with the Pharmacy Magazine CPD series, it will mirror the magazine’s programme

throughout the year. The series has been designed for you

to use as part of your continuing professional development.

Refl ection exercises have been included to help start you off in the CPD learning cycle.

CURRENT THINKING ON... FALLS PREVENTION

AND OSTEOPOROSIS

MODULE NUMBER: 73AIM: To review the prevention of falls in older people and the management of osteoporosis. OBJECTIVES: After studying this module, pharmacy technicians will:

Be aware of current treatments for osteoporosis

Understand the evidence in support of exercise as an intervention to prevent falls and fractures

Be aware of the role community pharmacy can play in preventing falls and fractures.

REFLECT

PLAN ACT

EVALUATE

CPD SUPPORT

considered to have a high enough risk of having a

amenorrhoea (an abnormal absence of menstruation) Ensure a balanced, calcium-

rich diet (700mg daily). The main dietary sources of calcium are dairy products and green vegetables Vitamin D is essential for

calcium absorption. The main source of vitamin D is sunlight.

Some everyday ways of obtaining vitamin D are: Spending 15-20 minutes a

day in the sun (from April to October) with hands and face exposed Exercising out of doors Eating foods rich in vitamin

D. The main dietary sources of vitamin D are fortifi ed foods such as margarine and breakfast cereals, as well as oily fi sh, meat and eggs. Taking a supplement. New

guidelines from the Scientifi c

Advisory Committee on Nutrition and Public Health England recommend that everyone over one year of age should take a daily supplement containing 10mcg of vitamin D.The importance of exercise People who fall frequently have poor muscle strength and balance. There is very good evidence to show that exercises that aim to increase muscle strength and balance help to prevent falls. So as well as doing regular exercise to keep the heart and bones healthy (the standard recommendation is 150 minutes of aerobic exercise each week), people should also be doing two sessions of exercise that help increase muscle strength and balance every week. It’s not necessary to go to the gym to do this. Instead,

C P D M O D U L E

Go to www.tmmagazine.co.uk to answer the CPD questions. When you pass, you’ll be able to download a certifi cate to showcase your learning. You can also add this to your online, personalised learning log.

refl ective exercise

Think about how you could go about making older people aware of the benefi ts of exercise to increase muscle strength and balance.

Next month: We focus on a clinical review of the year.

activities like heavy gardening, dancing and tai chi are effective. For people who are elderly or who have already fallen, it is best if they get expert advice about tailored exercises that are suited to their abilities.

The role of pharmacyThe community pharmacy team can help identify patients who are at risk of falling in several ways, including:

Medicines use reviews to identify medicines that might cause a person to fall and refer to the GP where appropriate

Helping people take their osteoporosis therapy correctly

Giving advice and information to older people and their families on healthy living, including exercises

Signposting to other services, such as sight and hearing.

Helping people take osteoporosis medicationThere are many reasons why people stop taking osteoporosis medication. They might:

Not understand the benefi tsBe concerned about side

effectsHave diffi culty with

complicated dosage instructionsSimply forget to take it.

Pharmacy staff can help people starting and continuing osteoporosis therapy to understand the benefi ts and risks of their treatment as well as the consequences of not taking it. Discussing medication with the patient can help pharmacy staff to understand the individual’s barriers to taking the therapy and offers the opportunity to educate, reassure and suggest practical solutions.

Health promotion and signpostingOlder people and their families need to be aware of how to prevent falls and how to access services that reduce the risk of falls. The community pharmacy team can provide information and advice passively (through information boards and leafl ets) and actively (through discussion with patients, family members and carers). Information can be provided about suitable local exercise classes and online resources.

How to talk to people Many older people are reluctant to accept advice about preventing falls. There are many reasons for this:

They think it is only relevant

to people older and more frail than themselves

They feel confi dent of their capabilities and do not want to be stigmatised as ‘old and frail’

Some people who have fallen do not believe they will fall again because they attribute falling to momentary inattention or illness rather than persistent vulnerability

Although some may accept they are at risk of falling, they

believe nothing can be done because it is an inevitable part of ageing

Others accept they are at risk but feel the downsides of preventative measures outweigh the benefi ts.

So rather than focusing on the risk of falls, it is better to talk to an older person about the benefi ts of improving strength and balance, staying active and maintaining mobility and independence. Targeting people according to their age, risk of falling or fear of falling is unlikely to be effective and advice given in an overly instructive tone is unlikely to be well received. People are more likely to make use of information and opportunities if they can choose the advice and activities that will suit their abilities, needs, priorities and lifestyles.

“There is very good evidence to show that exercises that aim to increase muscle strength and

balance help to prevent falls”

facts about falls and fractures

The incidence of falls is increasing by about two per cent each year

In England, the number of people aged over 65 is due to rise by a third by 2025; the number of people over 80 will double, and the number of people aged over 100 years will increase fourfold

Around one-third of people aged over 65 and nearly half of those aged over 80 fall at least once a year. Between 10 and 25 per cent sustain a serious injury

Most fractures in older people occur as a result of falling from standing height

Hip fractures are the most common cause of accident-related death in older people

20 per cent of people die within four months of a hip fracture and 30 per cent within a year

One-third of people become totally dependent following a hip fracture.

Dancing and other forms of exercise help to increase muscle strength and balance

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