Reducing Harm from Falls: What have we learned in the last 12 months?

Falls are a major cause of injury and reduced quality of life for older people.

Estimates suggest that more than a quarter of people over 65 years of age fall in any given year. Broken hips and head injuries are among the most serious complications of a fall.

This is why the New Zealand Health Quality and Safety Commission has spent several years encouraging the health sector in New Zealand to implement programmes that reduce harm from falls.

A set of evidence-based guidance, the ‘Ten Topics’ is available on the Commission’s website.

However, every day more than 4 new research papers about falls are published. The Safety Lit database contains over 1500 items for ‘Falls’ in 2017 alone.

Every week there are new systematic reviews, meta-analyses, guidelines or health technology assessments.

So what does all this new evidence tell us?

We know that in New Zealand aged residential care facilities 13% of patients have a fall in the previous 30 days.

We also already know that bisphosphonates are an important medication to fight osteoporosis and prevent fragility fractures in older adults. But did you know that they are cost-effective at a fracture risk of just 1%? And yet in New Zealand there is scope to increase the rate of bisphosphonate prescribing for patients suffering fragility fractures.

Strength and balance exercise programmes can help prevent falls and new evidence suggests that Tai Chi is also effective.

As for medications, data previously appeared to show that antihypertensives increase the risk for falls. But some large new reviews indicate this may mostly be due to falls in the first 24 hours after a dose adjustment, or if the patient is taking diuretics.

Selective beta blockers may not increase the risk of falls, and treating hypertension to guideline levels is likely to be safe.

We are now pretty sure that prescribing vitamin D to otherwise healthy older people does not prevent falls or fractures.

However, sleep disturbances can increase the risk of falls.

Finally, home safety assessment and modification programmes and in-home strength and balance exercise programmes appear cost-effective in the New Zealand context.

The above is just a taste of the new evidence available to help in reducing harm from falls, and the Commission’s website indicates that their ‘Recommended Evidence-based resources’ webpage will be updated annually.

So don’t just take my word for it, examine the new evidence for yourself, and we can all look forward to the next comprehensive update.

For now, the Ten Topics are an excellent resource for anyone who is in the business of reducing harm from falls, and reducing harm from falls is everyone’s business!