Urban Health Centres Europe

It’s true! A person can break a hip by a fall, and it will take a very long time to recover. Injuries by falling is a big problem in older age. In most European countries the figures show that approximately 30% of people over 65 years of age, living in their own home, fall each year (WHO, 2007). Not always with very serious consequences, but with higher age and higher levels of frailty the frequency increases and the injuries get more serious. Not only the human suffering but also the financial costs are an important reason to invest in prevention of falls (i.e in case of hospitalisation the average cost of one incident in Holland was estimated  22.000 Euro (ref. Zorgwijzer.nl). Besides that there are indirect cost of home care, loss of productivity, etc.). A fall in older age can also be the trigger for other health problems. After a serious fall people tend to be more careful, and less active in their life. With possible consequences of loneliness and feeling depressed. By that time there is the danger of a vicious circle: use of medicine, the fear of falling increases the risks of the next fall. We know from statistics that the first fall is a good predictor of a second fall.

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Because of this burden of falls in the elderly for our societies, it is not surprising that we know a lot about causes and prevention. Falls occur as a complex interaction of risk factors. There are four groups of factors. (1) The biological ones, such as age and gender, and as a result physical and cognitive capacities decline. Older people get a more insecure gait, and their balance gets worse. Because people normally get old very gradually, the changes in our physical conditions are not very alarming. Old people often don’t realize their own risk of falling. (2) Factors in the environment i.e homes can be risky, by slippery floors (in the bathroom!) and loose rugs.  (3) Behavioural factors, such as multiple medication use, lack of exercise, alcohol intake.(4)In addition there are connections with social-economic factors, such as inadequate housing.

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Because of these multiple causes a multifactorial approach is most effective in reducing the risk of falling. The prevention programme should contain at least an exercise programme, combined with control of medication, and/or vitamin D, and/or improvement of vision, and/or home safety adjustments, and/or living environment. This was the content of  the template that was proposed in the project. The cities filled it in with their possibilities of  specific activities. It’s no coincidence that the reduction of polypharmacy was also one of the main goals of the project. And of course all these interventions could be combined with others, related to the other health problems addressed  in the project, like loneliness. Doing exercises in a group is not only prevention of falls, but also prevention of loneliness. Now all the interventions are on their way, we see a lot of different ways of filling the template. The evaluation research hopefully will show us the results. Have these risk factors really changed?

 

Toon Voorham, University of Applied Sciences, Rotterdam

Who (2007) Global report on falls prevention in older age. ISBN 978 92 4 156353 6 

Koppelaar E,  R. Martijn, AJJ Voorham (2015) The development of a generic template for dealing with frail elderly in urban health centres, in five European cities. UHCE report.