European Geriatric Medicine - Supplement 1 - Volume 6 - September 2015

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Symposia / European Geriatric Medicine 6S1 (2015) S157 –S176 S171
Lecture 4: Logic-Based Foundations Within Fall Prevention
Recommendations (Patrik Eklund)
Abstracts:
Lecture 1: What is The Best Strategy to Prevent Hip Fracture?
The EUGMS Viewpoint: Fracture occurs when the intensity of the
mechanical load applied on a bone is greater than the strength of
the bone. Non-vertebral fracture, and hip fracture especially, are
most often induced by a fall from standing height. Prevention of
non-vertebral fractures, and particularly hip fractures, is a major
concern for older people, the group at highest risk of fall. A third
of people aged 65 or older fall at least once a year and 40% of them
are repeat fallers. Hip fracture occurs in 2% of falls and impaired
balance can predict about 40% of hip fractures. Falls prevention
is one of the main weapons in the armoury to prevent hip
fractures. Recent meta-analyses conclude that multiple-component
exercise including balance training reduces significantly the risk
of sustaining non-vertebral fracture, whatever the risk of falling,
suggesting that this kind of intervention has to be encouraged
in all people aged 65 or older. Further randomized controlled
trials need to be conducted to increase our knowledge on the
kind of exercise intervention (multicomponent intervention or
multifactorial intervention based on an individual risk assessment)
that is most efficient in the prevention of hip fracture depending
on frailty status and the estimated risk of falling of participants.
We must extend the use of falls prevention strategies as proposed
by the European Commission funded Prevention of Falls Network
for Dissemination (ProFouND) ) who have
produced a series of factsheets on bone health and exercises
strategies.
Around one third of hip fractures are due to bone fragility. Half
of those patients with a hip fracture have a history of previous
fractures. BMD measurement supplies significant information on
the hip fracture risk independently from the history and risk factors
of falls. Screening both subjects at risk of fall and bone fragility
is suitable in order to optimize the identification of patients at
high risk of hip fracture and to permit an effective hip fracture
prevention strategy. Anti-osteoporosis drugs should be targeted
towards patients with previous fragility fracture or low BMD (a T-
score lower or equal to −2.5 with risk factors of fracture), in whom
these drugs have shown to be effective to prevent non-vertebral
fractures, including hip fractures.
Lecture 2: A ProFouND Update: The European Network to Prevent
Falls: Each year, 35% of over-65s experience one or more falls.
Approximately 100,000 older people in the EU27 (countries within
the European Union) and European Economic Area countries will
die from injury from a fall. There is strong evidence for the
prevention of falls, including the use of strength and balance group
exercise, multi-component home exercise, Tai Chi, multi-factorial
assessment and intervention. However, it is not always a priority to
invest in prevention and where services are offered the evidence is
often modified or not applied. The likelihood of achieving positive
outcomes is also reduced by non-fidelity of staff, non-adherence
by older adults or lack of maintenance by older adults or staff with
time limited programmes and lack of follow-up.
The Prevention of Falls Network for Dissemination (ProFouND) is an
EU funded Thematic Network focusing on falls prevention. We aim
to bring about dissemination and implementation of best practice
in falls prevention across Europe. ProFouND’s objective is to embed
evidence based fall prevention programmes for elderly people with
the help of novel technologies and effective training programmes
available in at least 10 countries/15 regions. We achieve this through
the creation of evidence based information and resources that can
be accessed and downloaded from our website
alongside the development of the ProFouND Falls Prevention
Application (PFPApp) for use by healthcare practioners across
the EU. ProFouND provides cascade training for the delivery of
evidence based strength and balance exercises for the prevention
of falls across Europe. Through collaboration with other networks
we create networks and forums for stakeholders in the field of
information and communication technologies (ICT) and health,
engaging with industry to facilitate the development and adoption
of technological solutions to falls.
A full update will be given on progress. We have developed a large
collection of best practice resources, including factsheets for use
by practitioners, resources to guide practice development and to
help increase awareness about falls and fall prevention. We have
trained a large cohort of cascade trainers (80–100) based in 10 EU
countries, who have started training exercise instructors in some
46 regions, well in excess of our targets. We have developed the
App and it is now available for use. In October 2015 we will launch
a major falls awareness campaign across EU. We are organising the
second European Falls Festival in Bologna February
2016. EUFF2016 has the theme of Implementing Innovation into
Policy and Practice.
ProFouND thus aims to bring about real change in falls prevention
by promoting evidence based practice on many levels:
– Individual older people and families
– Health and social care practitioners
– Health care provider organisations
– NGOs and representative organisations
– Policy makers, governments and health authorities
– Technology providers
Lecture 3: Using Technology to Predict, Detect, Assess and
Prevent Falls: Falls in older people remain a major public health
challenge leading to injury and disability. Serious health and
social consequences including fractures, poor quality of life, loss
of independence, and institutionalisation are common. The annual
costs due to falls range between 0.85% and 1.5% of the total
health care expenditures. Therefore, important issues are the
accurate identification of persons at high risk, the detection of falls,
the recording and analyses of biomechanical and environmental
characteristics of falls and the development of effective fall
prevention measures.
Most of the knowledge on falls to date is derived from
epidemiological studies, interviews and intervention studies. The
contribution of objective measurements using information and
communication technology (ICT) is still modest but increasing.
Several new approaches and results will be presented including
video recordings, mobile health devices, body-worn sensors and
smartphones.
In the field of fall prediction the performance of most conventional
fall risk models is weak compared to models estimating, for
example, cardiovascular risk. Although many fall risk factors are
known, they seem to reflect the individual fall risk insufficiently. A
recent study demonstrated a considerable improvement in model
sensitivity when adding physical activity data measured by body-
worn sensors. Furthermore, a new concept to estimate fall risk
was proposed considering the actual time under risk measured by
accelerometry.
Objective measurement of real-world fall events itself can improve
the understanding of falls in older people and enable new
approaches to prevent, predict, and detect falls. However, these
events are rare and hence challenging to capture. Recently, a
Canadian research group demonstrated that video footage could
fill in some of the knowledge gaps pertaining to the contextual
factors of falls. Besides video footage biomechanical data measured
by body-worn sensors can add further knowledge. The FARSEEING
consortium started to build a meta-database of real-world falls,
currently including sensor signals of more than 200 fall events.
Based on these data new algorithms for fall detection have been
developed. Automatic detection of falls has become a more and
more important aim in last few years because it could enable rapid