Every year, a third of people over 65 living in the UK will experience a fall. This not only causes considerable emotional distress and physical harm, but also costs an already over-stretched health system over £1 billion each year.
Simple strength and balance training can effectively help to prevent falls, but BU research shows only a minority of older people will carry out these exercises. Dr Samuel Nyman has studied how best to motivate those at risk of falling to actually complete the exercises, as well as raising awareness of the importance of regular strength and balance training.
“Falling is a massive and complex issue. It has lots of risk factors and there is not just one solution,” said Dr Nyman, a Senior Lecturer in Psychology, who has been working with both health professionals and older people themselves.
“It is an issue for people of an older age because their reaction times are slower, so they are less likely to stop themselves. The consequences are also far greater too – falls are more likely to result in fractures, which are one of the main triggers for going into a care home.”
Falls in those aged 65 or above account for over 50% of injury-related hospital admissions, and 40% of all injury related deaths. This has a significant economic impact on the NHS, with costs of ambulance call outs and increased social care assistance following a fall. But Dr Nyman explains there can be seriously detrimental psychological effects as well.
“If people develop a fear of falling again, then they reduce their activity, they don’t go out as much and this relates to people becoming socially isolated and feeling lonely.”
Evidence shows that strength and balance training is the most effective way to prevent falls among older people living in the community.
Recommended exercises can range from tai chi classes to simple home-based techniques, like standing on one leg while doing the washing up.
Two key reviews by Dr Nyman, which looked at data from existing trials into falls prevention, found only around 30-42% of older people in the community are likely to follow interventions like strength and balance training over a 12 month period.
“There is robust evidence that strength and balance training is really effective,” Dr Nyman said. “As long as you can get people to start doing it and maintain it, there is about a 30% fall risk reduction, alongside benefits like meeting up with other people and socialising.
“But it’s not just about giving people the information – we need to see what works and what might prevent people from taking up the exercises.”
Dr Nyman’s work has been used to educate health professionals working with older people, through a training course, an online resource, and a new evidence-based website, which provides advice on the best forms of exercise to prevent falls.
The site applies Dr Nyman’s research to ensure the information is presented in the most appealing way to motivate older people to carry out the exercises.
“The evidence at the moment would say that it’s all about promoting the positives, not talking about falls at all,” he said. “It’s also about choosing exercises that are going to be suitable for them, that they will enjoy and are relevant to their age group – someone who is 65 will have very different wants and needs to someone who is 85.”
Dr Nyman has also co-founded and chairs the Dorset Alliance to Prevent Falls and Promote Independence (Dorset APP), which brings together several local organisations to work more effectively to prevent falls, including hospital representatives, council services, voluntary organisations, and older people. He now plans to work with the Bournemouth University Dementia Institute (BUDI) to look at preventing falls among older people with dementia.
“We now have a fair sense of what we need to do to prevent falls generally with older people, but not people with dementia, who might have slightly different needs,” he said.
“We know people with dementia are more at risk of falling but we want to look at the specific reasons why, and how we can best help them.”