Seminair 28-04-2015 Dr. O.J. de Vries
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Transcript of Seminair 28-04-2015 Dr. O.J. de Vries
Dr. O.J.
de V
ries
Valpreventie
Introduction
§ 30 % of all people 65 and older fall ≥ once/year § 15 % falls ≥ twice/year. § 10% leads to injuries § 5 % leads to fractures: 1-2% hip fracture § Big impact on quality of life. § 24% of 55 yr and over dies within a year following a hip fracture
Dr. O.J.
de V
ries
Valpreventie
Dr. O.J.
de V
ries
Valpreventie
Increased fall risk
§ Risk factors: § Age § Dementia § Diminished visual acuity § Low body weight § Gait disorder § Prior fall § ≥ 4 generic drugs § Psychofarmacologicaly active drugs § Orthostatic hypotension
§ Interaction intrinsic/extrinsic factors
Dr. O.J.
de V
ries
Valpreventie
Increased fall risk
§ Risk factors: § Age § Dementia § Diminished visual acuity § Low body weight § Gait disorder § Prior fall § ≥ 4 generic drugs § Psychofarmacologicaly active drugs § Orthostatic hypotension
§ Interaction intrinsic/extrinsic factors
Dr. O.J.
de V
ries
Valpreventie
Longitudinal Aging Study Amsterdam
§ 1992: inclusion of 3107 participants 65 yr and older in and around Zwolle, Oss and Amsterdam
§ 1995/1996: medical interview of 1509 participants
§ Fall registration during 3 years
Dr. O.J.
de V
ries
Valpreventie
Benzodiazepines
§ Screening-instrument (STOPP): § Especially avoid long-acting
benzodiazepines (half-life ≥ 24h) because of increased fall risk.
Dr. O.J.
de V
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Valpreventie
STOPP criteria
Gallagher et al, Age and Ageing 2008; 37: 673-9
Dr. O.J.
de V
ries
Valpreventie
STOPP criteria
Gallagher et al, Age and Ageing 2008; 37: 673-9
Dr. O.J.
de V
ries
Valpreventie
Benzodiazepines
§ Screening-instrument (STOPP): § Especially avoid long-acting
benzodiazepines (half-life ≥ 24h) because of increased fall risk.
§ Hypothese: § Short-acting benzodiazepines (T1/2 ≤ 10h)
are also associated with an increased fall risk.
Dr. O.J.
de V
ries
Valpreventie
Benzodiazepines
§ Screening-instrument (STOPP): § Especially avoid long-acting
benzodiazepines (half-life ≥ 24h) because of increased fall risk.
§ Hypothese: § Short-acting benzodiazepines (T1/2 ≤ 10h)
are also associated with an increased fall risk.
§ Result: § Short-acting benzodiazepines are
associated with an increased fall risk.
De Vries, O.J. et al. Age and Ageing 2013;0:1-7
Dr. O.J.
de V
ries
Valpreventie
Antacids
§ Literature: § Protonpump inhibitor use is associated with increased fracture
incidence.
§ Hypothesis: § PPI use is associated with more falls and fractures than other
antacids
§ Results: § PPI use is not associated with increased fall incidence § H2-blocker is associated with increased fall incidence.
Dr. O.J.
de V
ries
Valpreventie
Frailty
§ Literature: § Physical frailty is associated with increased fall risk
§ Hypothesis: § Frailty according to LASA is also associated with increased fall
risk.
§ Result: § Frailty according to LASA is associated with increased fall risk. § Prior falls are at least as predictive.
De Vries O.J. et al. Osteoporosis International 2013; 24:2397-403
Dr. O.J.
de V
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Valpreventie
Robinovitch S.N. et al. Lancet 2013;381:47-54
Dr. O.J.
de V
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Valpreventie
Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study.
§ 227 falls of 130 persons (mean age 78 yr, SD 10)
§ Activities during fall: § Walking forward 24% § Standing 13% § Sitting down 12% § Start walking 9% § Rising from a chair 9%
§ Cause of fall: § Weight shifting 41% § Trip or stumble 21% § Hit or bump 11% § Loss of support 11% § Collapse 11% § Slipping 3%
Robinovitch et al. Lancet 2013;381:47-54.
Dr. O.J.
de V
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Valpreventie
http://www.thelancet/cms/attachment/2024445407/2044188965/mmc1.mp4
Dr. O.J.
de V
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Valpreventie
CBO guideline (2004) “Prevention of falls in older persons”
Dr. O.J.
de V
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Valpreventie
The CBO fall guideline recommends:
§ Medication evaluation § Balance and strength training § Restore visual acuity § Safety in and around home § Estimate fracture risk § Consider evaluation of heart rhythm disorders
§ Possibly the highest risk reduction can be achieved in high risk older persons.
Dr. O.J.
de V
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Valpreventie
Multifactorial fall prevention study
§ Hypothesis: § Multifactorial analysis and intervention in older
persons with increased fall risk leads to prevention of new falls.
§ Method: § 217 older persons in and around Amsterdam § Recent fall (ED or general practitioner) § Intervention and control group(106 vs 111) § 1 year fall follow-up (calendar) § After 1 year measurement of QoL, mobility and
mood.
Dr. O.J.
de V
ries
Valpreventie
Multifactorial fall prevention study
§ Results: § No difference between intervention and control group in time to
first fall. § In both groups decrease of the number of falls. § No differences in secondary outcomes apart from mortality.
§ Discussion: § A lot of interventions in the control group. § Most potential participants refused: selection of the most
motivated. § The type of physical therapy possibly led to increased fall risk.
Dr. O.J.
de V
ries
Valpreventie
Medication reduction fall prevention
§ Hypothesis: § Stopping or reducing fall-risk-increasing drugs in high
risk older persons leads to prevention of new falls.
§ Method: § 612 older persons in and around Rotterdam and
Amsterdam § Recent fall (ED) § Intervention and control group (319 vs 293) § 1 year registration of falls, GP and ED visits. § After 1 year measurement of QoL.
Dr. O.J.
de V
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Valpreventie
Medication reduction fall prevention
§ Results: § No difference in time to 1st or 2nd fall nor in number of falls. § 40% of the FRIDs were necessary. § 36% of the medication reduction interventions failed.
§ Discussion: § ≥50% of the FRIDs were not discontinued; compliance,
dependence, necessity? § Possibly better effect with long-term physician-patient relation. Dr. O
.J. de
Vrie
s
Valpreventie
Meta-analysis
§ Gillespie LD, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012
§ 159 trials with 79,193 community dwelling participants
§ Results: § Physical therapy or tai-chi: reduces both fall risk
and fall rate. § Multifactorial fall prevention: reduces only fall rate. Dr. O
.J. de
Vrie
s
Valpreventie
Future
§ Studies of the relation between risk factors and effectivity of different interventions.
§ Studies of more effective fall prevention: medication, physical therapy, reduction of fear of falls, etc.
§ Clinically relevant and irrespective of dogmas
Dr. O.J.
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Dr. O.J.
de V
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