Dionyssiotis

Editor's Notes

• #3: There are an estimated 4 to 6 million postmenopausal women with low bone mass or osteoporosis in the US female population. Based on NHANES III, 54% of the women 50 to 64 years of age are estimated to have low bone mass or osteoporosis (T score –1.0 standard deviations or lower). These statistics increase as women age. Up to 86% of women 65 years of age and older have low bone mass or osteoporosis.
• #6: Why are falls important? Introductory slide
• #8: Hip fractures are generally disastrous for the patient.
• #9: Costs to the health services (Dolan and Torgerson, 2000) Currently there are just over 60,000 hip fractures in England and Wales each year, occupying 25% of all orthopaedic beds. These figures form the basis of Department of Health’s calculations for the costs of hip fractures. Based on these figures the annual costs of treatment of fractures among women is now estimated to be in excess of £1.8 billion pounds per year (Dolan and Torgerson, 2000).
• #12: Intrinsic vs extrinsic risk factors Everyone is a potential ‘tripper’ in that we stumble over objects and extrinsic risk factors such as unsafe or poorly lit stairs, slippery floors or carpets. Over half of all falls in the home are caused by such environmental hazards. Normally, we are able to adjust and correct the tripping movement by quickly grabbing a supporting object (a chair or rail) or making an adjustment to our balance or foot position. With declining functional capacity, e.g. muscle power and balance, we are less able to make these corrections, with the consequence that what might have been a slip or trip becomes an injurious fall.
• #14: Targeting the modifiable risk factors for falling While it is acknowledged that some risk factors for falls and fractures are not modifiable, others  – such as physical activity, environment and the effects of medication – can be positively influenced through appropriate education and intervention (Tinetti et al, 1995). Modifiable risk factors include low strength and power, poor balance/gait, fear of falling, functional capacity, depression, urinary urgency and incontinence, postural hypotension, and multiple medications (Skelton and Dinan, 1999). Those risk factors highlighted in the slide in bold are suitable for modification through physical activity programmes through specific targeting.
• #15: Improving risk factors – duration vs outcome There is substantial evidence to show that some of the risk factors for falls can be improved within a relatively short space of time (Skelton and McLaughlin, 1996). The immediacy of these improvements will greatly enhance the confidence of participants themselves as they will be able to experience at first hand significant improvements. This will also help in motivating older people to continue to participate. However, sustained participation is critical to ongoing and continued improvement. Such gains will soon be lost if participation is halted.
• #16: During the past decade, these therapeutic agents have a place in the osteoporosis treatment protocol. Efficacy data about increasing BMD, controlling bone turnover, and reducing fracture risk is included in this slide presentation. Interpreting the data through an analytical approach is important. Anabolic therapy for osteoporosis is also under investigation. Parathyroid hormone (PTH) stimulates bone formation and resorption, and its use in women and men with osteoporosis has been studied. 1,2 More research needs to be done on this possible therapeutic choice, however. 1 Neer et al. N Engl J Med . 2001;344:1434-1441. 2 Kurland E et al. J Clin Endocrinol Metab . 2000;85:3069-3076.
• #30: How active are older people? This section looks at some of the evidence relating to current levels of physical activity among older people. It contains some of the slides from the similar section in the Making the case for physical activity and older people presentation. Additional slides from that resource could be used to supplement this section.
• #31: Levels of sedentary behaviour, WOMEN aged 50+, England This chart indicates the proportion of women aged 50 and over whose behaviour is described as sedentary (Skelton, Young et al, 1999). ‘ Sedentary’ here means participating in physical activity less than once a week at an intensity defined as sufficient, at their age, to be likely to produce a health benefit. These figures are age-adjusted.
• #33: Putting it into practice – Recommendations and guidelines This section summarises current recommendations and guidelines for the role of exercise in the prevention of falls in older people.
• #34: Effective interventions The studies listed in this slide provide evidence of the effectiveness of exercise components both within a multi-factorial intervention and as a stand-alone intervention .
• #41: This suggests that among community-dwelling older people with a history of falls, exercise-alone interventions were significantly more effective in reducing recurrent falls compared to multifactorial interventions. More specifically, exercise-alone interventions were approximately 5 times more effective in reducing the incidence of falls compared to the multifactorial interventions.
• #49: Chair-based exercise – effective at targeting risk factors Chair-based exercise programmes have been shown to have a beneficial effect on maintaining or promoting independence and mobility in older people. The range of improvements demonstrated in research trials lasting 8 weeks or longer, considering chair-based seated and chair-assisted standing exercises, include: • strength • power • flexibility • functional ability • static balance • rehabilitation following a hip fracture, and • the performance of everyday tasks e.g. rising from a chair or using stairs. Compliance with chair-based programmes is generally better than compliance with standing or dynamic exercise, especially among the oldest old and among those with low baseline levels of fitness and function.
• #50: Chair-based exercise – effective at targeting risk factors (continued) Chair-based exercise programmes have been shown to have a beneficial effect in reducing: • depression • arthritic pain • postural hypotension • body fat and • the risk of future falls. Chair-based exercise has specific benefits as a training method. It stabilises the lower spine by providing a fixed base (particularly important in those with kyphosis or lordosis of the spine); it facilitates a greater range of movement by providing points of leverage and support; it minimises load-bearing and reduces balance problems in those with particularly poor mobility and arthritic pain; and it increases confidence in those unable to perform free-standing exercise.