Preventive activities in general practice 7th edition

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Screening tests of unproven benefit

Appendices

Disclaimer

Falls and physical activity

Falls and physical activity Age range table

Age

0 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 79

>80

Patients should be screened for risk factors for falls from 65 years of age (A).

Advice about moderate physical activity is recommended for all older people (A).

Approximately 30% of people aged 65 years or over report one or more falls in the previous 12 months.¹⁴² For the older person, physical activity provides the usual benefits, as well as minimising some of the limitations of later life such as reduced mobility, tendency to fall, and reduced interaction with the environment.¹⁴³ Impairment of vision has been well described as a risk factor for falls.¹⁴⁴ Untreated cataracts have been shown to be associated with increased risk of multiple falls¹⁴⁵ and reduced quality of life related to social isolation and depression.¹⁴⁶

Falls and physical activity: Risk
Who is at higher risk of falls?	What should be done?	How often?	Level of evidence and references
Average risk All people 65 years of age or over	Screen for risk factors^*	Every 12 months	I A 147,148
Moderately high risk Older people presenting with one or more falls, who report recurrent falls or with multiple risk factors	Screen for risk factors and involve in preventive activities^*	Every 6 months	I A 142, 147
* A vitamin D supplement should be recommended if inadequate sun exposure to reduce the risk of fracture ¹⁴⁹

Falls and physical activity: Risk

Who is at higher risk of falls?

What should be done?

How often?

Level of evidence and references

Average risk

All people 65 years of age or over

Screen for risk factors^*

Every 12 months

I A 147,148

Moderately high risk

Older people presenting with one or more falls, who report recurrent falls or with multiple risk factors

Screen for risk factors and involve in preventive activities^*

Every 6 months

I A 142, 147

* A vitamin D supplement should be recommended if inadequate sun exposure to reduce the risk of fracture ¹⁴⁹

Falls and physical activity: Intervention
Intervention	Technique	References
Screening for risk of falls	Ask about falls and any gait or balance problems Identify risk factors: increased age past history of falls chronic medical conditions (eg. stroke or Parkinson disease) multiple medications and specific medications (eg. long acting benzodiazepines, and psychotropic medication) impaired balance and mobility impaired gait reduced muscle strength sensory problems (eg. impaired visual acuity and depth perception and peripheral neuropathy) dizziness impaired cognition depression low levels of physical activity, low BMI and vitamin D deficiency fear of falling female gender There are many falls risk assessment tools. However, few tools have been tested more than once or in more than one setting. Therefore, no single tool can be recommended for implementation in all settings or for all subpopulations within each setting.¹⁵⁰ A quick screening tool is the ‘timed up and go test’ (TUGT) which involves looking for unsteadiness as the older person gets up from a chair without using his or her arms, walks a few metres and returns. The ‘turn ¹⁸⁰ degrees’ test is of similar value and can be administered in any setting. However, both tests rely on clinical judgment and the value of timed cut-off values for the TUGT and number of steps for the turn ¹⁸⁰ degrees test need to be considered Assess home environment for hazards including stairs, slippery surfaces and floor coverings, poor lighting, bathroom, and furniture. An occupational therapist can provide specialist advice	142,147,151-154
Falls risk reduction	Prescribe or refer for a home based exercise program. Encourage participation in a community based exercise program	155,156

Falls and physical activity: Intervention

Intervention

Technique

References

Screening for risk of falls

Ask about falls and any gait or balance problems
Identify risk factors:
- increased age
- past history of falls
- chronic medical conditions (eg. stroke or Parkinson disease)
- multiple medications and specific medications (eg. long acting benzodiazepines, and psychotropic medication)
- impaired balance and mobility
- impaired gait
- reduced muscle strength
- sensory problems (eg. impaired visual acuity and depth perception and peripheral neuropathy)
- dizziness
- impaired cognition
- depression
- low levels of physical activity, low BMI and vitamin D deficiency
- fear of falling
- female gender

There are many falls risk assessment tools. However, few tools have been tested more than once or in more than one setting. Therefore, no single tool can be recommended for implementation in all settings or for all subpopulations within each setting.¹⁵⁰ A quick screening tool is the ‘timed up and go test’ (TUGT) which involves looking for unsteadiness as the older person gets up from a chair without using his or her arms, walks a few metres and returns. The ‘turn ¹⁸⁰ degrees’ test is of similar value and can be administered in any setting. However, both tests rely on clinical judgment and the value of timed cut-off values for the TUGT and number of steps for the turn ¹⁸⁰ degrees test need to be considered

Assess home environment for hazards including stairs, slippery surfaces and floor coverings, poor lighting, bathroom, and furniture. An occupational therapist can provide specialist advice

142,147,151-154

Falls risk reduction

Prescribe or refer for a home based exercise program. Encourage participation in a community based exercise program

155,156

Guidelines for preventive activities in general practice 7th edition

Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

Falls and physical activity