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Prevention is better than falling

When thinking about the contribution made to society by health professionals it can be all too easy to view their work as reactive; diagnosing and helping people to recover from illness or injury. But to do so would be to ignore the increasing movement towards proactive health care; enabling individuals to live healthy lives either through prevention or early intervention.

One such success story comes thanks to the Chartered Society of Physiotherapy (CSP). Their research in conjunction with Agile, a professional network for physiotherapists working with older people, has identified that a multifactorial approach can lead to a 24% reduction in falls amongst older people. When coupled with an evidence based exercise programme that increases to 34%. That is a significant reduction, particularly when taking into account the cost of falls in terms of mobility and longevity, not to mention resource allocation.

As the CSP paper highlights, falls which result in injury are the leading cause of mortality in older people. So much so that following a fall there is a 10% probability of older people dying within a year and half will experience serious mobility impairments. With an estimated 500,000 fragility fractures each year and an overall cost of falls to the NHS of £2.3b per year, any measures which can result in a reduction in fall outcomes can only benefit individuals and the wider society.

By undertaking a multifactorial risk assessment, physiotherapists are not only able to detect early difficulties with mobility, strength and balance; they can also identify other environmental factors which could contribute to the chance of falls. These include the physical environment as well as behavioural and cognitive factors. With early identification comes the chance of early intervention; providing a range of strength and balance exercises to reduce the risk of falls. Providing holistic support such as recommending home modifications or referrals to other agencies can also help individuals to be mobile and play an active role within the community for longer. And of course, the more active someone is the better their chance of managing other health conditions such as obesity.

Interestingly, although half of those who have experienced a fall are afraid of falling again, up to half of those who have not fallen also have the same fear. This can lead to a modification of behaviour which in itself can lead to negative outcomes. For example, if an individual is afraid of falling whilst out walking then they may isolate themselves in their home. Helping people to understand and manage risk, including showing them how to get up safely after a fall, can help to overcome these fears.

In outlining the case for early intervention the CSP makes the case for effective service provision and the beneficial use of physiotherapy services. More importantly it also demonstrates the value of supporting preventative health services and the long term benefit which such support can deliver. Each successful intervention can lead to a significant improvement in the long term quality of life for the individual as well as a reduction in long term costs for the health service as a whole.

Time to heal? Consult your body clock.

What is your clock telling you? Time for lunch, time for that next appointment, or maybe it is something far more profound which could affect your entire wellbeing. Perhaps the answer depends on which clock you have tuned into. The clock on the wall may be telling you one thing, your body clock quite another.

The concept of the body clock isn’t a new one.  Anyone who has travelled abroad knows all too well the effect which multiple time changes can have on their system.  And even if you are more of a staycationer then you may still be all too aware of the impact of twice yearly UK clock changes on eating and sleeping patterns.

However, it seems as though the clash between imposed time and personal body clocks may only be the tip of the iceberg when it comes to our personal time zones. Indeed, the more that scientists study the body clock, more they are learning about the interaction between time and well-being. In this last month alone two important studies have illustrated the way in which well-being is influenced by our body clocks.

In the first study led by Professor David Montaigne of the University of Lille, researchers highlighted the way in which our body clocks influence our chances of recovering from heart attacks and heart surgery. Identifying some 300 genes which link the body clock to heart well-being, the study found that ongoing heart damage was more prevalent in those had undergone heart surgery in the morning than in the afternoon. So much so, that those who had surgery in the afternoon had a 50% lower chance of cardiac event than those scheduled for morning surgery.

The implications are profound and could lead to complete rethink of the way in which surgery times are scheduled not just for hearts but in respect of a range of conditions. The second study reinforced the importance of considering the body clock, and indeed the clock on the wall, when it comes to understanding recovery times.

The study reported by the Medical Research Council revealed that wounds received during the day healed 60% faster than those at night.  This apparently is down to ‘actin’, an essential protein which governs the ability of skin cells to migrate into wounds and to start the healing process. Actin is itself governed by the circadian clock, being more active in the day than in the night and therefore more able to in initiate the healing process by day.  Interestingly the study also revealed that in nocturnal mice the process is reversed.

Other studies in the past have cast light on the way in which our body clocks influence mood, concentration and our ability to carry out day-to-day tasks. Whether you are a morning or evening person could profoundly influence the way in which you approach your daily round; with tasks allocated in accordance with your circadian rhythms improving outcomes in areas such as productivity, accuracy and so on.

The more we understand our body clocks, the more we can optimise treatments and increase chances of recovery. Given their individual body clock, should a patient see a physiotherapist in the morning or afternoon, at what time of day would it be best for the individual to exercise in order to promote fitness or healing, and when is the best time to tackle that mountain of paperwork? We may not have all the answers yet, but as more and more studies report their findings it may not be too long before circadian rhythms are seen as an intrinsic part of managing well-being.

Physiotherapy, an essential part of dementia care

The National Institute for Health and Care Excellence (NICE) have published a new quality standard which aims to support people to live well with dementia.  The aim behind the standard (QS30) is that “a person-centred and integrated approach to providing care and services is fundamental to delivering high-quality care for people with dementia.”

In addition to acknowledging the importance of carers in the treatment of those with dementia the standard also looks at every aspect of a dementia sufferer’s care including leisure, health and relationships.  The standard also highlights the need for individual choice and control to be at the forefront of any programme especially when planning and evaluating services.

One element of the standard also looks at the importance of those with dementia and their carers being able to access “services that help maintain their physical and mental health and wellbeing.”  Whilst some of these services naturally include access to general practices and nurses, the list also includes care services such as hearing therapists, chiropodists and physiotherapists.

The Chartered Society of Physiotherapy (CSP) contributed to the development of the dementia standard with particular advice being sought from the network of physiotherapists who work with older people (Agile)*.  In commenting on the standard Agile chair, Janet Thomas, said “The dementia guidance we saw certainly had a different feel to other NICE guidance, with the emphasis shifted to the day-to-day living aspect of dementia care, and this is very important.”

With a growing body of evidence supporting the theory that “a healthy mind in a healthy body” is not just a saying but a vital component of wellbeing in later life, there is certainly something to be said for helping dementia sufferers to stay as active as possible.  Hopefully this means that those involved in physiotherapy and other related services will see a greater call on their time as they work with carers and those with dementia to help to provide an integrated holistic management programme.

Taking steps to reduce administration time, such as by managing diaries and storing patient records electronically, will help to maximise treatment time and hopefully enable physiotherapists to take their place at the forefront of this new approach to care.


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