Home' GP Pulse : GP Pulse October 2013 Contents Guest Column
ISSUE 28 : October 2013 : P9
Is your patient at risk
As GPs will know, falls are the leading cause
of injuries to older people. One out of three
older people has at least one fall a year, and the
impact of a fall can be devastating.
Even people who escape injury in a fall may
lose confidence and become more anxious.
They may reduce their physical and social
activities, which can be linked to loss of
fitness, poorer quality of life, depression and
Falls are the first focus of New Zealand’s
patient safety campaign, Open for better care.
The campaign is coordinated nationally by
the Health Quality & Safety Commission and
implemented regionally by DHBs and other
The Commission is
committed to working
with primar y care ser vice
providers, and is engaging
with ACC and other key
stakeholders to incorporate
early falls risk identification
into health assessments.
Older people may not
mention that they have had
a fall, especially if they were not injured or if
they’re afraid it may raise questions about the
need for residential care. Making it routine to
ask older people if they have had a fall in the
last year is recommended in clinical guidelines
on preventing falls in older people.
Ask, Assess, Act, one of the campaign’s 10
topics about reducing harm from falls,
suggests three questions GPs and other
health professionals can use to screen for falls
risk (see box).
Ask, Assess, Act recommends talking with
patients and their family/whānau to discover
the most relevant risk factors and determine
what actions should be taken to suppor t
Risk factors may include poor mobility and
muscle strength, effects and side effects of
medications, and problems with dizziness,
cognition, vision, footwear and continence.
Actions that can be taken to reduce risk
factors include: recommending exercise to
improve strength and balance; referral to
a specialist ser vice – for example, for poor
vision; and prescribing vitamin D to high-risk
In shared decision-making about treating
vitamin D deficiency in an older person who
is at risk of falling, the GP’s role is careful
critical assessment and clinical judgement
informed by the evidence.
Vitamin D and falls – what
you need to know is another
of the campaign’s 10 topics.
International falls prevention
guidelines recommend vitamin
D supplements to reduce falls
in older people, especially
those at higher risk of falling.
on taking calcium and/or vitamin D
supplements to prevent fractures are
inconsistent, and taking calcium supplements
has been highlighted recently as increasing
cardiovascular risk in older people.
People in aged residential care facilities who
take vitamin D supplements have significantly
fewer falls than those who don’t, but in
the general older population vitamin D
supplements do not reduce falls or fractures.
GPs can assume, without taking a blood test,
that older people are likely to be vitamin
D deficient if they are housebound, require
suppor t ser vices, live in aged residential care,
or are frail, dark skinned or obese.
The standard prescribed dose for people
with a vitamin D deficiency who are unable
to increase their exposure to direct sunlight is
two 50,000 IU cholecalciferol tablets (2.5mg)
in the first month, then reducing the dose to
one tablet per month.
Dietar y calcium is considered safer for older
adults than taking supplements.
For fur ther information, see the Open
campaign website at www.open.hqsc.govt.nz
To see a case study on vitamin D
supplementation in primar y care, go to:
Three simple questions can be
used by GPs and other health
professionals to screen for falls risk.
1 . Have you slipped, tripped or
fallen in the last year?
2. Can you get out of a chair
without using your hands?
3 . Have you avoided some activities
because you are afraid you might
lose your balance?
Consultant geriatrician Dr Shankar Sankaran
with a falls patient
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