A fall is where a person unintentionally ends up on the
floor or a level below them (1). Falls can have a number of outcomes; such as
the force of impact causing injuries of varying severity (2), a reduced quality
of life (3), or decreased confidence (4). Falls can also have an economic
impact, placing a burden on NHS resources (3). It is known that between 30-60%
of older people living within the community in Wales fall every year (5),
therefore falls can be considered a major problem in this respect. There is not
one main factor that contributes to an increased risk of falling. Falls have a
wide range of causes (5) and therefore, one must narrow down some of the key
points known to have an association with falls (6), which are often interlinked
and complicated (7).
There are up to “717 community pharmacies in Wales” (8)
that provide NHS services, such as medicines use reviews (MURs) and there are
approximately three national campaigns each year that are run focusing on these
community pharmacies to promote public health (9). This project uses data
collected during a National Community Pharmacy Public Health Falls Prevention
Campaign led by pharmacists Tim Banner and Sian Evans. This campaign identified
previously known risk factors with an association with falls and featured these
in a questionnaire seen in APPENDIX ONE. There has been evidence that
instability such as difficulty rising from a sitting position, and risks
surrounding the home environment, both have an association with falls (3).
Furthermore, certain medications have been identified as
having an association with falls, such as Amitriptyline (10, 11) and sleeping
pills (2, 12, 13). In the relevant literature, bladder control medication has
been associated with falls (14, 15), and studies have shown that blood pressure
pills also have a similar issue (2, 16). Other medications evidenced to
contribute towards falls are strong painkillers (17) and medication for
epilepsy (18, 2, 12, 19). Further studies show how medication to help
depression and nerves is associated with falls (2, 12, 20, 21, 11, 22), along
with eye drops for glaucoma (23, 24). Following on from this extensive
evidence, these medications were included on the campaign questionnaire.
Polypharmacy has been shown in studies to have a link with
falls (3, 5), however polypharmacy is often identified in different ways
throughout the literature (25). Therefore, this project has defined
polypharmacy as four or more medications as this definition of polypharmacy has
been evidenced in studies to be associated with falls (3, 26).
Research into how vision impairment could lead to an
increased risk of falls exists (27). Additionally, research has shown that in
older people, especially those with a vision impairment, hazards associated to
interactions with their environment lead to an increased risk of falls (27). The
risk of a fall occurring increases with age (28), and as the population in the
UK is ageing to the point that “over 70%” of people will be “over 60 by 2039”
(29), a focus on patients over 60 to obtain relevant data seems best, as these
have been proven to be more inclined to have a fall (2).
There has been a significant amount of research into falls
and their risk factors, covering a wide range of different topics. However, as
there has not been any published work looking at possible risk factors for
falls in the community setting in Wales, it was decided that this was a topic
for further investigation. As patients vary considerably in medication,
characteristics and demographics, it would be of greater benefit to gain
further understanding into what are the most prevalent risk factors in Wales.
This would allow policies to be developed to tackle falls and their
consequences in Wales, as falls have been proven to have significant
consequences elsewhere (2, 3, 4).
The research question for this project was: is there any
association between a selection of pre-determined risk factors and the
occurrence of a fall within the past 12 months based on a sample of patients
visiting community pharmacies in Wales? This research question then allowed us
to develop the aim: to identify whether there is any association between
pre-determined risk factors and the occurrence of a fall within the past 12
months based on a sample of patients who have visited a community pharmacy in
Wales. The data used for this project were collected during a National
Community Pharmacy Public Health Falls Prevention Campaign in early 2017.
The objectives in this project are as follows:
research of the literature relevant to the project to gain a greater
understanding of the current knowledge in this research area.
To create and validate
a database of data obtained during the falls prevention campaign
To identify if the
prevalence or absence of pre-determined risk factors varies by health board,
age or sex across Wales
To identify if patients
taking pre-determined drugs or classes of drugs are associated with an
increased risk of falls