Day Four: “Natural World” — Leading Lines

The Guardian – Wednesday 13 May 2015 16.15 BST Last modified on Wednesday 13 May 2015 16.18 BST

There are three million falls annually among older people, and the cost to the health service is estimated to be £2.3bn a year

Physiotherapist Dean Metz says that falls in old age are not inevitable. Photograph: Dan Prince Kate Murray

Starting an exercise regime in your 70s or 80s may sound unusual. But for a growing number of older people it could help them hold on to their independence for longer, and reduce the pressure on families, carers and the health and social care system.

“There is a lot of evidence that physical activity and exercise are valuable however old you are, and that frail, older people gain the most benefit,” says Louise McGregor, vice-chair of the Agile professional network for physiotherapists working with older people. “You are really never too old. We now have a lot more people who live into their 100s and they can still benefit from the right type of exercise.”

Prescribing more activity for older people is part of a more proactive approach by physiotherapists to prevent a loss of mobility and independence.
But first, says McGregor, we need to challenge some of the beliefs about ageing among older people, their carers and even some health professionals: “When people start to slow down, it’s not necessarily a part of normal ageing.

“We have to dispel the myth that nothing is reversible, when actually for many people problems of balance and muscle weakness can be addressed even when you’re in your 90s.”

The impact of a carefully tailored physiotherapy regime can be significant, in some cases, according to McGregor, a relatively small input can “transform lives”.

However, with an ageing population putting a strain on the NHS and social care – over-65s now account for 70% of bed days in hospital – there is also a real financial pay-off. There are three million falls annually among older people, and the cost to the NHS is estimated to be £2.3bn a year.

The Chartered Society of Physiotherapy believes that almost 200,000 of those falls could be prevented annually through physiotherapy-led prevention services, which would save £275m.

When people slow down, it’s not necessarily a part of normal ageing
Louise McGregor
One notable success story is in the north-east, where a multi-disciplinary falls prevention service at South Tyneside district hospital offers a “one-stop” clinic with joint assessments by a nurse and a physiotherapist to identify what may be causing patients’ falls and what can be done to help prevent them in future.

Dean Metz, falls specialist physiotherapist at the hospital, explains that the process includes everything from blood pressure and vision tests, to a full balance-and-strength assessment with follow-up programmes devised to help.

“As a child, when we develop, we learn to do things like stand on one leg. Often, as older adults, we need to relearn those skills, so we will do that with them in a safe environment,” he says.

Metz believes it is important to challenge the belief that falls are inevitable in older age. “A lot of older adults feel it’s just a natural part of getting older, they’ll say: ‘Oh, I fell over, I’m getting on,’” he says.

“And there’s a big amount of fear. Older adults don’t necessarily want to tell anyone in case people say maybe they shouldn’t be living on their own or maybe it’s time for them to go into a home.

“We want to encourage them to have that discussion as it’s important when it could be something simple to address.”

The programme has had some impressive results: 81% of patients reported a decrease in falls in the six months after visiting the service, although Metz says the real figure may be lower as patients were self-reporting. However, he says that he can see for himself the difference the service makes: “It’s wonderful to see one of my patients out and about.

“They are so grateful that they have got such an important part of their life back and they no longer feel prisoners in their own home.”

Another area where physiotherapy can have a real benefit is with people with dementia, where physiotherapists can play a key part in assessing a patient’s needs and ensuring high-quality care.

McGregor, who is also an allied health professional therapist consultant, older people rehabilitation, at St George’s NHS trust in London, says she often supports those with dementia and their carers, and is passionate about the difference physiotherapy can make.

“Working with people with dementia, you have to be a lot more adaptable and more creative. You have to be flexible – an older person with dementia would still benefit from exercise, but may not remember to do those exercises,” she says.

“However, getting to know the person can really help – finding out what they used to do can be helpful in finding a way to communicate. Then you can get really good results.”