Nobody would dispute that the volume of falls and fractures among the elderly is a major problem that has been defined by the NHS as ”An Unmet Clinical Need” with approximately half a million such fractures per annum at cost of more than £4bn. p. a. More than 50% of those over 75 have to live with a fear of falling that adversely affects their daily life and for those with osteoporosis – 2.5 million people in the UK – a very real danger of breaking bones in a fall. The knock-on effects are considerable in that 10% of all ambulance call-outs are for such falls and a significant amount of bed capacity in hospitals has to be allocated to those recovering from a hip repair operation.
Various nostrums have been tried, such as “multifactorial Interventions”, but have had to be abandoned after a trial in Australia – 6-PACK – demonstrated conclusively with 46,000 participants that they did not work. Balance exercises and computer games have also had no measurable impact on the numbers of falls and fractures, with the former tending to increase the numbers of falls, especially when the exercises were unsupervised, as would normally be the case.
To make matters worse, most falls are not recorded for a variety of reasons such as the faller having dementia, not wishing to be sent to a care home, forgetting to mention it to a nurse/carer etc. So nobody has any real idea how many falls occur, unless an injury results. Therefore identifying the cause(s) of falls in each instance is not easy, especially as the NHS have stated that there are over 400 contributory factors causing falls, many of them intersecting. They include patient infirmity, medication difficulties, environmental failures (e.g no hand-rails) and one-off events such as tripping over the dog.
Since it is obviously impossible to maintain nurse/carer surveillance over all residents in, for example, a care home, all of the time, and invidious to use video cameras in areas such as bathrooms and bedrooms, where almost 50% of falls occur, other technological solutions must be applied. Ideally the solution will prevent perhaps the worst example of falls injury, a broken hip, at the same time as capturing, through a sensor, essential data on every fall, without generating any false alarms. This information should be accumulated on a falls database which can then be analysed and common factors in falls identified. Clearly this is an ideal application for Artificial Intelligence since it will be impossible for human beings to hold in their heads the multiplicity of factors involved in a fall and correlate them to produce predictions that could be used to eliminate factors causing falls in specific instances, e.g at night, on slippery floors in bathrooms where no grab rails have been applied, to give a simple example.
Fall detectors in pendants and watches have been tried and largely abandoned because they both tend to generate too many false positive fall events as a result of spurious actions such as waving the arms around or suddenly lying back.
So why has this approach not been examined by bodies such as NIHR? The reason is that NIHR have taken advice from NICE and Cochrane Reviews that researched the use of hip protectors to prevent hip fracture in the last years of the last century and found that the devices then available were made from hard polyethylene shells that did indeed prevent hip fracture but only by transferring the load to the thigh and thence to the pelvis causing a pelvic fracture in some instances. The devices were far too uncomfortable to wear voluntarily unless there was a nurse present enforcing such wearing and as they were held in place by pants with hip pockets, they could not be worn in the bath or shower, or when toileting – times of maximum concern in terms of falling. Nobody would wear them in bed because they would be far too uncomfortable. So at best they provided protection less than 60% of the time.
It may well be asked, and I have frequently done so in the past ten years, why NICE, Cochrane, NHS and NIHR have not updated their views since the early 2000’s, given that new generations of hip protectors superseded the old hard shell devices some ten years ago. Indeed trials of new generations of devices have been held in the USA, China and Canada in recent years and have found that such devices prevent all hip fractures 24/7 and are so comfortable and unobtrusive to wear that user acceptance is almost total. Clearly a trial is required in the UK to validate sensors embedded in hip protectors and update the a/m reviews.
By William Beckett, Managing Director of Hip Impact Protection
William Beckett has led an extraordinary career in business over the past 50-odd years, after leaving Eton and a spell in a cavalry regiment defending Germany from the Russians in tanks. He worked for large and small hi-tech companies developing radical new systems and products, amongst them the very first commercial e-mail system, before managing the development of some of the first British multimedia products for Virgin, destined for the home and school markets. He then started his own company to produce a multi-player version of Cluedo® running on a PC or Mac, that was filmed in a real house with human actors and a real environment, to provide a unique game experience that sold well for more than 20 years. He and his business partner went on to produce and market a whole raft of innovative and unique products, during which he experienced many attempts by big business and various authorities to crush or suborn his company. Latterly he has taken on the healthcare authorities with brilliant new products that will improve and save countless lives, despite the best/worst attempts by the NHS and NICE to prevent them getting market traction. This book is designed to help you avoid or overcome such traps.
