The two “geriatric giants” of ageing which characterise physical and cognitive disability and cripple health and social care systems are falls and dementia. Falls are a very common problem in the older population with 30% of community dwelling older people >65 years of age falling each year and 12% of these falling at least twice. Incidence increases with age and frailty. Rates are as high as 50% in community dwelling over 80’s.
Approximately one quarter of falls result in physical injury incurring high costs in terms of qualtiy of life as well as significant health and social care expenditure. 45% of older people who sustain a hip fracture never achieve their previous level of independence and one third die as a result of injury.
Recurrent falls are themselves a common reason for admission of previously independent older persons to long-term care institutions. Falls are the principal reason for admission to institutional care (40% of cases) and the commonest reason for older persons to attend the emergency department. Even non-injurious falls have significant negative consequences for the individual because of fear of falling, functional deterioration, anxiety, depression and loss of confidence and hence independence. If not detected and treated early enough fallers pass a threshold after which interventions for risk factors are inadequate to reduce further falls and prevent a cascade of inevitable decline, loss of independence and eventually institutionalisation.
The high prevalence of falls in older persons is attributed to a complex interaction of intrinsic and extrinsic risk factors, superimposed upon the normal ageing process. A personalised multifactorial intervention strategy for treating falls reduces subsequent events by an average of only 30%. There is clearly a gap in our knowledge about the full contribution of other important influences such as psychological and neuropsychological function, and behaviour on falls risk. Similarly, falls and blackouts are intermittent and clustered. The components which complete the picture of falls biorhythms in real time have not been studied to date. Successful postural control relies on the interpretation of multisensory information involving prediction, route planning, expectations about movement and route memory – all of which are dependent on accurate attention, memory and decision-making processes.
A better understanding of multisensory and behavioural function which lead to falls informs the complete picture of a person’s risk profile and the ability to modify risk and improve quality of life.
The challenge for this research programme is to apply a truly integrated multisystem approach to early detection of postural and neurocardiovascular instability. The key objective is to enable prediction and prevention of falls and blackouts through measurement of neurophysiological, behavioural and cardiac responses in the real-world environment. The TRIL Centre research programme will describe the key characteristics of fallers, identify new multifactorial algorithms for fall prediction and new technologies for monitoring, feedback and intervention.