Older people’s health and wellbeing is a
significant area of interest for health improvement and can contribute
to the reduction of GP and hospital visits.
Falling is a serious and frequent occurrence in
people aged 65 and over. Each year, 35% of over-65s experience one or
more falls and about 45% of people aged over 80 who live in the
community fall each year.
Falls result in psychological problems, e.g. a
fear of falling and loss of confidence in being able to move about
safely, loss of mobility leading to social isolation and depression,
increase in dependency and disability, hypothermia, pressure-related
injury and infection.
The aim of the Falls Prevention Service is to
reduce the incidence of preventable falls, as well as raising awareness
of potential risks that may lead to a fall. Falls prevention is a very
cost effective intervention - there is clear evidence that comprehensive
integrated falls prevention and management programmes reduce the
incidence and severity of first falls – and proactive preventative
management of ‘first fallers’ reduces the likelihood of a subsequent and
more serious fall occurring.
Falls prevention advice:
|Check that slippers/ shoes
||Keep the home clutter free
|Remove loose rugs/ mats in
||Ask your GP for a
|Have a sight and ears
check each year
||Ensure the home is well
|Use non slip mats inside
the bath or shower
rubber ferrule on the bottom of walking sticks for wear.
|Keep yourself and the home
If you fall you should always consult your
doctor. There are lots of causes of falls which can be easily remedied.
See the Local
Initiatives page for information on how to contact the local Falls
Physical Activity and Older People
Physical activity –
and particularly training to improve strength, balance and coordination
– has been found to be highly effective in reducing the incidence of
falls. Adults should achieve a total of at least 30 minutes of at least
moderate intensity physical activity a day, on 5 or more days a week.
Older people should take particular care to keep moving and retain their
mobility through daily activity.
Activities that promote improved strength,
co-ordination and balance are particularly beneficial, in addition
to endurance which is beneficial for people of all ages.
Choice of activities should be made in the
light of an older person’s functional limitations and symptoms of
Regular walking remains extremely important
for the maintenance of independence and activities of daily living.
Low to moderate intensity activity can
produce a health benefit for older people, possibly because of their
relatively lower fitness levels. Due to the aging process, older
people have a reduced cardio-respiratory and muscle function. So the
absolute intensity of activities for older people can be lower than
it is for younger adults.
As there is a greater risk of injury among
older people, higher intensity activities, and activities that
involve sudden or complicated movements, should be undertaken
cautiously, unless the individual is already used to this type of
Certain activities, such as frequently going
up and down stairs, can aggravate some existing conditions such as
Activity can also prevent age-related weight
gain and help with weight loss
Physical Activity section and the
Physical Activity factsheet for more information, and the
Local Contacts page for details of Extend – Postural Stability
Classes – Chair Based Exercise Classes and Walking for Health local
The cold negatively impacts on many health
conditions and the risk of falling is increased as a result of a
decrease in dexterity. The cold is said to be the underlying cause of
80% of excess winter deaths and evidence has shown that experiencing
cold within the home can be linked to more regular use of health
services, and also an increased length of a hospital.
The Hotspots scheme enables frontline staff
across North Yorkshire and York to refer patients, who may be at risk of
poor health (physical and mental) as a result of living in a cold
environment, for practical support. It involves completion of a simple
referral card that offers clients access to benefits checks, a home fire
safety check, energy efficiency advice and assessment for home
improvements, e.g. insulation.
Older People and Hearing/Ear Care
Age-related hearing loss (presbyacusis) is due to
wear and tear of both cochlea. We cannot repair our cochleae so damage
manifests as a symmetrical (the same in both ears), sensorineural
hearing loss sometime accompanied with bilateral tinnitus.
Most people with presbyacusis find that they can
hear relatively well in the low pitches, which provide vowels sounds and
make up the middle of words. However, they do not hear so well in the
higher pitches which carry consonant sounds, particularly “s” and “t”.
These are at the beginning and end of words and provide its meaning, no
matter what language is being spoken. To most people with presbyacusis,
others might sound as if they are mumbling. They might also find it
hard to hear in groups or in background noise and they might find it
hard to hear speech on TV particularly if music is also on the
The solution is to fit a digital hearing aid to
the problem ear(s). People with bilateral aids, or with an aid in the
poor ear and good natural hearing in the other ear can better localize
sound, have improved balance (a particular problem for the elderly) and
experience improved speech intelligibility in noise. Digital hearing
aids are fitted routinely throughout the NHS and they are on a par with
good quality private hearing aids. Unlike analogue hearing aids which
boost all pitches, digital aids only boost the parts of hearing that are
not functioning well. They also process sound to remove some of the
unwanted background noise which provides a more natural hearing ability.
Audiology services for the elderly are not
restricted to hearing and hearing aids. Many audiology services offer
practical advise on how to deal with tinnitus and also will be involved
in determining how well you balance organs are working for people who
experience balance problems.
The amount of ear wax produced increases with age
the removal of the wax is predominantly the domain of a GP or nurse, who
use syringing when it’s safe to do so. If a GP practice does not
provide this service they may need to be prompted to refer to ENT for
Over the counter remedies such as sodium
bicarbonate in mineral oil will soften wax, but they do not generally
remove wax. Patients should be seen by a GP/nurse/ENT as soon as
possible after application, and keep applying until seen by the
How to refer to Audiology
Referral usually from GP’s, practice nurses and
speech & language therapists for hearing tests. Patients can also be
referred for bilateral, long standing troublesome tinnitus. However,
it’s best to recommend a visit to the GP first to check for wax and
other pathologies. This is essential if the following are described.
In these cases a GP ought to refer straight to
ENT because of the risk of life-changing/sinister pathologies.
Dental Health Care
All adult patients
Brush twice daily with fluoridated toothpaste
Use fluoridated toothpaste with at least
1,350 ppm (part per million) fluoride
Brush last thing at night and on one other
Spit out after brushing and do not rinse
The frequency and amount of sugary food and
drinks should be reduced and, when consumed, limited to mealtimes.
obvious current active caries, dry mouth, other predisposing factors,
All of the above,
Use a fluoride mouth rinse daily - 0.05% NaF
(Soldium Fluoride) at a different time to brushing
Use an oscillating/rotating power toothbrush
varnish to teeth twice yearly - 2.2% F– (Fluoride)
For those with obvious active coronal or root
caries prescribe daily fluoride rinse
For those with obvious active coronal or root
caries prescribe 2,800 or 5,000 ppm fluoride toothpaste
Investigate diet and assist adoption of good
All patients should
attend a dentist for regular check ups. The NICE guidelines on dental
recall interval are available
All adolescents and
Do not smoke
use smokeless tobacco (eg paan, chewing tobacco, gutkha)
Reduce alcohol consumption
to moderate (recommended) levels
Maintain good dietary
practices in line with The Balance of Good Health
Increase fruit and
vegetable intake to at least five portions per day
Take a history of tobacco use, give brief
advice to users and signpost to local
Stop Smoking Service
Signpost to local alcohol
misuse support services
Oral Health and the
Oral Health Factsheet for further information.
Foot care and Mobility for the older person
The average person walks the equivalent of five
times around the earth in their lifetime. As such, it is not surprising
that 75% of adults have some form of foot problem. Walking has been
identified as one of the easiest ways of keeping fit and healthy. A
lower level of activity can lead to weight gain, muscle weakness,
reduced mobility and increased risk of falls.
The first step in reducing foot pain and
increasing mobility is appropriate footwear. For comfort, stability and
long-term health a well fitting shoe with lace or Velcro fastening and a
shock absorbing sole will make all the difference to an individual being
able to walk pain free.
While foot health is
important to all, for individuals with specific medical conditions such
as Diabetes or Rheumatoid Arthritis there are specific risks - there is
relevant NICE guidance on these conditions.
www.nice.org.uk. If there are specific Foot and lower limb
problems, treatment can be sought from a Podiatrist either on the NHS or
privately. Further information on NHS services can be found on
www.nhs.uk and the
referral leaflet. For private treatment, individuals should
ensure that the Podiatrist or Chiropodist are registered with the Health
Professionals Council (check this on their web site
www.hpc-uk.org). You can also find local Podiatrist via
www.feetforlife.org – this website also carries a range of
information on caring for your feet and common foot conditions.
Even if a patient’s eyesight appears fine they
may have a condition that could threaten their vision and it is
important to have this diagnosed as soon as possible. If any changes in
vision are noticed or if they have any concerns about their eyes,
patients should have them checked out by an optician/optometrist as soon
Eyes need to be examined by an optician at
least every 2 years even if there are is no apparent change in
vision. The professional will also check on the health of your eye
to detect any underlying conditions. Some opticians can provide a
home service if the patient is unable to leave their home. NHS eye
tests are free to over 60s.
A balanced diet is
as important for eye health as for the rest of the body. Eating
plenty of green leafy vegetables such as curly kale and broccoli,
having lots of fruit such as oranges and kiwis and eating oily fish
regularly may help protect against some conditions.
Wearing sunglasses with a UV filter will
protect eyes from harmful rays in sunlight. Sunlight can also
increase the risk of some eye conditions.
Smoking restricts the flow of blood and
nutrients to the eyes and can increase the likelihood of developing
conditions such as cataracts.
You can find your local optician in the Yellow
pages, or by going to
NHS Choices website. Further information about eye health,
including advice on nutrition is available on the
RNIB website or telephone the helpline on 0303 123 9999.
If an eye condition already exists and the
patient is struggling to carry out everyday activities, there are many
practical things that can be done to make the most of their remaining
There are many different causes of sight loss and
the type of help needed will vary between individuals, however, these
are the key ways to make the most of any remaining sight:
Advise using vision aids such as magnifiers
Advise using the correct level and type of
light to undertake any task in hand
Advise using colour contrasts, e.g., placing
a white plate on a dark blue cloth makes it easier to see.
There are a wide range of aids and equipment
available which may help patients in all aspects of daily life. The
York Blind and Partially Sighted Society is a local charity which is
there to help anyone with sight problems. The Equipment and Information
Centre has a range of products available for people to see, try out and
buy if required. For further advice or information on any of the above
please contact YBPSS, Holgate Villa, 22 Holgate Road, York. Tel: 01904
636269 or visit their website at
www.ybpss.org. The Scarborough Blind and Partially Sighted Society
covers the Scarborough, Whitby and Ryedale area -
www.scarboroughblindsociety.co.uk or telephone 01723
Please see the
Falls Prevention and Older People’s Factsheet for further