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Irish Practice Nurses Association - North Dublin Branch Bone Health & Falls Prevention


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Irish Practice Nurses Association - North Dublin Branch Bone Health & Falls Prevention

  1. 1. An overview of Osteoporosis, Bone Health Falls Awareness & Falls Prevention Daragh Rodger Advanced Nurse Practitioner Care of the Older Adult Community
  2. 2. Report of the National Steering Group on the Prevention of Falls in Older People and the Prevention and Management of Osteoporosis throughout LifeFalls strategy 2008
  3. 3. Treatment
  4. 4. Osteoporosis comes from ‘osteo’ meaning bone and the greek word por (passage) ie simply it means porous bone. Osteoporosis results in loss of bone strength, thus making bone more fragile and easily susceptible to fracture. Osteoporosis is classed as a bone density 2.5 or more standard deviations below normal peak bone mass (WHO, 2002) • Normal Bone Density 0 - -1 • Osteopenia -1 - -2.5 • Osteoporosis > -2.5 DEXA SCAN RESULTS
  5. 5. DXA scan Bone health assessment Bone health Education •Diet •Exercise •Lifestyle choice St Mary’s Healthy Ageing Clinic
  6. 6. A T-score compares the patient’s results with the mean peak bone mass (thickness of bones) of a large number of normal females and males between the ages of 20-40. A Z-score compares the patient’s score with their own age group; this should only be used in the diagnosis of the spine in children and adolescents
  7. 7. Bone Density Results – Healthy Ageing Clinic 0 100 200 300 400 500 600 700 2010 Osteoporosis 561 Osteopenia 465 Normal 621
  8. 8. Osteoporosis Treatment Prevention and Treatment options Calcium and Vitamin D are essential for the treatment and prevention of osteoporosis. If it is not acquired in the diet it is necessary to take a supplement. This applies to everyone regardless of DEXA scan result. Exercise is also an essential component in the treatment and prevention of osteoporosis.
  9. 9. Treatment Options Anti resorptives – Bisphosphonates decreases bone resorption eg. Alendronate – Fosamax 70mg - once a week Alendronate combined with Vitamn D – Fosavance 5600 – Fosamax 70mg with 5600iu Vitamin D once a week Ibandronate – Bonviva 150mg – once a month Ibandronate – Bonviva by IV 3mg – every 3 months Risedronate – Actonel 35mg – once a week Risedronate – Actonel 35mg combi( with calcium) one actonel a week and one calcium 500mg for six days of week Zoledronic Acid – Aclasta – once a year IV infusion Osteoporosis Treatment
  10. 10. Strontium Ranelate – Protelos – dual action bone agent – prevents bone loss and it increases bone formation – one 2g sachet daily Parathyroid Hormone – Teriparatide – Forsteo Stimulates bone formation and is given by subcutaneous injection for a period of 18 Months. It mimics the action of natural human hormone. It is the most potent anabolic agent. It is reserved for use of severe osteoporosis and is usually only prescribed by a specialist physcian. Denosumab – Prolia – monoclonal antibody Prevents bone loss and osteoporosis – 60mg subcutaneous injection 6 monthly Osteoporosis Treatment
  11. 11. Compliance • Improved patient education • Good communication • Taking into account patient's preferences • Involving them in treatment decisions may improve adherence. • Offering support service – by phone • Follow up scan to show improvement Osteoporosis Treatment
  12. 12. Health Promotion • Health promotion was identified as a key factor for bone health and fracture prevention • Development of Primary Care multidisciplinary teams was of key importance to improve the prevention and management of osteoporosis • Primary Care is the appropriate setting to meet 90-95% of all health and personal social service needs. Strategy to prevent falls and fractures in Ireland’s ageing population June 2008
  13. 13. Bone Health What can we do Be aware – Community, Residential, Acute care. Identifying those at risk – Fractures new & old, falls. Carry out risk assessment for osteoporosis Refer for further interventions – DEXA, physio, OT. Provide education on diet, exercise and treatment options Provide support – compliance with medications Remember Bone health is a lifelong process.
  14. 14. Bone health through the ages 1-12yrs 13-22yrs Adult Over 80 years Peak Bone Mass Age related bone mass Age related bone loss
  15. 15. Bone Health in the Park
  16. 16. 19
  17. 17. www.bonehealth.co20
  18. 18. 21
  19. 19. Falls awareness
  20. 20. Impact on Older Adult • Where we work - Care of the Older Adult – all settings • Impact of these figures on our client group – Loss of independence – Suffering – Severe disability – Depression – Need for home support 23
  21. 21. • Ageing population • In 2030 a number of the present day work force will be over 50 years of age • In 2030 many of us may/will fall and will be a statistic • Through education we can help reduce these figures Real Life Facts 24
  22. 22. Impact on Society • Loss to family and community • Cost - Overstretched economy • Provision of services home care, respite care, extended care • Proactive approach required rather than reactive • Education is key 25
  23. 23. FOREVER AUTUMN Implementation of a falls awareness programme for all staff – clinical and non clinical, illustrating the potential for falls amongst the older adults in our care. Elements included: • Revision of St Mary’s Falls Prevention and Management Policy • New Falls Risk Assessment Tool • New Falls Risk Symbols • New Falls Reduction Measures
  24. 24. Key Message All staff have a role to play in reducing the risk of falls – clinical and non clinical – know your role!
  25. 25. Review of Falls Data from January - June 2013 New Data Measurement Interventions to prevent potential falls Evidence to staff of benefits of Forever Autumn Programme in action *Compared to falls data pre Forever Autumn in 2011 Phoenix Park Community Nursing Unit 33% Reduction* St Mary’s Hospital 15% Reduction*
  26. 26. Development of an online resource to offer support, guidance and continued education in falls prevention and management across the care spectrum for older adults:- •Acute Hospital Care •Community Care •Intellectual Disabilities Care •Palliative Care •Residential Care Proactive collaborative approach to falls prevention by providing a platform for continuing engagement
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  28. 28. To promote bone health, falls reduction, falls prevention and effective falls management To provide a platform to share the repository of information to the wider community to enhance quality care through presentations, articles of interest, develop special interest groups etc.
  29. 29. St Mary’s Community Falls Service The Falls Service at St Mary’s Hospital is a consultant Geriatrician led multidisciplinary service offering the following: – Clinical assessment by Nursing and Medical staff – Investigations – Physiotherapy assessment – Occupational therapy assessment – Social worker services – Education & support
  30. 30. Poster Campaign 2013 Prompt patients to ask about screening for osteoporosis and will be placed in key patient waiting Areas:- • A&E department • Fracture Clinic • Outpatient clinic • GP surgery • Health centre 33
  31. 31. Bone Health Further Information National Osteoporosis Society International Osteoporosis Foundation Strategy to prevent falls and fractures in Ireland’s ageing population June 2008 HSE, DOHC, NCAOP, Irish Osteoporosis Society