Slippers, small dogs and hip fractures

In some medical circles, slip-ons are called, “Granny killers” because of a informally observed correlation between elderly folks wearing them and falls. Another remarked cause of falls is small dogs. This is a repost from the blog NorthernDoctor

by northerndoctor

Killers (Not evidence-based)

Killers. (Not evidence-based.)

Gravity may well be the weakest of the four forces but your average GP will highlight the disproportional impact it has for patients who tend to fall. We’ve all picked little old ladies off the floor, dusted them down where possible but all too frequently we note the shortened, externally rotated leg that belies a fractured hip. We’ve fought with stroppy SHOs as we try to admit vulnerable people who have taken one fall too many and the least bad option is tragically a shabby dehumanising acute medical ward. All too often we’ve found their blood pressure in their boots and have hurriedly dropped one or two anti-hypertensives as we chalk up another iatrogenic casualty.

When I was a junior doctor we used to joke about ‘Granny Killers’. Not some geriatric sequel to an old Ealing comedy but the dodgy slippers that make the elderly stumble and prove to be the straw that breaks the camel’s back. Or in this case usually their neck of femur. Shabby ‘Granny Killer’ slippers might be responsible for more premature demises than any other item of bedroom clothing since they sold those highly flammable nighties in the 70s before smoking in bed was discouraged.

This week the BMJ has a paper and an editorial on falls. The study was a randomised controlled trial that recruited people after they had been picked off the floor by the ambulance service. Those in the intervention group were referred to a multidisciplinary falls prevention service. They took their BP, checked their medication, offered training in strength and balance, and removed hazards. I am guessing that removing hazards probably involves the ceremonial burning of Granny Killers and the re-homing of small dogs. The results were significant – the primary outcome showed that they had less than half as many falls (p<0.001) and secondary outcomes also suggested that their activity levels were better and fear of falling was reduced. In short, life was better.

There is actually a Cochrane review that looks at interventions for preventing falls in older people living in the community. Granny Killer slippers do not appear in the review but you will be unimpressed to learn that apparently an ‘anti-slip shoe worn in icy conditions can reduce falls’. Another pearl of evidence-based wisdom.

Cochrane do have some other more helpful suggestions. Exercise helps, but vitamin D supplementation probably doesn’t unless they were already deficient.

Exercise programmes may target strength, balance, flexibility, or endurance. Programmes that contain two or more of these components reduce rate of falls and number of people falling. Exercising in supervised groups, participating in Tai Chi, and carrying out individually prescribed exercise programmes at home are all effective.

So the findings of the BMJ study don’t constitute particularly new information and the challenge clearly remains in the implementation. We need some seriously creative and determined public health interventions to put some of this into action in an austere health service that is going to have little spare cash for falls clinics in every community. I suspect a wider social change to improve participation in exercise in all age groups is sorely needed. In the meantime, don’t forget to check out your Granny’s slippers as they might not be as cosy and benign as you think.

Logan, P., Coupland, C., Gladman, J., Sahota, O., Stoner-Hobbs, V., Robertson, K., Tomlinson, V., Ward, M., Sach, T., & Avery, A. (2010). Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial BMJ, 340(may11 1) DOI: 10.1136/bmj.c2102


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