Medication use is linked to higher risk of falls

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Younger people who use two or more prescription medications are at an increased risk of unintentional falls, new research has found.

There is already a well-established association between prescription medications and falls in older people, but the authors believe this is the first study of its kind to make the link with working age adults.

The study examined fall rates in people aged 25-60 in Auckland, New Zealand, comparing those on multiple prescription medications to those on one or none.

The researchers analysed 335 cases of people who had died or were admitted to hospital as a result of unintentional falls, and 352 controls randomly selected from the electoral roll.

The findings suggest that, as in the case of older people, younger working age adults who use multiple prescription drugs are 2.5 times more likely to have falls resulting in hospital admission than those that do not. The authors said this is ‘an aspect that should be considered in falls prevention programmes’.

Antihypertensives and lipid powering drugs were the most common groups involved. The study found a threefold increase in the odds of falls among people on antihypertensive medications, consistent with previous research among older adults.

However, the study notes it was not able to determine if the association to falls related to the drugs or to underlying comorbidities and suggests further research is needed to disaggregate the effects of drugs with medical conditions.

The authors conclude: ‘The association between prescription medications and fall-related injuries revealed a largely unrecognised problem among this younger age group.

Not withstanding the limitations of the study, the findings signal a need for greater awareness of the association between prescription medications and falls in younger adults, whether this is due to the medications, underlying conditions or a combination of both related factors.’  
Bridget Kool et al; Injury Prevention published online first: 16 January 2012 doi: 10.1136/injuryprev-2011-040202

Vitamin D

Supplements top up sunshine vitamin

Health professionals are being warned to watch out for patients who may need vitamin D supplements, after new evidence emerged about deficiency.

‘We know a significant proportion of people in the UK probably have inadequate levels of vitamin D in their blood,’ warns England’s chief medical officer, Dame Sally Davies.

Deficiency can cause musculoskeletal problems – often misdiagnosed, especially in older people. Some research also links it with heart disease and cancer.

And a new study shows a link between multiple sclerosis and a genetic defect that causes low vitamin D levels.

Last year’s report from the National Diet and Nutrition Survey (NDNS) revealed that average daily intake of vitamins in all age groups was near recommended levels – with the exception of vitamin D.

The best-known sign of deficiency is the bone-weakening condition rickets. This died out in the UK as nutrition improved during the twentieth century – aided by widely used supplements such as cod-liver oil. But it has made a comeback in recent years.

Now Dame Sally Davies is asking health professionals to check that groups at risk are taking vitamin D supplements. These are recommended for under-fives, pregnant or breast-feeding women and people over 65.

As the body needs sunshine to make vitamin D, people most at risk live north of Birmingham; or have dark skin; or cover their skin all year round.

Restricted diets increase the risk too, especially those without oily fish.
Annals of Neurology 2011: 70; 881–886. DOI: 10.1002/ana.22678National Diet and Nutrition Survey. Headline results from Years 1 and 2 (combined) of the Rolling Programme (2008/2009 – 2009/10)


Public health

Olympic games – health hazard or long term legacy?

As the 2012 Olympics near, many physiotherapists will be wondering how best to maximise the opportunity offered to promote physical exercise and, in the longer term, leave a legacy of better sporting venues in the event centres.

A paper in the Lancet journal, Infectious Diseases, hit the headlines recently, looking at the risk of infection at a mass gathering such as the Olympics.

But an earlier viewpoint paper, published in the main Lancet last year, is likely to be of more interest to physiotherapists.

It looked at how best to measure the impact of the games on the health and wellbeing of the population. No Olympic games before this one has aimed to improve the overall health of the host country’s population.

The paper from Professor Kaye Wellings, Jessica Datta, Paul Wilkinson and Professor Mark Petticrew, look at potential models for measuring health outcomes.

‘The 2012 Olympics is seen as a catalyst to increase mass participation in physical activity,’ say the authors.

‘This project involves comprehensive physical, social, and economic renewal of one of the most impoverished parts of the UK,’ they add, referring to the East London site.

Some commentators doubt the power of the Olympics to inspire physical activity, they acknowledge.

The  Department for Culture, Media and Sport has commissioned a meta-evaluation focusing on six legacy promises: sport and physical activity, regeneration, culture, sustainability, the economy, and disability.

The challenge, says the paper, will be to deliver evidence to show not only whether the games affect public health, but how.

‘The games are not classic public health interventions with conventional health-related endpoints and there is little scope for controlled trials’, the authors point out. But there are existing surveys, such as the Health Survey for England, which can be used.

‘The effect of structural improvements on the health of local populations could take a generation to be felt,’ warn the authors.

‘Capture of evidence for such long-term effects would be slow and costly, but useful.’
The 2012 Olympics: assessing the public health effect The Lancet, Vol. 378 No. 9797 pp 1193-1195;Prof Ibrahim Abubakar et al, Global perspectives for prevention of infectious diseases associated with mass gatherings, The Lancet Infectious Diseases, Volume 12, Issue 1, Pages 66-74

Comments & Conclusions

The economic recession has made nearly a third of workers more likely to go into work when they’re ill, a survey by Nuffield Health revealed in January.

Of the 1600 people polled, 72 per cent admitted they had gone into work when ill in the past year, often with an infection such as a cold.

Shop workers and those earning under £20,000 feel the most pressure to work when ill, said the health charity.

A press release on the study is available at

News reports that a plant substance called luteolin protects against bowel cancer stemmed from a study of luteolin’s effects on cells in a laboratory.

The study wasn’t looking at the effects on humans of eating luteolin-rich fruit and vegetables.

But it does add to what scientists know about how these healthy foods work.

So it provides extra support for the message that eating plenty of fruit and veg is good for you – a link that is also backed by many human studies.
Young Lim D et al. BMC Gastroenterology 2012: 12; 9.

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