Uni researchers create a data-based tool that could help GPs prevent serious falls

A new tool is set to help doctors accurately identify patients at high risk of serious falls based on 20 years’ worth of data.

It could have a big impact on the way older patients are managed in primary care, improving targeting of drug treatment and fall prevention strategies for high-risk individuals.

The tool has been developed by researchers from the Nuffield Department of Primary Care Health Sciences at the University of Oxford.

Published in The BMJ, the research used 20 years’ worth of data from 1.7 million anonymised healthcare records to develop the tool. The research then checked its accuracy against a separate database of almost four million healthcare records.

Dr Constantinos Koshiaris, Senior Medical Statistician in the Nuffield Department of Primary Care Health Sciences at the University of Oxford, who developed the tool, said: “In the past, we have struggled to identify people at risk of falling in the community. Previous falls-risk tools were not very accurate and, in some cases, had methodological flaws.

“Our new ‘STRATIFY-Falls’ tool can predict which patients are most at risk of falling in the next one to ten years. This could allow GPs to provide more personalised care and target falls prevention strategies for patients, such as exercise-based interventions or drug reviews.”

The University of Oxford notes that many factors influence the risk of a person falling as they get older. One such factor, which doctors can control, is the amount and type of medications prescribed, such as blood pressure medications.

Blood pressure medications can be very effective in preventing diseases such as stroke or heart attacks. However, if not carefully monitored, these drugs may lower blood pressure too much. This can cause a temporary drop in the amount of blood that flows to the brain leading to fainting and falling, the university says.

Professor Richard McManus, practising GP and Professor of Primary Care Research at the Nuffield Department of Primary Care Health Sciences at the University of Oxford, added: “GPs often have to balance the risks and benefits of medications for specific conditions, such as high blood pressure, against the potential risk of adverse events such as falls.

“Having reliable tools to estimate people’s individualised risk of falling and change their medication to lower this risk would be very welcome. This kind of tool could in time be built into GP records systems to automatically flag such patients.”

The researchers used a database of over 1.7 million healthcare records from GP surgeries in England between 1998 and 2018, the Clinical Practice Research Datalink (CPRD), to create the tool.

By linking this to data from hospitals, they were able to identify over 60,000 people aged 40 and up who had at least one high blood pressure measurement and had experienced at least one serious fall during the study period (that required hospital treatment or led to death).

They used this information to create a model of the factors that might predict people’s risk of falling in the 10 years following a high blood pressure measurement. This included factors such as gender, age, ethnicity, prescribed medications, alcohol usage, and smoking.

Dr Lucinda Archer, Lead Author on the publication and Lecturer in Biostatistics at the Centre for Prognosis Research, School of Medicine, Keele University, commented: “We discovered that a history of previous falls, having a diagnosis of multiple sclerosis, heavy alcohol consumption, a high deprivation score, and prescribed drugs were all strong predictors of fall risk, conditional on other variables in the model.

“The tool we developed considers all these factors, and more, to determine an individual’s risk of falling over the next one to ten years.”

They tested the model against a second set of CPRD data for the same period, which included nearly one million records.

“After some minimal tweaks, we found the new tool’s predictions were very accurate at differentiating between groups of high and low risk patients,” continued Lucinda.

The tool is now freely available to other researchers for further testing and can be downloaded here.

The University of Oxford says that the tool is not ready for GPs in clinical practice to use yet, as the research team plans to test it in a new randomised controlled trial.

Professor McManus explained: “In 2023, we will begin recruiting over 3,000 participants who are at high-risk of falls to the NIHR-funded OPTIMISE2 trial. We will use the STRATIFY-Falls tool to identify these potential participants and then follow them up to see if they experience fewer falls after deprescribing their blood pressure lowering treatment.”

The research is funded by the Wellcome Trust, Royal Society and National Institute for Health and Care Research (NIHR).

Read the full study in The BMJ full here.

Currently, NHS England is also focusing on falls management ahead of the challenging winter period. As part of this, the health service is expanding its falls response services in England. It will see local teams sent to help people who have fallen in their home or in care homes, rather than unnecessary trips to hospital.

This expansion could see around 55,000 ambulance trips freed up to treat other patients each year, according to NHS England.