Drug side effects such as dizziness are a major reason older people fall. Weaning off medications may be the answer. But the decision on this is complex. That is why doctors at the Valpoli in Amsterdam UMC have recently been supported in that decision by software developed with artificial intelligence. There are more and more initiatives in the Netherlands to reduce the risk of falling. Other good examples, in addition to this initiative in Amsterdam, are smart beds in St. Anonius Hospital that monitor patients with sensors, including for the risk of falling. Another example is the hip airbag that is used at TanteLouise for elderly people who have limited mobility.
Drastic consequences fall
These are all important developments, because a ‘fall’ can drastically change the lives of the elderly in particular. For example, if it leads to a broken hip, quality of life is regularly severely affected and independent living may become impossible. The figures actually say it all: in 2020, 103,000 elderly people aged 65 and older visited a hospital emergency room after a fall accident. This means that in 2020, on average, every 5 minutes an over-65 was the victim of a fall accident with injuries requiring treatment in an emergency department. More than one in three elderly people was admitted to hospital after visiting the A&E department (36700 elderly) and 5,012 elderly people died as a result of a fall.
Fall risk in focus
With the push of a button on the computer screen, a doctor at the Valpoli in Amsterdam UMC can show the patient what the probability is that someone will fall in the coming year. “Then it turns out, for example, that a patient has a 56 percent chance of falling in the coming year,” says professor of Geriatric Medicine Nathalie van der Velde on the website of Amsterdam UMC. “Certainly with such a high score, it is advisable to start a conversation with a patient. Which drugs does someone use and are there side effects that make you more likely to fall?”
Van der Velde is principal investigator of the so-called ADFICE_IT Study. In this study, doctors at the Valpoli use software developed with the help of artificial intelligence. The software not only predicts the probability of a patient falling, but also provides tailor-made advice that appears directly in the electronic patient record. That advice states which risk medicines a patient is taking, what the side effects are and whether it is wise to continue. Van der Velde: “The system supports, but the doctor and the patient decide.”
This study with AI will officially start in October 2022. The elderly are not always aware that medication can increase the risk of falling. But after impaired mobility in general, this is the second leading cause of falls. “Older people often use different medicines at the same time. Think of sleeping pills and sedatives, antidepressants, painkillers and water pills for cardiovascular diseases to lower blood pressure. People can fall because of the side effects. Such as drowsiness, dizziness, slower reaction, muscle laxity and reduced vision.”
Fall risk & tapering off medication
Weaning off medications can be a solution, but talking about it with people is sometimes difficult for doctors. “For example, if a patient is given a drug to prevent a heart attack, a doctor doesn’t just suggest stopping it. The drug is not prescribed for nothing, is it? Do I know enough to make this decision? Doctors are trained to act. Stopping a drug feels unnatural.” In short, stopping requires good consultation with the patient and complex considerations. It is then nice if smart software can provide targeted support to make a decision.
risk drugs
Joost van den Berg, who has been working with the system as a medical assistant at the Valpoli since early September 2022: “The system is efficient, because you can immediately see what risk medicines a patient is using with the customized advice. And it is transparent, because it is directly in the electronic patient file. All the different medicines with their advantages and disadvantages, all those loose puzzle pieces, are clearly presented. People can watch. That makes the conversation and making a decision easier.” In practice, there appears to be a lot of national and even international interest in this promising research.
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