Falls and fractures in people aged 65 and over account for over 4 million hospital bed days each year in England alone. Injurious falls, including 70 000 hip fractures annually, are the leading cause of accident-related mortality in older people. After a fall, an older person has a 50% probability of having their mobility seriously impaired and a 10% probability of dying within a year. Falls destroy confidence, increase isolation and reduce independence, with around 1 in 10 older people who fall becoming afraid to leave their homes in case they fall again (Charters, 2013).
A tailored exercise programme can reduce falls by as much as 54% (Charters, 2013). Have you ever danced with the people you are caring for? If so, why? If not, why not?
My background is in paediatric nursing; we often danced around, jiggling unsettled little ones or holding the hands of preschool children while dancing to Agadoo and The Locomotion, with more laughter than finesse. We were never taught to do it, nobody lectured us on the benefits of dance moves that involved pushing pineapples or shaking trees. We just intuitively knew it was a good thing. We took our paediatric dancing skills with us when we moved to our adult placements and received a mixed reception. I was fortunate that the first adult ward I worked on had a fabulous sister, who allowed us a fairly free rein and encouraged us to transfer our skills from children to adults. A friend and I were often placed on the same ward, with a bay of elderly women to care for. We had limited experience of caring for people who lived with dementia, so we just did what we thought was best; we sang familiar songs and waltzed to Edelweiss and did the Hokey-Cokey.
One of the most profound moments of my career was when I arrived one afternoon, for a late shift, to see eight elderly women sitting in their chairs staring into space or calling out in a distressed way. On entering the bay, I was grabbed around the waist by Elizabeth, a lovely, gentle woman who collected things to put under her pillow. She started singing Do the Conga with a beaming smile. It seemed far more important to dance than to turn down beds; I still do a mean Conga, given half a chance.
Evidence-based nursing practice was introduced in the 1800s by Florence Nightingale but it didn't evolve significantly until the 1990s. Nurses were still putting egg white and oxygen on nappy rash, and the belief that neonates did not feel pain as much as older people was still considered a truth by many. The National Institute for Health and Care Excellence (NICE) was only established in 1999 and clinical guidelines were few and far between; nursing was far more idiosyncratic until then.
So, did our intuition mirror current evidence-based practice? A 6-month study following a group of elderly people who took part in a 1-hour-a-week dance class had several positive effects, including better posture, quicker reaction times, more agility, sharper minds and a better overall sense of wellbeing. Dancing helped the elderly people improve their motor skills and balance too. There were no unwanted cardiorespiratory effects (Kattenstroth et al, 2013).
It isn't a step too far to see that something that promotes motor skills and balance, that improves posture and agility, is likely to result in a reduction in falls. The research and evidence base is there.
NICE clinical guideline 161 recommends strength and balance training. It suggests that multifactorial interventions with an exercise component are recommended for older people in extended care settings who are at risk of falling. Falls prevention programmes should also address potential barriers such as low self-efficacy and fear of falling, and encourage activity change as negotiated with the participant (NICE, 2013).In other words, ask the person if they want to dance and reduce the risk or fear of falling by holding them as they waltz or conga. The caveat is that the person should have had a comprehensive falls risk assessment and not be pushed into dancing if they struggle to stand or walk alone—sometimes dancing in your chair is better.
You could ask your physios to create a suitable dance tape and help you determine who can dance in your elderly care ward or care home. It might make the days much more fun for patients, visitors and staff alike. It might also reduce the number of falls.