One in three over 65s and one in two over 80s fall each year. Injuries sustained from falls are one of the most common causes of death in people aged 75 years old and over. There is a high possibility for people who have fallen to have repeated falls after an initial fall. Aside from increased risk of death as a result of falling, there's also an increased risk of disability, loss of self-confidence and reduced quality of life. There are many risk factors for falls in older people including medication, reduced strength and balance, dementia, acute and chronic medical conditions, alcohol misuse, poor vision, inappropriate footwear and environmental factors. Osteoporosis can potentially increase the risk of a fall and result in serious injuries such as fractured neck or femur.
What do we know?
In Shropshire admissions to hospital from falls increase with age and there are significantly more admissions from females over the age of 75 years old. This is important due to the fact that there are large numbers of people aged 75 year and over in Shropshire, and the population in this age group is expected to continue increasing.
What are we doing?
In Shropshire there is a Falls Prevention Service which operates both in the community and in community hospitals. Services provided are compliant with NICE and other clinical standards guidance such as the AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older People, 2010.
The service assesses patients who have fallen or who are at risk or fearful of falling, and incorporates bone health assessment. Places on evidence-based exercise programmes or one to one home-based exercises are offered, and provision is made for people with dementia. Information and training is provided about falls prevention in hospital and the community, and ‘falls champions’ have been identified across different community services.
Engagement work identified falls as being a particular current concern to GPs in the Shrewsbury area as there was also concern about the capacity of services to deal with increasing demands. Falls have consequences for utilisation of both primary and secondary care services. In the south of the county services around frail and vulnerable populations, which may include those that have suffered a fall, were seen as being an area of good practice.
An audit of the falls prevention service patient feedback forms has been undertaken. The results indicated that patients were happy with the service.
What can we do?
NICE gives guidance for specific strength and balance exercise training for falls prevention in older people (for further information follow the link at the end of this page). It recommends that:
- Older people who have fallen in the past year, and how the fall happened, should be identified by health professionals. If they have reported a fall they should be observed for balance and gait deficits and considered for an intervention.
- If an older person attends for medical attention for a fall they should be given a falls risk assessment which will identify falls history.
- Older people who have fallen or who are at risk of falling should be given a falls prevention intervention. This should include strength and balance training, home hazard assessment, vision assessment and a medication review
- Verbal and written information should be given to people at risk of falling and their carers about what they can do to prevent further falls.
- Healthcare professionals working with people at risk of falling should have basic competence in falls assessment and prevention.