Falls and Osteoporosis

Recommendations

Preventing older people from falling is a key challenge for the NHS and local authorities, as the consequences of a fall and subsequent fragility fracture impact on all local agencies working with older people.  Although falls and osteoporotic fractures mainly affect older people, there is a corresponding effect on in-patient, out-patient and community services as well as family and carers.

Unless organisations take effective joint action on falls and osteoporosis now, the number of falls and fragility fractures will continue to increase.  Both statutory and voluntary service providers must therefore be engaged as part of the solution and supported to understand their contribution to reducing the number of falls locally (DoH, 2009a).  Evidence suggests that an integrated approach to tackling the problem can reduce the number of falls and the negative consequences of falls, by up to 30% (DoH, 2003).

The prevention of falls and fragility fracture care pathways and initiatives should be based on the following broad objectives:

  • Prevention – to ensure that population approaches to reducing the occurrence of falls, osteoporosis and fragility fractures are in place, linking with work on key health behaviours such as healthy eating, physical activity, sensible drinking and stopping smoking.
  • Identification – to ensure that older people at higher risk of falls, osteoporosis and fragility fractures are identified in a timely and effective manner.
  • Assessment – to ensure that people identified as being at higher risk of falls and/or osteoporosis and those that have already fallen and/or fractured, are assessed and referred to appropriate, evidence based specialist services.
  • Treatment – to ensure that the people assessed as requiring a referral to specialist services have timely and appropriate access to evidence based intervention

Recommendation 1

Central Bedfordshire Council and Bedfordshire Clinical Commissioning Group should work together to implement existing guidance and explore commissioning comprehensive, evidence based, falls and fracture prevention pathways, including rehabilitation and reablement services.  The work should incorporate:

  • Specific measures for falls and fragility fracture prevention in contracts with care homes.  Measures should incorporate a formal process for monitoring and measuring the number of falls and injuries, plus key aspects of prescribing for care home residents e.g. calcium and vitamin D, bisphosphonates, sedatives and psychotropic medication.
  • Information pathways which ensure GP Practices receive details about a fall or fracture, from the setting in which it is recorded (NOS, 2013).
  • A consistent, multifactorial falls risk assessment.
  • The identification of opportunities for third sector organisations to provide elements of local falls and fracture care pathways.
  • Increasing opportunities to take part in strength and balance exercise.
  • Provision of falls awareness and prevention training to relevant frontline staff, including care providers.
  • A greater emphasis on the needs of black and minority ethnic older people who are at risk of falls and fractures.

Recommendation 2

Consider commissioning a Fracture Liaison Service.

  • The service should be based on a best evidenced model e.g. Glasgow model for acute based services or the West Sussex model for primary care based services.
  • The service should include care home residents and capture non-admitted patients with non-hip fragility fractures.

Recommendation 3

Identify funding to commission Central Bedfordshire Falls Group(s) which include strength and balance exercise programme(s).

Recommendation 4

Ensure local falls and fragility fracture data, and the subsequent collection / sharing of that data, is robust and available to help inform commissioning decisions.

  • Improve the coding of falls and fractures within the NHS so that a patient’s fall is coded in addition to the resulting injury they sustain.
  • Improve the flow of information about patients who fall and/or fracture between the NHS, social care, EEAST and other relevant services.

Recommendation 5

Actively promote messages to reduce the risk of falls and fractures in later life.

  • Ensure that patients, carers and professionals are aware that a fall or fracture in an older person requires further assessment and possible treatment, and not an inevitable part of getting old.
  • Public health messages should promote good bone health and healthy lifestyles to reduce falls risk in later life.

Recommendation 6

Ensure patient views are captured.


Last updated Friday, 22nd April 2016