Considerations for future activity
Commission a Fracture Liaison Service (FLS)
An FLS is a multi-disciplinary service that assumes responsibility for the secondary prevention of osteoporotic fractures by assessing and performing diagnostic evaluations with a view to making specific treatment recommendations. It should focus on two particular groups:
- Patients with new fragility fractures
- Patients who have fractured in the past or are at risk of osteoporotic fractures in the future (DoH, 2009)
Case-finding should take place within both acute and primary care. There should be:
- Proactive case-finding in inpatients, outpatients and within primary care.
- Timely and appropriate access to diagnostic evaluations, including dual-emission X-ray absorptiometry to measure bone mineral density.
- An osteoporosis assessment i.e. FRAX
- Signposting to falls prevention services.
Rationale: The best way of reducing the number of fragility fractures suffered by older people is through a comprehensive falls and fracture prevention service which incorporates a FLS (NOS, 2012).
Strength and balance exercise programmes
Increase provision of strength and balance exercise programmes.
Rationale: Physical activity and the prevention of falls in older people is well researched and it has been demonstrated that even those who take up exercise in later years reap significant benefits.
Strength and balance training is recommended by NICE (2004 & 2013). Those most likely to benefit are older people living in the community with a history of recurrent falls and/or balance and gait deficit. Ideally the programme should be individually prescribed and monitored by an appropriately trained professional.
Multifactorial interventions with an exercise component are recommended for older people in extended care settings/ care homes.
Falls prevention and awareness training
Provide falls prevention and awareness training for care providers and relevant frontline workers continue to roll out falls awareness training to care homes as part of the work undertaken by the Complex Care Team.
Rationale: The rate of falls in care homes is almost 3 times that of older people living in the community and injury rates are considerably higher, with 10-20% of institutional falls resulting in a hip fracture. Thirty percent of people admitted to hospital with a hip fracture come directly from a care home (DoH, 2009). Despite this, many care homes still do not have protocols in place to prevent, identify or act upon falls among residents (NOS, 2012).
Last updated Friday, 22nd April 2016