Falls and mobility

Falls and fall-related injuries are a common and serious problem for older people. Half of those aged over 80 fall at least once a year (NICE 2013).

Falls in older people can result in pain, distress, a loss of confidence, a reduction in activities, and increased dependecy on carers and services. A first fall can set in motion a downward spiral of fear of falling which, in turn, can lead to more inactivity, loss of strength and a greater risk of further falls.

Though the majority of injuries due to falls occur in those over 65, there is another peak of hospital admissions due to falls in young children, particularly those under 5. This section, however focuses on falls and mobility in older people.

What do we know?

Falls are linked to a wide range of risk factors which often co-exist in older people. Some factors relate to the individual themselves, including; having had previous falls, being unwell (for example having an infection), having poor mobility including problems such as arthritis or Parkinson’s disease, having poor vision or hearing, having memory problems including dementia, or being on multiple medications in particular medications to lower blood pressure. Other factors relate to the environment such as ill-fitting shoes, poor lighting and slippery surfaces (The human cost of falls 2014).

Not only are older people more likely to fall, but they also are more vulnerable to the effects of a fall. In some cases falls can lead to significant injuries. Falls are the most common cause of death from injury in the over 65s. Falls are a leading reason for people to call an ambulance and account for 10% of all 999 calls (Ambulance Service Network factsheet 2010).

Evidence suggests (as reflected by the NICE guidance on falls prevention) that just as risk of falls is multifactorial, so interventions to reduce risk of falling should be multifactorial. This should include: strength and balance training, home hazard modification, vision assessment and medication review. The Otago Exercise programme is a strength and balance training programme that has been shown to reduce the risk of falls by around a third (NIHR Review).

Facts, Figures and Trends

There were approximately 700 admissions to hospital due to falls in total in Slough over 2014/15. Of these, a quarter resulted in a fractured hip and over a hundred resulted in wrist fracture.
(Source: Slough Better Care Fund Metrics)

In terms of falls in older people only, the rate in 2013/14 of injuries due to falls in those aged over 65 was approx. 2,400 per 100,000. This rate is significantly higher than the national average as well as the South East average (Figure 1).

Figure 1. Injuries due to falls in people aged 65 and over in Slough

Figure 1: The distribution of people aged 75-84 years in Slough (Source Singleton, 2012)

The rate of hip fracture specifically in those over 65 is similar to both the South East and England average of around 600 per 100,000.

Figure 2. Hip fractures in people aged 65 and over in Slough

Figure 2: The distribution of people aged 85-89 years in Slough (Source Singleton, 2012)

(Source: Public Health England Fingertips)

Though, as mentioned above, falls are multifactorial and involve complex interacting factors we can look at levels of potential risk factors in the population. For example, in those admitted to hosptial with falls, a significant proportion of have hypertension coded in their medicak notes as an 'underlying factor'. (Source: Hospital Episode Statistics). Additionally, it is known that there are approximately 300 people aged over 75 registered as partially sighted or blind in Slough, which is higher than the national average with many more being at risk of poor vision.

In terms of quality of hospital care for falls, the Wexham Park Hospital Report from the National Hip Fracture Database as part of the Falls and Fragility Fracture Audit Programme shows performance of the local acute trust in comparison with national average.

The 2015 audit results show that though falling in the lowest achieving for admitting patients to an orthopaedic ward within 4 hours, WPH performs around the national average in terms of surgery on the same day as admission, as well as average length of stay and is among the best performing units in terms of returning home within 30 days.
(Source: National Hip Fracture Audit)

National and local strategies (current best practice)

National

Though a national falls strategy does not currently exist, a number of NICE guidelines and quality standards outline best practice in terms of falls prevention and management. In addition, falls and falls outcomes are key indicators as part of both the NHS and Adult Social Care Outcomes Frameworks as well as the Public Health Outcomes Frameworks.

In terms of preventing falls, NICE guidance CG161 Falls in older people: assessing the risk and prevention ( 2013) relates to the routine assessment and management of all people aged 65 and over who come into contact with health services and may be at risk of falls.

In terms of treatment of hip fracture NICE guidance CG124 Hip Fracture: Management (2011) exists for those aged 18 years and over who are suspected to have sustained a hip fracture. It relates to the management of hip fracture from admission to discharge in the community.

Local

In 2015 a Falls Prevention Service was launched across Berkshire. ‘Fallsfree4life’ offers a service to those aged over 60 based on an initial risk assessment with a wellness coach or physiotherapist followed by a personalised package of community-based support.

Also run by the falls prevention service is a weekly Otago Exercise Class available at three community centres across Slough.

What is this telling us?

Falls remain an important cause of morbidity and mortality among older people. A new falls prevention service for Slough has, however, already shown indications of a positive effect on risk reduction.

What are the key inequalities?

Little published evidence is available linking risk of falls to particular socioeconomic or ethnic groups. It is clear, however, that risk of falls is strongly associated with increasing age.

What are the unmet needs/service gaps?

  • While work in the community is underway to reduce risk, there remains a need for more work in care homes to assess risk and implement effective interventions
  • National Hip Fracture Audit show areas for improvement for the local acute trust.

Recommendations

  • Monitor implementation and effectiveness of new falls prevention service.

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