Up and About or Falling Short? - A Report of the Findings of a Mapping of Services for Falls Prevention in Older People

Executive Summary

With an ageing population, falls and the consequences of falls are a major and growing concern for older people and health and social care providers. Recurrent falls are associated with increased mortality, increased rates of hospitalisation, curtailment of daily living activities and higher rates of institutionalisation. Falls and fractures in people aged 65 and over account for over 390,500 bed days each year in Scotland. Injurious falls are the leading cause of accident-related mortality in older people.

However, falls are not an inevitable consequence of old age. Well-organised services, based on recommended practice and evidence-based guidelines can prevent many falls and fractures in older people in the community. As part of the National Falls Programme, a national mapping exercise benchmarked service provision in Scotland against these criteria. The main aim was to identify the extent to which recommended practices to prevent and manage falls and fragility fractures are built-in to the wider systems of care for older people in Scotland. Between May and October 2011, Community Health (and Care) Partnership (CH(C)P) Falls Leads completed a self-assessment of arrangements in their locality for falls prevention and management and fracture prevention for older people.

The findings presented in this report represent a snapshot of service organisation in June 2011 (or October 2011 for NHS GGC CH(C)Ps). They indicate that in some areas modest steps forward have been taken since a previous mapping in 2009/10 and that there is much improvement work in progress. Many services are currently in a state of transition. However, the findings also show that there is still unacceptable variation in service provision and quality within and across NHS board areas in Scotland, and in some localities services remain poorly developed. Scotland still has much to do to provide older people with equitable, high quality services for fall and fracture prevention.

To address the consistent shortfalls identified in this report, the following actions for the National Falls Programme and recommendations for NHS boards and partnerships are identified:

Actions for the National Falls Programme

• The National Falls Programme will develop, test and report on, the use of four community falls care bundles.
• A Health Economist will carry out an evaluation to quantify the potential clinical and financial benefits gained from implementing the bundles, (at CH(C)P, NHS board and Scotland level) and the resources and associated costs required to do so.
• The National Programme Manager will work with falls leads, osteoporosis leads, ISD, ehealth services and other partners to develop a national measurement framework.
• The National Programme Manager will work with the Scottish Centre for Telehealth & Telecare (SCTT) to share learning and explore further opportunities for the appropriate use of telehealthcare technologies.

Recommendations for NHS boards and partnerships

• CH(C)P Falls Leads, Strategic Falls Leads, Osteoporosis Leads and other relevant colleagues, such as Reshaping Care for Older People leads, Unscheduled Care leads and local authority partners, should critically review local responses to the questionnaire; consider recommendations in this report and develop and deliver a local action plan.
• To capitalise consistently on opportunities to prevent recurrent falls and fractures, health and social care services should establish:
  • Fracture Liaison Services or equivalent, with referral protocols and pathways to multidisciplinary services providing secondary falls prevention.
  • Basic falls risk screening in services providing urgent or acute care for older people who have fallen.
  • Robust referral pathways from services providing urgent or acute care for older people who have fallen/sustained a fracture to multidisciplinary services delivering secondary falls and fracture prevention.
• To ensure falls prevention programmes are effective, key evidence-based interventions should be available, when required, to older people throughout Scotland.

We cannot expect to demonstrate a significant reduction in emergency admissions from falls and fractures if key components of evidence-based care are missing or inadequate in most localities. A systematic and targeted approach, supported by strong leadership at all levels is required.