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Nurses encouraged to ‘routinely’ ask elderly about falls

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Older people coming into contact with nurses and other health professionals should be asked “routinely” about falls, according to a joint initiative to reduce their impact.

A falls and fracture consensus statement has been published today outlining actions that the health and social care and housing sectors can take to help prevent older people having falls and fractures.

“This statement and advice on preventing falls and injuries will be invaluable for those working with older people”

Kevin Fenton

It has been produced by the National Falls Prevention Coordination Group, which includes Public Health England and the Royal College of Nursing.

The aim is to encourage better identification of patients at risk of falls so they can be targeted with exercise programmes that improve strength and balance, and efforts to reduce hazards in the home.

The statement recommends that fracture risk assessment should be considered in all women aged 65 and over, all men aged 70, and for patients younger than this if risk factors are present.

“Older people coming into contact with professionals and organisations, which have health and care as part of their remit, should be asked routinely about falls,” said the statement.

It added: “Older people reporting a fall or at risk of falling should be observed for balance and gait deficits, and considered for risk assessment and risk reduction interventions.”

“Older people reporting a fall or at risk of falling should be observed for balance and gait deficits”

Statement on falls

However, to support these aims the statement highlighted that the development of workforce competencies and training may be necessary for a wide range of health and other professions.

In addition, it said the large number of primary care consultations carried out with older people, including in care homes and at home, provided a “significant opportunity for case finding”.

For patients identified as potentially at high risk of falls or fractures, a comprehensive risk assessment should be carried out by a trained healthcare professional, said the statement.

Appropriate interventions cited in the case of falls may include strength and balance exercise programmes, vision assessment and referral, and the modification or withdrawal of medicines.

For fractures, interventions could include the prescribing of bone strengthening medicines or referral for interventions to reduce falls’ risk, it said.

Meanwhile, the “optimum approach” for most older people living in the community with a low to moderate risk of falls should include strength and balance exercise programmes, said the statement.

Such programmes have been shown to be effective for both primary and secondary prevention of falls and non-vertebral fractures, it noted, adding that “greater efficacy” had been seen in those with a history of recurrent falls or a balance or gait deficit.

Public Health England

Professor Kevin Fenton

Kevin Fenton

To be effective, the statement said such programmes should comprise a minimum of 50 hours or more delivered for at least two hours per week.

They should involve highly challenging balance training and progressive strength training. At the end of the programme, older people should be assessed and offered a range of follow-on classes.

The statement highlighted that, while there was evidence that walking had “numerous health benefits for older people in general”, it should not be included in programmes for those considered at high risk of falling as it may spark further falls.

Professor Kevin Fenton, Public Health England’s national director for health and wellbeing, said: “Each year around a third of people aged 65 and over and half of those aged 80 and over experience a fall.

“It’s vital that as people get older they get the support to stay healthy and maintain their strength and balance through being physically active,” he said. “This statement and advice on preventing falls and injuries will be invaluable for those working with older people.”

Survey reveals lack of public awareness on falls risk reduction

Survey findings published to coincide with the falls and fracture consensus statement have indicated the need to educate older patients on fall risk reduction.

The survey, commissioned by the Centre for Ageing Better, which is part of the group behind the statement, 41% of over 70s do not realise the importance of good strength and balance to reducing falls.

The research, by Ipsos MORI, showed that many people in all age groups aged 40 and over were “confused” about what activities help with improving their strength and balance, said the centre.

A total of 93% of respondents said it was important for someone their age to do strength and balance exercises or activities twice a week.

But 35% did not realise that heavy gardening jobs, such as digging, counted as well as 46% who did not realise that carrying heavy loads, such as groceries, counted.

Meanwhile, 95% said that walking was a helpful activity, though moderate or slow walking does not improve muscle strength or balance – despite it being good for general health.

Louise Ansari, the centre’s director of communications and programme director for physical activity, said: “People can improve their own strength and balance by doing more activities like carrying shopping and doing the gardening as well as exercise like dance and tai chi.

“The NHS and local authorities can help to prevent falls by commissioning evidence based services that improve strength and balance and making them available to those most at risk,” she said.

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