Managers and Medicine

Published: 27/03/2003, Volume II3, No. 5848 Page 35

Charity Help the Aged is running a programme to help carers prevent older people tripping or falling in their own homes. Alison Moore reports

Falls are one of the leading causes of loss of independence for older people and cost the country an estimated£1.8bn each year in NHS and social care costs.

So it is not surprising to find falls prominent among the national service framework standards - and prevention a key aim. By April, local healthcare providers are meant to have risk management procedures in place to stop older people falling, and by April 2005 they should have set up an integrated falls service.

This could involve identifying older people at risk and intervening when appropriate.

More than 95 per cent of hip fractures in older people are due to falls and around 30 per cent of over-65s living in the community will fall each year.

Progress is patchy, according to Pamela Holmes, manager of the avoiding slips, trips and broken hips programme at Help the Aged. A survey of 94 primary care trusts carried out by the organisation showed some regions were on target to hit the framework milestones but others were only just getting underway.

Worryingly, it found some posts specialising in falls had been lost and extra short-term resources did not help with setting up longterm programmes or posts.

'There are falls co-ordinators in post and often much has been done to develop falls services. But in other areas there are no falls co-ordinators and people are having to do it in addition to their other jobs, ' says Ms Holmes.

Help the Aged now runs the avoiding slips, trips and broken hips programme which was previously funded by the Department of Trade and Industry. It offers leaflets, posters and website advice on avoiding falls and is aimed both at older people and those who care for them, such as pharmacists and chiropodists (www. helptheaged. org. uk).

Many of these resources stress the multitude of factors which can make falls more likely - from ill-fitting shoes, to lack of exercise, to taking a mixture of prescribed medications.

But not all areas are acting on these risk factors, according to the National Osteoporosis Society. Assistant health services liaison manager Angela Jordan says: 'Some people do seem to be on target but there are others who do not appear to have begun.'

The society works to raise awareness of osteoporosis and its link with falls, and to ensure it is involved in PCTs' forward planning - such as commissioning more diagnostic equipment in planned diagnostic and treatment centres. Osteoporosis is found in as many as 90 per cent of over-75s who fracture a hip - and all but a tiny percentage of hip fractures are due to falls.

However, PCTs have an enormous agenda with other clinical priority areas, organisational changes and financial problems, she adds.

Professor Ian Philp, national director for older peoples' services, says the work on falls is an excellent example of how services can be redesigned around older peoples' needs. 'It allows people for the first time in decades to do the joint planning around needs.' l Campaign trail: how Cornwall has a head start Preventing falls is a multi-professional task - which is why meter readers and other people who regularly come into contact with older people have been called in to help the NHS in Cornwall and the Isles of Scilly.

With the help of a pocket-sized card as a memory aid, they are encouraged to point out potential hazards in the home which could contribute to falls during their normal visits. The Checkmate campaign also aims to inform older people themselves of potential dangers, and covers issues such as cluttered floors.

The campaign is thought to be the first of its kind and is part of a multi-pronged effort. A website offers information about preventing falls and osteoporosis; a self assessment tool to help older people who fear they may be at risk; and details about local services - from care and repair schemes, to balance and stability classes.

The NHS in Cornwall and the Isles of Scilly has had a falls prevention strategy in place for over a year but one of the main reasons for the swift progress was that work had started well in advance of the national service framework, according to Cathie Shipwright, older persons' services manager at Central Cornwall primary care trust. Funding for a falls prevention and management project had been secured through Cornwall health action zone five years ago. This allowed issues such as medication, exercise programmes and the use of hip protectors to be addressed - and a falls co-ordinator to be put in place. 'The key was HAZ funding and the enthusiasm of staff, ' she says.

www. fallsprevention. co. uk