To discuss information relevant to the review.

The Committee received a presentation on falls prevention for older people and the care of people who have fallen.

A scoping statement for a review of elderly falls had been approved by the Committee in September 2007.

Lillian Somervaille, Public Health Consultant at the Primary Care Trust gave a presentation.  The principal points are summarised below.

Why focus on falls?

Every year around 35% of people over the age of 65 and 45% of people aged over 80 will have a fall.  Of those that fall 20-30% will suffer moderate to severe injury. Falls result in loss of confidence, increased dependency, isolation, and depression.  A history of falls is a good predictor of hip fracture in older people.  Someone with osteoporosis and a recent fall is 25x more likely to have a fragility fracture.

Cost

Locally in Herefordshire there is an older population than the national average and this older age group is increasing.  A large number of hospital in-patient admissions are due to injury caused by falls.  The rate of hip fracture in older people is higher than the national average – and remains high when age and rurality are taken into account.  The 2007 Director of Public Health’s report calls for a county wide audit to establish the action triggered when an older person attends with a falls related injury.  There is a need to work with partners to reduce hospital admissions for hip fractures.

Preventing falls –  national picture

Fewer than 1 in 50 older people recorded as having a high risk of falling has a recorded referral to a falls service or exercise programme.  Older patients are unlikely to have a computer recorded history of falls.  Most patients returning home from A&E after a fragility fracture were not offered a falls assessment; only 22% were referred for exercise programmes to prevent future falls.

Caring for those who have fallen – national picture

Nearly three quarters of older women with diagnosed osteoporosis and a previous fracture receive the appropriate drugs.  After recovery from hip fracture surgery less than 50% were on appropriate treatment for osteoporosis.  For the minority of patients attending a falls clinic, the falls and fracture assessments and treatments were improved.

Case Study

Mr W – an 85 year old widower in rural area with frequent falls attendance at Minor Injuries Unit.  He eventually agreed to home assessment.  The problem was related to  chopping firewood  to raise income.  Following a referral to benefit check it was no longer necessary for him to chop wood.  The study highlights desire for independence and that people are entitled to refuse help.  Solutions are often not found within the NHS.

What should we do?

Are national findings reflected in local practice? Local benchmarking is needed. 

Referral to the falls clinic is very important.  Equity profiling is needed to see if  referrals to the falls clinic are consistent around the county and if not, why not.

Identification of those at risk of falling - are the right details being recorded in patient records, especially electronically (A&E, MIUs, primary care, ambulance services, other)?

Services in Herefordshire 

Key posts are being filled:

·         PCT based Health Improvement Manager with responsibility for the health of older people – appointed and commences in January 2008

·         Appointment of a specialised falls nurse with County wide remit

The Committee noted the data collection activity being undertaken that would inform further consideration of this subject.