Differing approaches to falls and fracture prevention between Australia and Colombia

Abstract

Falls and fractures are major causes of morbidity and mortality in older people. More importantly, previous falls and/or fractures are the most important predictors of further events. Therefore, secondary prevention programs for falls and fractures are highly needed. However, the question is whether a secondary prevention model should focus on falls prevention alone or should be implemented in combination with fracture prevention. By comparing a falls prevention clinic in Manizales (Colombia) versus a falls and fracture prevention clinic in Sydney (Australia), the objective was to identify similarities and differences between these two programs and to propose an integrated model of care for secondary prevention of fall and fractures. A comparative study of services was performed using an internationally agreed taxonomy. Service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE) and previous reports in the literature. Comparison included organization, administration, client characteristics, and interventions. Several similarities and a number of differences that could be easily unified into a single model are reported here. Similarities included population, a multidisciplinary team, and a multifactorial assessment and intervention. Differences were eligibility criteria, a bone health assessment component, and the therapeutic interventions most commonly used at each site. In Australia, bone health assessment is reinforced whereas in Colombia dizziness assessment and management is pivotal. The authors propose that falls clinic services should be operationally linked to osteoporosis services such as a “falls and fracture prevention clinic,” which would facilitate a comprehensive intervention to prevent falls and fractures in older persons.

Effects of the falls and fractures clinic as an integrated multidisciplinary model of care in Australia: a pre–post study

“…Reductions in falls and falls-related injuries are highly associated with clinical interventions,2 4 9 which could have an ever-stronger beneficial impact would fracture prevention be integrated in the usual model of care. Therefore, it has been previously proposed that falls clinic be operationally linked to osteoporosis services such as FFC, which would facilitate a combined falls and fracture prevention in older persons 32 33. Discordant findings from other studies, where no change was observed, may also be related to their patient profile 9 10…”