Falls prevention and support: translating research, integrating services and promoting the contribution of service users for quality and innovative programmes of care

Abstract

Falls are a significant threat to the safety, health and independence of older citizens. Despite the substantial evidence that is available around effective falls prevention programmes and interventions, their translation into falls reduction programmes and policies has yet to be fully realised. While hip fracture rates are decreasing, the number and incidence of fall-related hospital admissions among older people continue to rise. Given the demographic trends that highlight increasing numbers of older people in the UK, which is broadly reflected internationally, there is a financial and social imperative to minimise the rate of falls and associated injuries. Falling is closely aligned to growing older (Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010). According to the World Health Organization, around 30% of older people aged over 65 and 50% of those over 80 will fall each year (Falls Fact Sheet Number 344, WHO, Geneva, 2010). Falls happen as a result of many reasons and can have harmful consequences, including loss of mobility and independence, confidence and in many cases even death (Cochrane Database Syst Rev 15, 2009, 146; Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010; Falling Standards, Broken Promises: Report of the National Audit of Falls and Bone Health in Older People 2010, Health Care Quality Improvement Partnership, London, 2011). What is neither fair nor correct is the common belief by old and young alike that falls are just another inconvenience to put up with. The available evidence justifiably supports the view that well-organised services, based upon national standards and expert guidance, can prevent future falls among older people and reduce death and disability from fractures. This paper will draw from the UK, as an exemplar for policy and practice, to discuss the strategic direction of falls prevention programmes for older people and the partnerships that need to exist between researchers, service providers and users of services to translate evidence to the clinical setting. Second, it will propose some mechanisms for disseminating evidence to healthcare professionals and other stakeholders, to improve the quality and capacity of the clinical workforce.

Improving Osteoporosis Management in Primary Care: An Audit of the Impact of a Community Based Fracture Liaison Nurse

“…The need for better coordination and integration of care have been flagged by others, however the use elsewhere of a primary care based fracture liaison nurse is novel and not reported within these reviews [ 43 , 44 ] There may be other factors such as a good diet and exercise, which have been outside the scope of this audit; but might be important in fracture management [ 45 ].…”

“The Right Way at the Right Time”: Insights on the Uptake of Falls Prevention Strategies from People with Dementia and Their Caregivers

“…Respecting the individual person with dementia and their caregiver, respecting the context of their lives in which falls prevention strategies are to be implemented, are crucial for, and consistent with, principles of person-centered care. Person-centered care involves generating shared values (25), shared power, and responsibility in decision-making (26). Drawing on the work of Kitwood (27) in the context of falls prevention, understanding personhood, that is, recognition and respect of the person, will allow both caregiver and health professionals to consider prior experiences and preferences, adapt to the changing needs of the person with dementia from which a prevention program can be formulated.…”

Improving Policy for the Prevention of Falls Among Community-Dwelling Older People—A Scoping Review and Quality Assessment of International National and State Level Public Policies

“…These policy definitions were broadly consistent with the policy definition used in this scoping review. Only eight articles specified the guiding theoretical or conceptual framework on which the policies were based, and these included the public health approach [65][66][67], social and environmental determinants of health [68,69], prevention continuum [62], quality improvement [70] and a legal framework [71].…”