Policy briefing

Prevention is vital in reducing harm from falls

Royal Society for the Prevention of Accidents issues national accident prevention strategy for England 

Royal Society for the Prevention of Accidents issues national accident prevention strategy for England

A strategic approach to falls prevention among over-65s could reduce harm
Picture: Tim George

Essential facts

Accidents are among the leading preventable causes of death, serious injury and long-term disability, while falls are the leading accident-related cause of death and hospital admission among older people.

There are nearly 700 emergency admissions related to falls every day in England. About one third of all people aged 65 or over fall each year, a figure that increases to half in those aged 80 or over.

Among older people living in the community, 5% of those who fall sustain fractures and hospitalisation.

What’s new?

Halting the year-on-year rise in the number of older people falling, and then reducing the number of falls, is one of England’s greatest accident prevention challenges, according to the Royal Society for the Prevention of Accidents’ (RoSPA) A National Accident Prevention Strategy for England.

Across England, about 7,300 people aged 65 or over die each year as a result of accidents and there are 370,000 accident-related hospital admissions.

Falls are the leading cause of death, followed by road accidents, threats to breathing including choking, poisoning and fire.

Most falls are the result of multiple risk factors, including a history of falls, muscle weakness, poor balance, visual impairment, environmental hazards, polypharmacy, use of specific medicines and specific medical conditions.

RoSPA says that programmes to prevent accidents in the home, particularly falls, among over-65s are critical to the reduction of harm, emergency department attendance and hospital admission.

There is also a need to tackle common risk factors, such as muscle weakness, poor balance, visual impairment and polypharmacy, at population level.

A strategic approach to falls prevention across the population could ensure significant improvements for the health and well-being of older people, and for the health and social care sector, the document says.

It strongly supports the implementation of Public Health England’s (2017) Falls and Fracture Consensus Statement.

Implications for nurses

  • Be aware that falls are not an inevitable part of ageing.
  • Ensure early identification of those at risk of falling.
  • Promote healthy ageing at all stages of life.
  • Ensure that local hospitals and care and nursing homes are focused on falls.
  • Commission services that provide an appropriate response to people who have fallen, as well as multifactorial risk assessment and timely and evidence-based tailored interventions for those at high risk of falls.
  • Commission services that provide evidence-based strength and balance programmes, and home hazard assessment and improvement programmes.

Expert comment

Bernadette RoseBernadette Rose is specialist community falls nurse at Manchester University NHS Foundation Trust

‘The impact of falls on older people is profound and can be devastating.

‘A fall often takes away a person’s independence because it affects them physically and psychologically.

‘The longer they are in hospital, the harder it becomes to get back to the baseline they were at before.

‘The most important part of any approach is prevention, which includes bone health and management of osteoporosis. This is made clear in RoSPA’s national strategy and Public Health England’s statement.

‘It is important to encourage people to look after their health and take exercise so they become less likely to fall or, if they do fall, less likely to break bones.

‘Another important nursing aspect is to carry out or request a medication review. Some medication can cause postural hypotension, which is an important factor in falling, and a medication review can lessen its effect.

‘These are good documents, but they need to be implemented locally to make a difference.’

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