The Scope of the Framework for Action
The focus is on older people because of the high incidence of falls in older people and the potential seriousness of the consequences of falls in this group, specifically high morbidity and mortality and decline in quality of life. However, younger people fall too, and some actions are equally applicable. Interventions ought to be provided according to individual need rather than age. Fall and fracture risk can also be influenced by lifestyle and other factors in young and middle age, but this is not within the scope of the Framework.
Cognitive impairment, dementia and falls
People with cognitive impairment and people who have a diagnosis of dementia are at increased risk of falling. All partners in the pathway must work to ensure that people with dementia and people with cognitive impairment have equitable access to services and interventions in the same way as any other person. Service providers may need to adapt their approach to meet a person's needs. Screening and assessment processes need to include consideration of a person's capacity to make their own decisions - this is of critical importance at Stage Three of the pathway. People with dementia and people with cognitive impairment need to be involved and supported to take decisions about their care and support. Where appropriate, carers need to be involved in the assessment and planning of support, care and treatment.
Bone health, osteoporosis and fragility fractures
Falls and bone health are inextricably linked. Osteoporosis is a very common long-term condition amongst older people, particularly older women. If a person has osteoporosis, he or she is at greater risk of sustaining a 'fragility' fracture if they fall (a fragility fracture is a low trauma fracture, usually occurring from a fall from standing height or less). For this reason falls and fracture risk management must be considered in combination, and services for falls and osteoporosis (including Fracture Liaison Services and DXA services) operationally linked or dovetailed.
The Framework considers bone health in the context of falls prevention for older people. SIGN is currently updating Clinical Guideline 71. Management of Osteoporosis. When available, it will provide specific guidance on assessment and management of fracture risk.
Falls prevention within secondary care is outside the scope of the Framework. However, people admitted to hospital following a fall should have the same opportunities for assessment and tailored intervention. This often requires continued management of risk following discharge from hospital, with robust referral pathways into community services aiming to support a person to restore their independence and reduce their risk of further falls. Effective communication and co-ordination is critical at times of transition.
Email: Susan Malcolm