Falling is not an inevitable consequence of ageing and there are simple practical ways to reduce the risk of older people falling and fracturing. That’s the key message of Help the Aged’s National Falls Awareness Day (NFAD), which this year was more successful than ever. Over 600 events took place across the UK and there were also events in Ireland, Greece and Brazil.

The theme of this year, ‘Stepping out’ led several local groups to organise ‘poor pavement’ events. Groups toured the area to determine the state of local pavements and then contacted the local authority using the Charity’s pavements postcards. To support this work the Charity published a new report, Falling Short - the state of our pavements; an investigation for the National Falls Awareness Day Campaign which revealed that local authorities in England, Wales and Scotland hold back millions of pounds to cover the potential cost of personal injury claims when people fall on pavements. Many councils also say they face funding shortfalls to keep public walkways safe.

More than 2,300 older people fall on broken pavements every day (1). The 66 councils which responded to the Charity’s questionnaire set aside an average of £250,000 each to cover potential legal costs when people fall.

The Charity produces pavement ‘reporting’ postcards; one part is to send to the local authority to identify an area of bad paving and alert the council to the problem. The other half is sent to the Charity which will then follow up with the local authority to see how repairs are going. The Charity is calling for safer pavements to be pushed further up the local government agenda and has lobbied 90 councils in this way since the work began in 2007.

Poor pavements repair is clearly a topic that strikes a chord with many. There was extensive media coverage of the issue on NFAD. Breakfast TV, national newspapers and local radio stations all ran stories featuring Help the Aged spokes people and in some cases, older people who had experienced horrific falls on bad pavements. Many interviews were about the Charity’s view that some of the funds councils hold in legal and compensation reserves should be spent on pavements repairs rather than compensation claims.

But there is also the wider question of the ‘cost’ of falls and fractures to older people themselves. When someone falls, even if they ‘only’ end up with cuts and bruises, it is often their confidence which has been damaged and this can have serious implications for getting out and about. Research found that 2.5 million (26%) people aged over 65 in the UK have fallen to the ground due to damaged or uneven pavements and 332,000 (13%) of those who fell, were afraid to leave their home in case they fell again (2). The Government’s aspiration for sustainable communities (3)- places where people want to live and work, now and in the future - will not be achievable if older people do not feel safe to leave their homes for fear of falling.

While the aim of NFAD is to raise awareness about the risk of falls to older people on a particular day, the work of Preventing Falls Programme at Help the Aged carries on throughout the year. A big focus presently is the national disgrace that is the treatment of many older people who fall and end up in hospital with a hip fracture. The Charity is working with clinicians, academics and other stakeholders in a loose coalition around the National Hip Fracture Database (4) to improve standards in primary and secondary care for those who fracture or are at risk of fracture.

Hip fracture is the most common cause of acute orthopaedic admission for older people. During 2006/7, in excess of 76,000 hip fractures occurred in the UK and the incidence is projected to increase by 50% by 2020 (5). Studies report that half of hip fracture patients had fractured at an earlier point in their lives but, at the time of first fracture, had not been investigated or been given treatment for osteoporosis. Yet in January 2005, NICE advocated osteoporosis assessment and treatment for all female patients over 50 years of age that have suffered fragility fractures (6).

The Charity is also working closely with the Department of Health on developing a commissioning toolkit care pathway for falls and fractures for PCTs (in England). It is hoped that better commissioning will improve assessment and treatment for falls and fractures, although a recent Kings Fund report highlights a worrying reduction in PCT budgets for musculo-skeletal services (7). And while there has been no successful conclusion to the call for osteoporosis to be in the GP contract as part of the Quality Outcomes Framework system, the recent announcement of Directly Enhanced Services funding, just agreed with primary care, is a small but important step forward. Over the next two years £10m (£5m this year and £5m in 2009/10) will be spent incentivising practices to diagnose and treat patients with osteoporosis.

Help the Aged has a number of exercise resources available to older people concerned about their risk of falling including the exercise DVD/video called Step to the Future and for frailer older people, Be Strong Be Steady. Copies can be purchased through Help the Aged Home Shopping by phone, 0870 770 0441, or online www.helptheaged.org.uk/homeshopping.

There is also a free advice leaflet called Staying Steady. Advice leaflets can also be picked up from local Help the Aged shops or downloaded from the Help the Aged website: www.helptheaged.org.uk.

1) Spotlight Report, Help the Aged, 2008.

2) Spotlight Report, Help the Aged 2007

3) Sustainable Communities: building for the future, Office of the Deputy Prime minister 2003.

4) http://www.networks.nhs.uk/networks/page/683

5) British Orthopaedic Association. Care of the fragility fracture patient. 2007.

6) NICE Technology Appraisal Guidance 87, 2005.

7) Widespread variations remain in local NHS spending - new analysis from The King's Fund. September 2008.

End of Policy and Practice section