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|Topic title||Falls and bone health (2015)|
|Topic owner||Mary Corcoran|
|Topic author(s)||Gill Oliver/Sally Garlick/Marie Ward|
|Topic quality reviewed||Lindsay Price|
|Topic endorsed by||Long Term Conditions Strategic Group (City)|
|Topic approved by||Long Term Conditions Strategic Group (City)|
|Current version||August 2015|
|Linked JSNA topics|
|Insight Document ID||130947|
Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year. The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall. Falls are estimated to cost the NHS more than £2.3 billion per year. Therefore falling has an impact on quality of life, health and healthcare costs. Guidance on the assessment and prevention of falls in older people was updated in 2013 (NICE CG161) [i].
The key issue of concern is not simply the high incidence of falls in older people, but the combination of a high incidence and a high susceptibility to injury. Bone health is therefore considered alongside falls in this JSNA because osteoporosis increases bone fragility and susceptibility to fracture, particularly as a result of a fall (NICE).
Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Osteoporosis leads to over 300,000 patients presenting with fragility fractures to hospitals in the UK each year. Because of increased bone loss after the menopause in women, and age-related bone loss in both women and men, the prevalence of osteoporosis increases markedly with age, from 2% at 50 years to more than 25% at 80 years in women. If people at risk can be identified, treatments and therapies are available. Guidance on assessing people at risk was updated in 2012 [ii].
[i] CG161 Falls: Assessment and prevention of falls in older people, June 2013
[ii] CG 146 Osteoporosis: Assessing the risk of fragility fracture, August 2012
Addressing falls and bone health enables older people in Nottingham to increase healthy life expectancy. However a number of factors will widen unmet need and service gaps:
Current unmet needs and service gaps include:
Audit by the Royal College of Physicians, published in 2011, made 4 recommendations covering the Falls and Bone Health pathway[i].
[i] Falling standards, broken promises Report of the national audit of falls and bone health in older people 2010. Royal College of Physicians 2011
Falls and bone health assessments and interventions are multifactorial and may be provided by a range of health and social care providers. Commissioners will need to ensure that services and pathways are consistent with NICE guidance (CG161 and CG146), the recommendations in the Royal College of Physicians audit report and the forthcoming NICE Quality Standard.
Key priorities for implementation brought forward from CG161 (2004) are:
Osteoporosis guidance (CG146) recommends targeting risk assessment in all women aged over 65 and men aged over 75, and in women and men aged over 50 in the presence of risk factors e.g. history of falls.
In order to achieve this the main recommendations are: