Intended for healthcare professionals

Clinical Review State of the Art Review

Prevention of falls in older people living in the community

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1419 (Published 28 April 2016) Cite this as: BMJ 2016;353:i1419

Re: Prevention of falls in older people living in the community

This article is most welcome, as a really thorough treatment of an important subject. However, we note that 'No patients were asked for input in the creation of this article.' If they had been, it might have been even better. (I did notice a couple of typos!)

Although the setting for the article is the USA, many features apply to the UK. Yearly physical examinations are obviously a good idea, together with medication review. One thing that would also be helpful, particularly for elderly people with chronic conditions, is yearly reassessment for stability. Even better, a recent development in Edinburgh has been the availability of direct patient referral to Social Care Direct for 'a non-urgent falls assessment' within seven working days, involving a physiotherapist and an occupational therapist.

Unfortunately patients don't always know about this possibility: in early 2013 we didn't ourselves. In the case of my husband, disabled after a stroke in 2007, I noticed he was becoming more unsteady, and asked his GP for a re-assessment. Three months later we were still waiting for one, when he did in fact have a serious fall, which meant calling out the community alarm service, who skilfully helped him up and administered basic first aid: he was badly bruised but did not need to go to hospital.

The very next day, after another call to his GP, a joint team of physiotherapist and OT came along and helped greatly with fitting up new aids and suggesting exercises, illustrating good combined working between NHS (the physiotherapist) and Social Care (the OT). The community alarm service is another great idea: it works with an alarm round the patient's neck, which he only has to press to gain help at home: it is a huge relief to me to know that if I am out and my husband has a fall he will be helped appropriately. It costs us £4 a month, and is well worth it. (The service is means-tested and for some it is free.)

For a wholly different reason, about a year later, with his GP's permission, my husband discontinued two of the drugs (statins and beta-blockers) he had been on for the previous six years, since his stroke. Although he had had minor falls before the episode described above, since then he has had none. It is interesting to note that once more polypharmacy may be the culprit. (1)

Heather Goodare (retired counsellor)
hm.goodare@virgin.net

Patient consent obtained.

1. Goodare H. Discontinuing drug treatments (rapid response). BMJ 2014; 349:g7013.

Competing interests: No competing interests

02 May 2016
Heather M. Goodare
retired counsellor
Edinburgh