Approximately 30 per cent of people aged over 65 years fall each year
(1) one-tenth of whom sustain a fracture including fracture neck of femur
which is associated with significant mortality and loss of independence
(2).
The high social and health care costs associated with falls should
encourage routine screening of elderly patients as highlighted by Järvinen
et al (3). The assessment of a person after a fall should take account of
appropriate footwear, visual impairment, postural hypotension, continence,
the timed ‘get up and go’ test and medication review.
The meta-analysis by Gates et al (4) provides less than helpful
conclusions. There was considerable heterogeneity in the trials included
and the number of participants was small. The results contradict those of
SIGN (5), NICE (6), the Cochrane reviews (1,7) and guidance from the
National Service Framework for Older People (2). These conclude that multi
-factorial interventions are successful in reducing falls, even in a
population-based approach. Additionally, recent studies demonstrate that
single targeted interventions are as effective in people at risk (8) and a
benefit to cost ratio of multi-targeted community intervention programs of
20:1 (9).
With an annual cost to the NHS of around £1.7 billion (6), it would
make more sense to implement preventative care, conduct nationwide studies
on cost effectiveness and campaign for rehabilitation, to prevent further
unbundling of services.
1. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG,
Rowe BH. Interventions for preventing falls in elderly people. Cochrane
Database of Systematic Reviews 2003, Issue 4.
2. Implementing the NSF for Older People Falls Standard – Support for
commissioning good services. Department of Health, 2003.
3. Järvinen TLN, Sievänen H, Khan KM, Heinonen A, Kannus P. Shifting
the focus in fracture prevention from osteoporosis to falls. BMJ 2008;
336:124-126
4. Gates S, Fisher JD, Cooke MW, Carter YH, Lamb SE. Multifactorial
assessment and targeted intervention for preventing falls and injuries
among older people in community and emergency care settings: a systematic
review and meta-analysis. BMJ 2008; 336: 130-133
5. Scottish Intercollegiate Guidelines Network. SIGN 56. Prevention
and management of hip fracture in older people. SIGN, 2002
6. NICE. Falls: The assessment and prevention of falls in older
people. National Institute for Health and Clinical Excellence (NICE).
National Clinical Guideline 21, November, 2004
7. McClure R, Turner C, PeelN, Spinks A, Eakin E,Hughes K.
Population-based interventions for the prevention of fall-related injuries
in older people. Cochrane Database of Systematic Reviews 2005, Issue 1
8. Campbell AJ, Robertson MC. Rethinking individual and community
fall prevention strategies: a meta-regression comparing single and
multifactorial interventions. Age and Ageing 2007; 36: 656–662
9. Beard J, Rowell D, Scott D, Beurden E, Barnett L, et al. Economic
analysis of a community-based falls prevention program. Public Health
2006; 120: 742–751
Rapid Response:
Preventing Falls – clinically and cost effective
Approximately 30 per cent of people aged over 65 years fall each year
(1) one-tenth of whom sustain a fracture including fracture neck of femur
which is associated with significant mortality and loss of independence
(2).
The high social and health care costs associated with falls should
encourage routine screening of elderly patients as highlighted by Järvinen
et al (3). The assessment of a person after a fall should take account of
appropriate footwear, visual impairment, postural hypotension, continence,
the timed ‘get up and go’ test and medication review.
The meta-analysis by Gates et al (4) provides less than helpful
conclusions. There was considerable heterogeneity in the trials included
and the number of participants was small. The results contradict those of
SIGN (5), NICE (6), the Cochrane reviews (1,7) and guidance from the
National Service Framework for Older People (2). These conclude that multi
-factorial interventions are successful in reducing falls, even in a
population-based approach. Additionally, recent studies demonstrate that
single targeted interventions are as effective in people at risk (8) and a
benefit to cost ratio of multi-targeted community intervention programs of
20:1 (9).
With an annual cost to the NHS of around £1.7 billion (6), it would
make more sense to implement preventative care, conduct nationwide studies
on cost effectiveness and campaign for rehabilitation, to prevent further
unbundling of services.
1. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG,
Rowe BH. Interventions for preventing falls in elderly people. Cochrane
Database of Systematic Reviews 2003, Issue 4.
2. Implementing the NSF for Older People Falls Standard – Support for
commissioning good services. Department of Health, 2003.
3. Järvinen TLN, Sievänen H, Khan KM, Heinonen A, Kannus P. Shifting
the focus in fracture prevention from osteoporosis to falls. BMJ 2008;
336:124-126
4. Gates S, Fisher JD, Cooke MW, Carter YH, Lamb SE. Multifactorial
assessment and targeted intervention for preventing falls and injuries
among older people in community and emergency care settings: a systematic
review and meta-analysis. BMJ 2008; 336: 130-133
5. Scottish Intercollegiate Guidelines Network. SIGN 56. Prevention
and management of hip fracture in older people. SIGN, 2002
6. NICE. Falls: The assessment and prevention of falls in older
people. National Institute for Health and Clinical Excellence (NICE).
National Clinical Guideline 21, November, 2004
7. McClure R, Turner C, PeelN, Spinks A, Eakin E,Hughes K.
Population-based interventions for the prevention of fall-related injuries
in older people. Cochrane Database of Systematic Reviews 2005, Issue 1
8. Campbell AJ, Robertson MC. Rethinking individual and community
fall prevention strategies: a meta-regression comparing single and
multifactorial interventions. Age and Ageing 2007; 36: 656–662
9. Beard J, Rowell D, Scott D, Beurden E, Barnett L, et al. Economic
analysis of a community-based falls prevention program. Public Health
2006; 120: 742–751
Competing interests:
None declared
Competing interests: No competing interests