Falls and Fracture Prevention
Key risk factors for hip fracture are age and gender. The rate of fracture is higher in very elderly groups (80+ years) and also higher in post-menopausal women. West Sussex has an increasing number of people in“very elderly” age groups, and given differences in life expectancy more of these people are women. In recent years the trend in emergency admissions for hip fracture has been fairly stable but projected increases in the very elderly age group is expected.
Work on falls prevention and recovery cuts across organisations and sectors. The West Sussex Falls & Fracture Prevention Steering Group, led by Public Health, includes representation from Districts and Boroughs, health, Fire and Rescue Service, social care and the voluntary sector. The group identify how to improve local provision.
June 2019 Performance
Hip fractures can result in pain, loss of independence, distress and an increased risk of mortality. They are largely caused by falls and a major cause for requiring social care. Age and sex are major risk factors for hip fractures – they are more common amongst people aged 80+ and post-menopausal women.
The age standardised rate for Emergency Hospital Admission for hip fractures in West Sussex in 2017/18 is 569 per 100,000 65+ population which is similar to the rate for England. This is down from 595 per 100,000 65+ population for 2016/17, a numerical but not statistically significant reduction. It is worth noting that the emergency admission rate for those aged 80+ was significantly worse than the rate for England in 2016/17 and is now similar to the England rate, a reduction from 1,658 to 1,568 per 100,000 80+ population. While these reductions are to be welcomed, it needs to be highlighted that any activity impacting on them will be historical relating to the period of data collection.
Falls and fall related injuries are priorities at both county and STP levels - it is one of the three SES STP priority areas for action along with MSK and CVD. STP workshops are currently taking place with representation from all key stakeholder organisations within the footprint to identify high value interventions across 4 aspects of the pathway:
Non-injured falls at home
Post ED or hospital admission falls prevention / home hazard assessment
Fracture liaison service development
Low level falls prevention / osteoporosis identification
The delivery of a major communications campaign
There are a wide range of falls and fracture prevention services in West Sussex:-
West Sussex Falls and Fracture Prevention Service is the specialist community NHS service for older people at risk of falls and fall-related injuries. It offers a number of services including multifactorial risk assessment in the home, strength and balance exercise programmes, home hazard assessment and modification, education and training for other professionals. There are teams in Chichester, Haywards Heath, Horsham and Worthing.
Fracture liaison services (FLS) identify people with a first fragility fracture and then treat and monitor them to reduce the risk of a second more serious fracture including hip fractures. Crawley FLS is an innovative GP-based service which offers care closer to home and frees up consultant time.
West Sussex Wellbeing Hubs provide evidence based strength and balance exercise programmes for people who are scared of falling, feel unsteady or have a history of falls. To increase the availability of falls prevention focused exercises for older population West Sussex County Council Public Health team funded 15 spaces on an OTAGO Exercise Programme training course, with graduates of the course running programmes at Wellbeing Hubs and Age UK
WSCC Independent Living Service works with adults who have a physical impairment or illness including people who have experienced falls-related injuries or who have a history of falling. Occupational therapists assess the home environment to identify hazards and barriers to independence and then provide advice and assistance around home adaptations to address these.
Chichester Careline is an independent living service that provides telehealth for falls detection and response including wearable pendants and units that can be used to raise an alarm call in the event of a fall and fitting falls detection sensors in the home.