Falls a community approach

A multifactorial approach to falls assessment and prevention,

which includes physiotherapy, reduces falls in older people.

Physiotherapy includes the delivery of evidence-based

exercise programmes to optimise an individual’s strength and balance.

Physiotherapists work in partnership with community exercise groups

to ensure continuity of care and provide the recommended dosage

of exercise, enabling sustainable long term benefits.

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Evidence-based multifactorial falls assessment and

personalised

care reduces falls

Multifactorial falls risk assessment reduces falls by 24% and should be offered to all older

people who have fallen or are at risk of falls(1-3). Physiotherapists are able to detect early

difficulties with movement, strength and balance. This enables them to identify the most

appropriate risk factors for individuals, as well as determining an individual’s overall risk of falls.

Physiotherapists also assess for other causes of falls, such as behavioural and environmental,

to pinpoint contributing factors(3).

Based on assessment findings, a person centred care plan is developed. The care plan may

include options which assist individuals to achieve their agreed goals, for example positive

risk-taking based on the individual’s strengths (i.e. what they can do). This proactive approach

enables people to remain active and live well

Multifactorial interventions may reduce rate

of falls

Multifactorial interven tions may reduce the rate of falls compared

with usual care or attention control(5). These interventions should

be considered for people who have fallen, or are at a risk of falls,

including older people in settings such as care homes(3).

Physiotherapists advise on managing modifiable risks,

such as footwear, and co-ordinate referrals to health and

community services(3).

The cost of falls to the NHS in England due to hazards in the

home environment is £435 million(6). Home hazard modification

is a cost-effective intervention, which includes support,

equipment and advice to complete daily living activities,

often delivered in partnership with occupational therapists(7).

A long lie on the floor is associated with serious injury,

increased mortality and increased risk of secondary complications

. Physiotherapists teach people how to get

up from the floor safely and/or how to minimise time spent

on the floor. Specific strength training may enable individuals

to get up from the floor independently.

Fear of falling affects approximately 50% of people who have

fallen and up to 50% who have never fallen, which can reduce confidence

and independence, and lead to social isolation. Exercise programmes

may reduce fear of falling in the short term, without increasing the risk or

frequency of falls. Cognitive behavioural therapy

can be delivered by trained support workers and can

reduce both fear of falling and depression.

The NHS Long Term Plan has recommended a

significant increase in the number of first contact

practitioner roles in general practice. First

contact physiotherapists, alongside community

physiotherapists, are ideally placed to provide advice

on lifestyle, falls prevention, bone health and reduction

of fracture risk using NICE recommended screening

tools, such as FRAX and QFracture

Physiotherapists also work as fracture liaison service

(FLS) coordinators to systematically identify and assess

people at risk of fragility fractures and recommend

interventions for bone health and falls prevention

Per 300,000 population, an effective FLS will prevent

250 fragility fractures, including 140 hip fractures, over

five years The total expected local savings to the

NHS and social care is £2.1 million for a service cost

of around £640,000 (a net benefit of £1.46 million);

however, FLS is not consistently available