National Audit of Falls and Bone Health in Older People

The Royal College of Physicians was commissioned by the Healthcare Quality Improvement Partnership (HQIP) formerly the Healthcare Commission to perform a National Audit of Falls and Bone Health in Older People three year programme of work.

National audit of falls and bone health in older people report - 2011

The national report and executive summary for the national audit of falls and bone health audit in older people are now available to download below.
 
This is the first time that the both an organisational and clinical audit have been performed together as part of the falls and bone health audit programme. The full report contains detailed information about falls and bone health services and the delivery of care for people that have fallen and had a fragility fracture. The executive summary is a short version of the national report containing the national picture for 16 ‘key indicators’ and a summary of other findings.

The audit shows that there is unacceptable variation in the quality of NHS services for care and prevention of falls and fractures. In many areas, there is a major gap between what NHS organisations state what they provide, in terms of commissioning, protocols or structure; and what clinical audit reveals in terms of actual care provided. The audit shows that older patients with fractures do not routinely receive key aspects of care for falls prevention or bone health, needlessly exposing them to a greater risk of further falls and fractures.

The audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit (CEEU). Information on nearly 10,000 patients came from all NHS Acute Trusts, or equivalent, in England, Wales and Northern Ireland, as well as Primary Care Organisations, Mental Health Trusts and a sample of care homes.

Audit timetable

Objectives

• To assess the national progress in the implementation of integrated falls services as described in Chapter 6 of the NSF for Older People
• To assess the national progress in the implementation of the NICE Guideline and Health Technology Appraisal relating to Falls and Osteoporosis.
• To assess the progress since the Round 1 and 2 National Audit of the Organisation of Services for Falls and Bone Health in Older People and Round 1 National Clinical Audit of Falls and Bone Health.
• To enable the benchmarking and comparison of the organisation and provision of falls and bone health services between trusts.

Older People's Experiences of Falls and Bone Health Services

In a survey of over 1,000 patients from the Royal College of Physicians, three-quarters (76%) felt that their experience of falls prevention services had been positive.  However, there are still problems with effective communication between patients and healthcare professionals, and many of the exercise programmes described were not evidence-based which limits their effectiveness.

The findings have led to new recommendations for falls prevention services on better communication, both verbal and written, at each stage of the process – assessment, investigation and intervention, including taking more account of individual concerns at each stage of the programme.
 
Falls prevention services should provide information  about the specific types of exercise needed to reduce the risk of falls, to both professionals and the public, promote evidence-based courses and train health and exercise professionals to deliver these programmes.  They should also provide education programmes to promote the benefits of healthy active ageing to help prevent the onset of falls and maintain the benefits from attending exercise classes following a fall.

Both the full report, Older People's Experiences of Falls Prevention Services (63 pages) and the executive summary (10 pages) are available for download below.

2010 update with patient questionnaire

The questionnaire used to compile this report has been updated, ready for use by local NHS sites, with the following supporting information which you will be able to download below:

• Falls patient questionnaire
• Local patient invite letter
• Supporting information for questionnaire

People’s Experiences of Falls and Bone health services project, 2008

This was a joint patient involvement project using focus groups with the Royal College of Physicians (RCP), London and Help the Aged. It was funded by the Healthcare Commission and Help the Aged as a patient / public involvement project. The report, the focus group pack and the patient leaflet are available below.

Outputs from the Patient Involvement (PPI) Focus Group Work 2008/09

A patient leaflet is available to download as a word document so that it can be adapted and used, also available below is the focus group reference pack, PPI report and executive summary among the resources available to download from the RCP...

See also

• NSF for Older people on the DoH website
• Clinical guideline on Falls on the NICE website
• Clinical guideline on Osteoporosis on the NICE website
• Falling standards, broken promises - a lay summary of the 2010 falls and bone health audit report