Background Falls and fragility fractures in older people are a major cause of significant morbidity and mortality. NICE recommends that healthcare personnel in contact with older people should routinely obtain a history of falls and offer a multifactorial risk assessment in the setting of a specialist falls service.
Objectives We therefore evaluated the clinical practice at two teaching hospitals in London, whether a history of falls is routinely communicated to the GP and/or whether those with a history of falls are referred to the falls-clinic.
Methods A total of 200 patients, >65years age, 100 from each centre, admitted to the acute medical wards at two London teaching hospitals were included. Medical records including discharge summaries were analysed to collect data on the recording of a history of falls, initiation of bone-protection treatment during the admission, discharge summary communication with the general practitioners and/or onward referral to dedicated “falls-clinic”. A focused history of falls and fractures was obtained by the researchers, which were compared with that documented in medical records.
Results The patient mean age was 80years and 99 were female. In all, 34/100 and 24/100 presented with a fall; 17/100 and 6/100 presented falls as a secondary complaint; and 17/51 (30.3%) and 6/30 (20%) were found to have a fracture, at centre 1 and 2, respectively. Of those primarily presenting with falls, 32/34 (94.1%) and 18/24 (75.0%) had a history of previous falls and 21/34 (61.7%) and 2/24 (8.3%) had a history of previous fractures. Only19/100 and 9/100 were previously investigated for osteoporosis and 38/100 and 27/100 were already receiving calcium and/or vitamin D supplementation. Of the remaining and with a fall, 2/27 (7.4%) and 4/17 (23.5%) were commenced on at least calcium supplementation treatment.
A history of falls was documented in only 30/51 (58.5%) and 25/30 (83.3%) discharge summaries. Only 6/51 (11.5%) patients were directly referred to a falls-clinic and 6/51 (11.5%) patients were directly referred to community physiotherapy in Centre 1, and 5/30 (16.7%) patients were directly referred to a falls-clinic in Centre 2. Recommendations for the GP to refer to a falls-clinic were made in only 7/51 (13.7%) and 4/30 (13.3%) discharge summaries. In both centres, all direct referrals or GP recommendations were made by, or following advice from, Care of Elderly teams.
Conclusions Our results indicate that older people at risk of recurrent falls are not identified when receiving care in acute medical units. Consequently, only a minority are highlighted to the GP and/or are referred for multifactorial risk assessment in falls-clinics, contributing to suboptimal implementation of NICE guidance. Therefore, improving awareness of healthcare personnel is vital to improve outcomes for these elderly patients at risk of falls and falls-related complications.
NICE Clinical Guidelines; Falls: Assessment and Prevention of Falls in Older People. NICE CG161; July 2013.
Disclosure of Interest None declared