Our service for older people who have osteoporosis or have had falls is developing. One recent improvement is the screening of all patients over the age of 64 who present at A&E for risk of falls. They are screened by the nurse and then referred to the occupational therapist to carry out a falls risk assessment that covers medication, vision, hearing, walking, balance, transfers and footwear.

Miles Morgan,* aged 76, attended A&E after he fell at home while transferring from his bed to his commode in the early hours of the morning. He was found by his care worker who visits every morning to help him wash and dress. He was taken by ambulance to hospital where he had his painful hip x-rayed for fractures. Fortunately, there were no bone injuries and doctors hoped that he would be able to return home that morning.

He was finding it difficult to stand up due to hip pain and it was identified that he was at risk of further falls. Miles would be likely to have difficulties with some of his activities of daily living for the next couple of weeks until his hip pain resolved itself.

Social services arranged a temporary increase to his care package, so that he could have help in the evening. He was also provided with a toilet frame and bed leaver to enable him to get on and off the toilet and get in and out of bed independently and with reduced pain. With this additional equipment and care, he could be discharged safely back home that morning.

Miles was referred to his GP to arrange an x-ray of his spine to check for crush fractures - an indicator for osteoporosis. His GP was also asked to review his medications as he was on a combination of different types. If people are taking four or more types of medication a day, their risk of falling is significantly higher.

Miles was told about the benefits of exercises to improve strength and balance and to build up confidence. Older people prefer this to concentrating on hazard reduction, which can be viewed as limiting activity rather than promoting it. He agreed to attend a six-week falls prevention programme at the day hospital.

Miles uses bifocal glasses that meant he was less likely to see anything close to him that might cause him to trip. His last eye test was over two years ago and he agreed to have his eyes re-tested.

Falls prevention works best when a range of interventions from health and social care professionals are provided. It is important that those giving advice to older people stress the benefits of strength, balance and keeping confident, rather than turning them off, or frightening them, with talk of hazards and risk.

* Not his real name

See also Help the Aged advice leaflet Don't Mention the F-word! (www.helptheaged.org.uk)

James Lampert is an occupational therapist at East Kent Hospitals NHS Trust.