Someone in the UK dies almost every five hours as a result of a fall. There are 200,000 fragility fractures a year, mostly caused by falling, and many thousands of older people find themselves seriously physically and mentally debilitated once they’ve had a fall.
Help the Aged says that 30% of people over 64 living in the community will fall in any 12-month period. That figure rises to half in the over-80 age group. And of those who fall once, 60% will fall again in the same year.
Impact of falls
Pamela Holmes who runs the falls prevention programme for Help the Aged says falling has a devastating impact on people’s lives. “Often it will be a precipitatory factor in being admitted to a care home. We have an aging population, so we need to be aware that while falling isn’t an inevitable part of getting older, it is an important issue we need to tackle.”
The immense physical, psychological – and economic – impact of falls is now being addressed by a Europe-wide group of researchers and practitioners through an e-network known as ProFaNE (Prevention of Falls Network Europe). Founded by Manchester University’s professor of primary care in community health Chris Todd to pool the falls expertise and on-the-ground experience gathered in each European country, the network’s website has been going since 2003 and the research data it holds is now regularly referred to by around 3,000 professional members. Originally funded by the EU, Help the Aged has recently recognised its work by funding its running costs to the tune of £30,000 for the next 12 months.
Though falling still lacks a high profile in European medical communities, it’s recognised that the UK is a leader in research into the causes of falls and the interventions that can help people re-start their lives in the aftermath. Leading falls expert Dawn Skelton, also the network’s scientific co-ordinator, says that it is the sharing of expertise in what works that is the draw for many people when it comes to logging onto ProFaNE’s popular discussion forum.
Diana Hebden, a falls prevention nurse at the East Lancs Hospitals Trust agrees. “ProFaNE keeps me up to date with the latest research. If there’s anything new that comes up, I’ll take it to my managers and discuss it with them,” she says.
Much of the previous available research data had focused on falls in the community, she explains. In February this year however, the website alerted her to newly published research dealing with falls in a hospital setting that was immediately relevant to her daily practice.
“Falls from beds, for instance, are more common than people realise, and we were working to new guidance around bed rails,” she says. “New evidence was published around whether they help, and it turns out that they usually do, but they have associated risks.”
For her team, working with older people recovering on a rehabilitation ward, becoming aware of those risks means they can be planned for, hopefully, improving results for people building the strength and confidence to return home. It’s a group that can well do without having to deal with the devastating setback that would result from yet another fall while in hospital.
“I’ve asked a couple of questions on the forum and you get answers from all over Europe, from professors even, and you get them really quickly,” Hebden adds.
Another regular ProFaNE user is Ellen Freiberger, a researcher into falls at the Institute of Sport Science at Erlangen University in Germany. She was asked to join one of the network’s four working groups, formed to bring together, evaluate and disseminate findings on research topics ranging from classification of falls across Europe, the ways in which different countries’ medical services deliver various interventions, and the psychological impact of falling, incorporating whether people are willing to participate in activities such as strength and balance training after the fall.
“The website has broadened my own expertise and helped me network with other people in my field,” she says. “One of the most profound benefits is that it is helping me to implement others’ knowledge into Germany.”
Comparing Germany to other countries, she observes that researchers there have no national falls database, so are only able to speculate on how many people fall, why they fall, the type of fall and how serious it was.
“And doctors here don’t really diagnose falls, only the injury that results,” she continues. “They don’t have an official classification for noting ‘falls’ like they do for cancer, and don’t have the topic of falls at the top of their heads. So they won’t tend to ask about whether an injury resulted from a fall, and patients won’t tell them.”
With falls prevention not yet high on the health agenda in Germany, Freiberger is now using the research data on the long-term cost of falls that she has gathered from other countries on the ProFaNE network to alert the German medical insurance industry to the economic impact of the injuries that result; she’s hoping that this is one way in which falls awareness will spread in the medical community.
ProFaNE’s work has been recognised internationally, with founder Todd being asked to sit on the World Health Organisation global falls strategy steering group. Lobbying for health commissioners to take note of the research findings that ProFaNE has co-ordinated from across Europe is the next step for the network, says Skelton.
“For instance, we know people need nine months of exercise following a fall, and presently they get six weeks,” she points out. “I know the NHS can’t afford nine months, but we’re not giving the patient a chance to make the transition to leisure and community provision – they need help [from service providers] to be pointed to that.”