New proposals call for fall prevention assessment to be extended to people aged 50 and over, so is it time for safety professionals to proactively ask older colleagues about falls, asks RoSPA’s Falls Engagement Lead, Jules Robinson.

RoSPA has recently responded to the National Institute for Health and Care Excellence (NICE) consultation on an update to their guidelines ‘Falls: assessment and prevention in older people and people 50 and over at higher risk’.

In existing guidelines, the routine screening of over-50s was conducted exclusively in hospital and inpatient settings. However, the latest update proposes far broader screening to include people over 50 outside of these settings who have conditions which put them at higher risk, many of whom are part of our workforces.

This is a positive step for fall prevention as it increases the chance of people getting help to reduce their falls risk before having an accident and going to hospital. But, as we are all aware, NHS staff and services are already stretched, so is there more that can be done away from healthcare settings?

RoSPA has responded to the consultation calling for a broader range of professionals to be involved in signposting fall prevention advice such as that provided on our Fall Prevention Hub and through our free awareness materials Fall Fighter. Case finding, where an individual at higher risk is identified for support ahead of suffering ill-consequences, is key to reducing the burden of falls on our society. 

Analysis of data for RoSPA’s NAPS campaign revealed the number of people killed by falls over the last decade has risen by 90%. Over 400,000 hospitalisations every year happen due to a fall, including at least two people every 15 minutes in England suffering a hip fracture. 

Falls rarely have a single cause; 100 people might walk by a raised slab without issue before someone falls. Injurious falls are the result of multiple and often interconnected risk factors in the environment and individual.

The traditional focus of slips, trips and falls prevention is environmental controls, followed by falls arrest and management. So why have personal risk factors been so far neglected?

Amongst 400 other personal fall risk factors, age, medication, strength and balance, underlying health conditions, and previous fall experiences all play a part in determining an individual's falls risk. The comprehensive assessment used in healthcare settings covers around 22 of these in great depth.

Professionals with a background in safety are perfectly placed to offer support and signposting to colleagues at a higher risk of falls. As we have recently seen in the rollout of mental health first aid and signposting in response to increasing number of employees in need, falls prevention could very well follow the same pathway.

Supporting a colleague to reduce their personal falls risk could be as simple as encouraging annual eye tests - proactive management of eyesight is crucial to identifying environmental hazards and avoiding accidents including falls.

The proposed NICE guidelines include a list of personal risk factors which unmanaged would place a 50-year-old at high risk of falls. This list contains factors such as:

• Gait, balance and mobility 
• Cardiovascular stress and blood pressure
• Bone and foot health
• Fluid intake, diet and alcohol misuse
• Medication side effects
• Fear of falling, cognition and mood
• Hearing and eyesight.

Raising awareness of the associated falls risk empowers workers to act and could reduce the chance of suffering an injurious fall at work or at home. In turn, a reduction in lost time spent recovering from fall-related injury or caring for family members who suffer falls is also possible.

The broad scope of risk factors necessitates a person-centred approach to risk reduction. While the clinical nature of some risk factors reduces the safety professionals’ involvement to signposting the appropriate medical professional,  there are some factors whose improved control would yield benefits beyond fall prevention. Promoting exercise, improving diet and addressing the misuse of alcohol are all likely to have a positive impact on quality and enjoyment of life.

Undertaking a comprehensive assessment of all of a workforce’s risk factors would be unhelpful in reducing overall risk. This is because some factors are irreversible, such as age, or because the evaluation requires specialist equipment or skills. That said, active monitoring of specific personal risk factors may complement environmental fall risk controls. Examples of this practice already exist in the workplace i.e. medications which make an individual unsuitable for driving and operating heavy machinery.

The challenge to safety professionals is finding constructive ways to engage their workforce with assessment and management of personal fall risk factors. The first step is raising awareness of the factors and how they can affect people aged over-50 to varying extents.

Fall Fighter, RoSPA’s free falls prevention awareness presentation for older adults, introduces the most common and effectively controlled fall risk factors. It can be delivered in person and includes presenter notes to assist delivery and promote engagement with the topic.

Colleagues aged below 50 can also benefit from having sight of fall risks as they age, and by gaining knowledge they can share to support and protect older family members.
 

Jules Robinson is RoSPA's Falls Engagement Lead.