RCP: Falls prevention services good but problems remain

Thursday, 25 February 2010 12:00 AM

In a new survey of over 1,000 patients from the Royal College of Physicians, three-quarters (76% - 767 of 1,028 total respondents) felt that their experience of falls prevention services had been positive.

However, among the 24% of respondents reporting a less than positive experience, the majority of issues were related to communication between patients and healthcare professionals, and many of the physical exercise programmes described in the results were not evidence-based, which limits their effectiveness.

Participants also felt that the exercise programmes they were offered did not continue for long enough, were not sufficiently frequent and that the location was not always convenient enough to be really beneficial.

The postal survey, commissioned by the Healthcare Quality Improvement Partnership (HQIP), carried out by the RCP's Clinical Effectiveness and Evaluation Unit (CEEU) and supported by Age Concern and Help the Aged, showed that the majority of people were positive about their experiences of local falls prevention services.

Key findings: at least 3 out of 4 people from the total sample group:

. Knew why they had been referred to the service (95%)

. Felt they had been seen quickly enough to help with their recovery (78%)

. Felt they received a thorough health check up (85%)

. Felt they had been involved in deciding what actions should be taken after being seen (80%)

. Were fully satisfied that good communication took place (85%)

. Found it easy or fairly easy to travel to appointments (76%)

. Were asked about their experiences of losing their balance or falling (84%)

Overall experience of interaction with Falls Prevention Services:

When asked to describe their overall experience of using their local Falls Prevention Service, of 1,028 respondents, 767 (76%) stated this as 'Useful for me'. Some 89 patients (9%) marked the 'Quite useful but could be better' option, 41 (4%) marked 'Not useful for me' and 111 (11%) did not respond.

Some 123 patients (just under 12%) responded when asked to explain why the service was not useful or could have been improved. The key theme identified by this group was poor communication, either between patients and healthcare professionals, or between different healthcare professionals. Examples include delays in referral, no estimate of waiting time once referral made, poor explanation of check up, and uncertainty about whether information about their attendance at the falls prevention service had been provided to their GP.

Of the 650 people in the survey participating in an exercise programme, 602 provided comments about what sort of exercises they were doing. These comments show that many people are continuing to participate in some form of exercise programme, but find self motivation to exercise at home is harder than when attending a class.

Many patients are limited as to what exercise they can do by factors such as pain, tiredness or other health problems, but would like more exercise classes, longer courses, options for home visits, follow up from courses, more local classes and help with transport.

It is of concern that many are participating in exercise programmes that have no evidence base for reducing risk of falls. This means they are not, for example, sufficiently specific, frequent, challenging or progressive. Evidence based programmes include Otago, FaME and Strength and Balance classes.

Recommendations on communication and exercise interventions:

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 classes following a fall. The full set of recommendations is available in the report, which will be free to download from the College website.

Jackie Riglin MCSP, Falls Prevention Coordinator and Clinical Specialist Physiotherapist, and RCP Clinical Associate for Falls, said:

'The findings from this report raise important issues for improving the delivery of a timely, appropriate and effective local Falls Prevention Service. I do hope that both service providers and commissioners will take on board the recommendations around communication and provision of local, long term, evidence based exercise interventions'.

Michelle Mitchell, Charity Director at Age Concern and Help the Aged said:

"It's well documented that falling can have a serious impact on an older person's health and quality of life and falls prevention services play an important role in reducing the number of people who have this type of accident.

"While it's encouraging that most service users in this survey had a positive experience of fall prevention services, it does reveal there is room for improvement around better communication and exercise programmes.

"Age Concern and Help the Aged urge local falls prevention services to take adopt the recommendations in this report and obtain feedback from their own service users to help identify areas for improvements."

Dr Jonathan Potter, Clinical Director, RCP Clinical Effectiveness and Evaluation Unit, said:

"The Royal College of Physicians is delighted to present this report on the patients' experience of falls services. While there are some good findings and some less good findings, the most important aspect is that the patients' view is being heard."

Notes to Editors

Falls Prevention Services aim to reduce a person's risk of falling. Services differ across the country but they include a check up (assessment) for someone who has had a fall or a balance problem. Community based healthcare professionals such as district nurses, occupational therapists or physiotherapists may visit people at home, undertake a risk assessment, and may recommend either home exercises or attendance at a Falls clinic, which is usually held in a GP practice, hospital or community centre.

The Royal College of Physicians of London provides a huge range of services to our 20,000 Members and Fellows and other medical professionals. These include delivering examinations, training courses, continuous professional development and conferences; undertaking clinical audits; publishing newsletters, guidelines and books through to maintaining the College's historical collections. We also lead medical debate, and lobby and advise government and other decision-makers on behalf of our members.

HQIP was established in April 2008 to promote quality in healthcare, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. It is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices (formerly the Long-term Conditions Alliance). HQIP is a not-for-profit organisation funded by the Department of Health.

Age UK is the new force combining Age Concern and Help the Aged. We will be known by our new name from Spring 2010. The Age UK family includes Age Scotland, Age Cymru and Age NI. We will help people enjoy a better later life - here and in 70 other countries - by providing life-enhancing services and vital support. We will keep developing products that are specifically designed for people in later life. We will provide advice and information through our helplines, publications and online. We will fund pioneering research into all aspects of getting older. By joining forces, we will ensure more of our funds go where they're needed.

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