One can barely imagine the trauma, pain and suffering experienced by a frail older person who sustains a fracture from falling. Yet it isn’t an uncommon experience. A recent Melbourne study indicates that falls account for 38 percent of all hospital injuries.
Osteoporosis Australia suggests that a fifth of those who break a hip will die within six months and, of those who live, one half will be unable to live independently.

A National Falls Prevention for Older People initiative funded by the Commonwealth Department of Health and Ageing in 1999 appears to have barely dented the surface of this critical issue. 

This columnist has had the unfortunate experience of observing a 98 year old woman, who fell while resident in a minimally-staffed 30 bed low-care aged-care facility, wheeled to the hospital operating room for surgery and then see her returned to the ward after the decision to operate was reversed. She died after two days of agonising pain. As her daughter said at the time, "We treat our dogs better than this". Sadly, it seems this experience is not an unusual one. 

Then, of course, there is the economics of it all. Think orthopedic surgeons, operating theatres, acute-care beds, follow-up care, subsequent delays in surgery waiting lists, high level aged care and much more. The Melbourne study, quoted above, estimates the cost at about 2 billion dollars nationally. 

Given the high incidence of falls and fractures sustained by frail older people in hospitals and aged-care facilities, the trauma they experience, as well as the associated costs, one might expect that there would be consistent, well-researched, evidence-based policies and practices operating across all our hospitals and aged-care homes - ones which would take into consideration the following issues and more.

• Should restraints be used to prevent patients/residents falling from chairs and beds? 
• How can daily routines best be managed so that those most at risk are supervised, or assisted, when moving around the hospital or facility?
• Should those patients/residents most at risk of falling wear hip protectors at all times? 
• What diets, dietary supplements or exercise regimes help prevent thinning bones?
• What type of chairs and bedding best assist patient safety?

Of course, one assumes that most hospitals do have fall prevention policies, at least in theory. But how workable are they - given current nurse/patient ratios? And are they consistent with best practice and the latest research? This columnist is aware of two hospitals, administered by the same health service, which have opposing policies on the use of restraints to prevent falls. Figure that one out!

Some health professionals believe that hip protectors (undergarments with padded cushions) are worth their weight in gold.  For example, the Australian Physiotherapy Association endorses their use, while others remain uncertain. You might think it would be worth someone working this one out too. Hip protectors are not cheap. (Starter kits are generally priced at about $150.00.) Yet distributing these freely to nursing homes and hostels would seem to be a small price to pay if we could be sure they would prevent even some of those painful and expensive-to-repair hip fractures.

It was reported just this week that here, in sunny Australia, more than half of our nursing home residents are likely to have a vitamin D deficiency. Evidently, research shows that giving older people vitamin D supplements reduces the risk of fractures by more than 20 percent. Thus, University of Melbourne endocrinologist, Peter Ebeling, would like the Australian Therapeutic Goods Administration to make higher dose vitamin D tablets readily available. Again, if giving out vitamins helps prevent injury from falls, then why on earth aren’t we doing it? 
 
Falls often have traumatic consequences for the individual. They are costly to the community and many are avoidable. We do have some instances where people seem to be working hard to prevent them from occurring. For example, reports indicate that a three-year fall-prevention project at Caulfield General Medical Centre in Victoria has reduced the number of falls sustained by patients by 19 percent and the number of falls resulting in serious injury to 77 percent.

It is also claimed that preventative strategies, such as the close monitoring of residents, having non-slip surfaces, and the use of high-low electric beds, at Richmond Community Nursing Home in NSW are having some effect.

But the high number of frail older people who fall and suffer fractures makes it very clear that much more could, and should, be done. 

Health and Ageing might well have produced a booklet on falls prevention and developed a training module for nurses as part of its National Falls Prevention for Older People initiative.  But in hospitals and aged-care facilities right across Australia vulnerable frail people are sustaining debilitating and life-threatening falls in huge numbers.

Let us get real about developing some consistent, well-researched policy on falls prevention in this country – and start putting it into practice.

Feedback:

Posted by: eekamouse [1 May 2006]

1. Old-Age Policy in the United States: A Case in Institutional Politics - Evening Forum - Tuesday 9th May @ 5:30pm

On Tuesday the 9th of May at 5:30pm, the CPP, in association with the University of Melbourne School of Social Work, will be welcoming Robert B. Hudson, Professor of Social Policy, Boston University, to give an address on the topic Old-Age Policy in the United States: A Case in Institutional Politics. Professor Hudson's principal interests are in the politics and policies of aging, the design and implementation of health and social service programs, and the in place of the aged in welfare states cross-nationally. Professor Hudson has extensive experience in writing, editing, teaching, and speaking in these areas.

This event will be held in the Public Policy Lecture Theatre, 2nd Floor, 234 Queensberry Street, Carlton. There is no cost involved and no need to RSVP: all welcome! For more information about this event, please visit the website:

http://www.public-policy.unimelb.edu.au/events/hudson.html

Posted by: Holly [16 May 2006]

Holly says:
"An elderly woman I know who has dementia has just broken her hip for the second time in 6 months. She can't remember to use her walking frame and so she really needs staff on hand to keep an eye on her. But the staff at her hostel all seem to be busy in the office most of the time. I hardly see anyone out in the corridors and sitting areas with the residents."

"The Columnist" Replies:
 
Yes Holly, it is so sad to see the result of these falls. People rarely get back to where they were.

We need to do so much more about the 'falls' epidemic - including taking another look at the staff/resident ratio in aged-care facilities.
 
The Columnist