Prevention is better than falling

When thinking about the contribution made to society by health professionals it can be all too easy to view their work as reactive; diagnosing and helping people to recover from illness or injury. But to do so would be to ignore the increasing movement towards proactive health care; enabling individuals to live healthy lives either through prevention or early intervention.

One such success story comes thanks to the Chartered Society of Physiotherapy (CSP). Their research in conjunction with Agile, a professional network for physiotherapists working with older people, has identified that a multifactorial approach can lead to a 24% reduction in falls amongst older people. When coupled with an evidence based exercise programme that increases to 34%. That is a significant reduction, particularly when taking into account the cost of falls in terms of mobility and longevity, not to mention resource allocation.

As the CSP paper highlights, falls which result in injury are the leading cause of mortality in older people. So much so that following a fall there is a 10% probability of older people dying within a year and half will experience serious mobility impairments. With an estimated 500,000 fragility fractures each year and an overall cost of falls to the NHS of £2.3b per year, any measures which can result in a reduction in fall outcomes can only benefit individuals and the wider society.

By undertaking a multifactorial risk assessment, physiotherapists are not only able to detect early difficulties with mobility, strength and balance; they can also identify other environmental factors which could contribute to the chance of falls. These include the physical environment as well as behavioural and cognitive factors. With early identification comes the chance of early intervention; providing a range of strength and balance exercises to reduce the risk of falls. Providing holistic support such as recommending home modifications or referrals to other agencies can also help individuals to be mobile and play an active role within the community for longer. And of course, the more active someone is the better their chance of managing other health conditions such as obesity.

Interestingly, although half of those who have experienced a fall are afraid of falling again, up to half of those who have not fallen also have the same fear. This can lead to a modification of behaviour which in itself can lead to negative outcomes. For example, if an individual is afraid of falling whilst out walking then they may isolate themselves in their home. Helping people to understand and manage risk, including showing them how to get up safely after a fall, can help to overcome these fears.

In outlining the case for early intervention the CSP makes the case for effective service provision and the beneficial use of physiotherapy services. More importantly it also demonstrates the value of supporting preventative health services and the long term benefit which such support can deliver. Each successful intervention can lead to a significant improvement in the long term quality of life for the individual as well as a reduction in long term costs for the health service as a whole.