Older people who fall: why they matter and what you can do

The population is ageing in all developing nations. As treatments and survival rates improve for conditions affecting younger people, age-related problems linked to frailty, functional impairment and long term conditions will pose an ever larger challenge to health and social care systems. Falls and associated injuries or loss of function are such a problem. Effective falls intervention strategies mean that primary care and community nursing must play a central role, as many patients will never present to hospital services, nor could hospital services cope--for instance one in three people over 65 will fall in a given year and one in two women will sustain a fracture during their lifetime. Fall and fracture prevention has, until the past few years, been a low priority in service delivery, training and research. However, its importance as a public health challenge has been increasingly recognized in government policy and in clinical guidelines, though we are still a long way off delivering evidence-based interventions and assessments to those who would benefit. There is plenty that clinicians can do to reduce the chance of further falls and injuries, to optimize patients' confidence and ability to cope and to use falls as a 'case-finding' trigger to address a host of other, often unrecognized problems. There is plenty community nurses can do in initial assessment, intervention and monitoring. This article sets out the key practice points and in particular the key sources of evidence for practice development.