1. Falls and Fragility Fractures The Public Health England View Daniel MacIntyre - Population Health Services Manager

2. Epidemiology 11.1 million people aged 65+ (17.4%) 35% aged 65+ fall at least once, 45% aged 80+ 10-15% of falls result in fracture Higher rates in women, care and nursing homes 2Falls and Fragility Fractures: the Public Health England View

3. Risk factors Intrinsic factorsExtrinsic factorsBehavioural factors Previous falls, fractures, stumbles and trips Muscle weakness Impaired balance/gait, restricted mobility Medical history of Parkinsons, stroke, arthritis, cardiac abnormalities Fear of falling Medication (e.g. polypharmacy, psychotropic medication) Acute illness Dizziness Stairs and steps Clutter and tripping hazards (e.g. rugs, flexes) Floor coverings Poor lighting, glare, shadows Lack of appropriate adaptations (e.g. grabrails, stair rails) Low furniture No access to telephone or alarm system Poor heating Thresholds, doors Limited physical activity / exercise Poor nutrition/fluid intake Alcohol intake Carrying, reaching, bending, risk-taking behaviour (e.g. climbing on chairs or ladders) Footwear Clothing Inappropriate use of/ refusal to use assistive Devices Source: College of Occupational Therapists, 2015 3 Falls and Fragility Fractures: the Public Health England View

4. Service complexity Private landlords – Social housing providers - Private, VCS and LA physical activity services – General practitioners - District nurses – Pharmacists – Physiotherapists - Occupational therapists – Residential nursing and care homes - Ambulance Trusts – Falls services - LA Public health teams – Fracture Liason Services – Trauma and Orthopaedics Departments – Emergency Departments – Public Health England – inpatient care – Opticians –Geriatric Medicine Departments 4 Falls and Fragility Fractures: the Public Health England View

5. What needs to be covered 5 Falls and Fragility Fractures: the Public Health England View

6. Falls prevention: the evidence base InterventionEvidence baseExamples Muscle strengthening and balance retraining RR 0.80 (95% C.I. 0.66-0.98) National physical activity strategy Be Active, Be Healthy Home hazard assessment and modification RR 0.66 (95% C.I. 0.54-0.81) Liverpool Healthy homes, Hertfordshire Fire service home safety checks service Multidisciplinary, multifactorial risk factor screening and intervention History of falls: RR 0.86 (95% CI 0.76-0.0.98); Care home: RR 0.60 (95% CI 0.50-0.73) NHS falls prevention and bone health service, Hertfordshire Emergency Care Practitioner & Social Worker service + Fracture Liaison Services Primary falls prevention Falls and Fragility Fractures: the Public Health England View

7. PHE activity Physical activity – Everybody Active Every Day Primary falls prevention – screening tools, social marketing Allied Health Professionals – Fire and Rescue Service Secondary falls prevention - Sir Muir Gray’s question 7 Falls and Fragility Fractures: the Public Health England View

8. Developing the evidence base Ways of delivering what works Fracture liaison services Primary falls prevention 8 Falls and Fragility Fractures: the Public Health England View

9. Next steps Working together to develop the evidence base around falls and fragility fractures… Daniel MacIntyre – daniel.macintyre@phe.gov.uk 020 8654 48472daniel.macintyre@phe.gov.uk 9Falls and Fragility Fractures: the Public Health England View