Falls Prevention Services Research Articles

The everydayness of falling: consequences and management for adults with cerebral palsy across the life course

Purpose To explore the cause, influences and consequences of falling for adults with cerebral palsy (CP) across their life course, and how this is managed. Materials and Methods We used interview data from a multimethod UK study exploring the effects of ageing with CP and healthcare across the life course. Twenty-six participants were recruited and interviewed using various digital platforms to maximise inclusive participation in the UK. Follow-up email semi-structured interviews were conducted to further explore experiences of falls. Transcribed interviews were analysed thematically. Results Falling and fear of falling (FoF) is problematic for over half of the participants in the sample. They perceived falls and FoF as limiting their participation, autonomy and independence in employment, social and cultural activities. Participants used their own management strategies, due to limited specialist interventions or practitioner knowledge to manage or prevent falls. Practices, such as the use of a wheelchair or avoiding activities prompted changes to relationships and identity. Conclusions Falling for adults with CP happens earlier in life compared to the general population. Adults with CP may benefit from specialist falls prevention services to help maintain muscle strength and balance. Research is needed to evaluate effective interventions for people with CP.

Transitioning Towards a Virtual Falls Prevention Program for Frail Seniors: Learning from the Experiences of Older Adults During the COVID-19 Pandemic.

The literature to date is unable to clearly characterize the appropriateness of virtual care for falls prevention services from the patient perspective. In response to COVID-19, the Falls Prevention Program (FPP) at Sunnybrook Health Sciences Centre was modified to include virtual components. We set out to uncover the experiences of this unique older-adult patient population to inform FPP quality improvement and appropriate incorporation of technology post-pandemic. FPP patients during the COVID-19 pandemic (February 2020 - February 2022) and their primary caregivers met inclusion criteria. Out of 18 eligible patients, 10 consented to participate in 20-minute, semi-structured telephone interviews conducted and transcribed by the first author. Inductive coding followed by theme generation occurred through collaborative analysis. The participants (n=10) were 60% female, mean age 84 years (SD 5.8), 60% living alone, and 70% university educated. We generated three main themes: 1) First Steps First, revealed a common desire for physical and mental support and the perceived essentials of a successful FPP highlighting the importance of program length and individualized attention; 2) Overcoming Obstacles, highlighted participants' experiences overcoming barriers with technology in the context of an isolating pandemic; and 3) Advancing Care Post-Pandemic, elaborated on the appropriateness of virtual care and delved into the importance of program personalization. The interviewed older adults revealed agreement on the FPP's necessity and the importance of increasing program length, one-on-one interaction, and program flexibility for unique patient needs. Incorporating virtual assessment prior to in-person exercises was largely favoured and should be considered as an appropriate use of technology post-pandemic.

Development and external validation of the eFalls tool: a multivariable prediction model for the risk of ED attendance or hospitalisation with a fall or fracture in older adults.

Falls are common in older adults and can devastate personal independence through injury such as fracture and fear of future falls. Methods to identify people for falls prevention interventions are currently limited, with high risks of bias in published prediction models. We have developed and externally validated the eFalls prediction model using routinely collected primary care electronic health records (EHR) to predict risk of emergency department attendance/hospitalisation with fall or fracture within 1 year. Data comprised two independent, retrospective cohorts of adults aged ≥65 years: the population of Wales, from the Secure Anonymised Information Linkage Databank (model development); the population of Bradford and Airedale, England, from Connected Bradford (external validation). Predictors included electronic frailty index components, supplemented with variables informed by literature reviews and clinical expertise. Fall/fracture risk was modelled using multivariable logistic regression with a Least Absolute Shrinkage and Selection Operator penalty. Predictive performance was assessed through calibration, discrimination and clinical utility. Apparent, internal-external cross-validation and external validation performance were assessed across general practices and in clinically relevant subgroups. The model's discrimination performance (c-statistic) was 0.72 (95% confidence interval, CI: 0.68 to 0.76) on internal-external cross-validation and 0.82 (95% CI: 0.80 to 0.83) on external validation. Calibration was variable across practices, with some over-prediction in the validation population (calibration-in-the-large, -0.87; 95% CI: -0.96 to -0.78). Clinical utility on external validation was improved after recalibration. The eFalls prediction model shows good performance and could support proactive stratification for falls prevention services if appropriately embedded into primary care EHR systems.

Risk of Falls and Fractures in Individuals With Cataract, Age-Related Macular Degeneration, or Glaucoma

Three leading disease causes of age-related visual loss are cataract, age-related macular degeneration (AMD), and glaucoma. Although all 3 eye diseases have been implicated with falls and fracture risk, evidence is mixed, with the contribution of different eye diseases being uncertain. To examine whether people with cataract, AMD, or glaucoma have higher risks of falls or fractures than those without. This cohort study was a population-based study in England using routinely collected electronic health records from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum primary care databases with linked hospitalization and mortality records from 2007 to 2020. Participants were people with cataract, AMD, or glaucoma matched to comparators (1:5) by age, sex, and general practice. Data were analyzed from May 2021 to June 2023. For each eye disease, we estimated the risk of falls or fractures using separate multivariable Cox proportional hazards regression models. Two primary outcomes were incident falls and incident fractures derived from general practice, hospital, and mortality records. Secondary outcomes were incident fractures of specific body sites. A total of 410 476 people with cataract, 75 622 with AMD, and 90 177 with glaucoma were matched (1:5) to 2 034 194 (no cataract), 375 548 (no AMD), and 448 179 (no glaucoma) comparators. The mean (SD) age was 73.8 (11.0) years, 79.4 (9.4) years, and 69.8 (13.1) years for participants with cataract, AMD, or glaucoma, respectively. Compared with comparators, there was an increased risk of falls in those with cataract (adjusted hazard ratio [HR], 1.36; 95% CI, 1.35-1.38), AMD (HR, 1.25; 95% CI, 1.23-1.27), and glaucoma (HR, 1.38; 95% CI, 1.35-1.41). Likewise for fractures, there were increased risks in all eye diseases, with an HR of 1.28 (95% CI, 1.27-1.30) in the cataract cohort, an HR of 1.18 (95% CI, 1.15-1.21) for AMD, and an HR of 1.31 (95% CI, 1.27-1.35) for glaucoma. Site-specific fracture analyses revealed increases in almost all body sites (including hip, spine, forearm, skull or facial bones, pelvis, ribs or sternum, and lower leg fractures) compared with matched comparators. The results of this study support recognition that people with 1 or more of these eye diseases are at increased risk of both falls and fractures. They may benefit from improved advice, access, and referrals to falls prevention services.

Knowledge, attitude and practice on fall risk factors and prevention among rural older community-dwellers in Vietnam.

Falls among the elderly are an important global health problem. This study assesses knowledge regarding risk factors of falls, as well as attitudes and practices towards fall prevention among older adults in the rural community. A cross-sectional study was performed in four rural communes in Thai Binh province, Vietnam. A total of 3038 older people were recruited. Knowledge was assessed by using Falls Risk Awareness Questionnaire. Questions about attitudes were based on the Health Belief Model. Other questions regarding attitudes and practices regarding fall prevention were also asked. Multivariate regression was performed to identify associated factors with knowledge, attitudes and practices. Results showed that the mean score of knowledge regarding risk factors of falls was low at 11.37/32. The highest scores were observed in terms of drug aspects, followed by medical condition and behavioural aspects. Older people mostly agreed with perceived severity, susceptibility, benefits and barriers, but their attitudes about cues to action, health motivation and actions were most neutral. Meanwhile, more than half of the participants practised recommended fall preventive measures. To conclude, health education interventions and fall prevention services that enhance community-based fall prevention knowledge, attitudes and practices for older adults should be performed to reduce the burden of falls in this population.

Supporting Fracture Liaison Services in England and Wales: A role for pharmacists?

Abstract Introduction Fracture Liaison Service (FLS) deliver secondary fracture prevention to adults aged 50 years and over. Performance is measured against ten benchmarks [B1-10]: cases identified [B1], spine fractures [B2], assessment within 90 days [B3], dual x-ray absorptiometry (DXA) within 90 days [B4], falls risk assessment [B5], bone treatment recommended [B6], strength and balance by 16 weeks [B7], 16-week follow-up [B8], treatment by first follow-up [B9] and 1-year drug adherence check [B10]. Each indicator has standards for meeting >80% of target (green), 50-79% (amber) and <50% (red). For Spine fractures [B2], >20% identified denotes green, amber for 11-19% and red for <10%. For bone treatment recommended [B6], green denotes >50% and red <50%. Audit data is uploaded to the Fracture Liaison Service Database (FLS-DB).1 Aim To establish whether FLSs meet performance targets and identify how pharmacists could support the service. Methods This work was done as part of a PhD project at the University of Nottingham looking at how pharmacists could improve osteoporosis medication adherence. Therefore, an existing service which encounters people with osteoporosis (FLS) was investigated to see if it required support. Approval reference: 017-2021. National averages for benchmarks were analysed to see if targets were being met over a 5-year period (2016-2020).1 The Royal Osteoporosis Society (ROS) Clinical Standards for FLSs2 were reviewed to identify areas where pharmacists could support the service. Findings were reviewed by two authors of the Clinical Standards for FLSs. Results Less than half (49%) of FLSs’ in England and Wales submitted data consistently between 2016-2020. Of those who submitted, only recommendations to initiate bone treatment [B6] met the required target (>50% of patients) in 2018 (53%), 2019 (52.4%) and 2020 (52.9%). However, B9: Treatment by 1st follow-up targets were not met. Possibly due to the lack of data for pharmacy support, the ROS Clinical Standards for FLSs do not mention pharmacists. Staffing data shows no pharmacists employed at FLSs. However, the research team identified eleven areas where implementation of referral pathways between community pharmacy (CP) and FLSs could support patient management. These were related to identification of people aged over 50 years with a fragility fracture (1.1), investigations of fragility fracture risk within 12 weeks of a fracture diagnosis (2.1, 2.2), provision of information to patients and healthcare professionals (3.1, 3.2, 3.3, 3.4), interventions such as drug treatment initiation, reviews, referrals to falls prevention services (4.1, 4.2, 4.3) and integration of the wider healthcare system to ensure long term management of osteoporosis (5.1). Multi-disciplinary working and incorporating primary and secondary fracture prevention and medicines review outcomes,3 would help inform transfer of care on this pathway. Discussion/Conclusion FLSs’ needs support to ensure benchmark targets are met especially related to anti-osteoporosis medication initiation and adherence. Due to their expertise, pharmacists could support the FLS, particularly with treatment initiation and adherence related monitoring. Implementation of a two-way referral pathway between FLSs’ and community pharmacy could help improve patient outcomes. Limitation: There is missing data as not all FLSs upload to the FLS-DB.

Update of the recommendations of the Federal Falls Prevention Initiative-Identification and prevention of the risk of falling in older people living at home

To reduce falls and their consequences, evidence-based and consensus-based recommendations are needed for risk stratification, screening, assessment, and fall prevention as well as treatment. In 2020, the Federal Falls Prevention Initiative (BIS) published recommendations for physical training for falls prevention as agroup or individual intervention for older people living at home. In 2022, the world guidelines for falls prevention and management for older adults (WFG) were published. To update the recommendations of the BIS. The recommendations of the BIS were compared with those of the WFG and, if necessary, extended by methodological and subject-specific aspects. The following areas were considered: 1)screening and risk stratification, 2)interventions, 3)multifactorial assessment and interventions, and 4)specific target groups. The BIS recommendations are largely consistent with those of the WFG. The main reason for differences is the previous focus of the BIS recommendations on physical training. The multifactorial approach, which is described in detail by the WFG, has so far been mentioned in the recommendation paper on physical training in individual settings but not elaborated in detail. The BIS recommendations are supplemented or clarified in this respect. By updating the BIS recommendations, the establishment and promotion of fall prevention services for older people in Germany can be further advanced. The implementation can thus be carried out as consistently and scientifically proven as possible.

Why should clinical practitioners ask about their patients' concerns about falling?

Concerns (or 'fears') about falling (CaF) are common in older adults. As part of the 'World Falls Guidelines Working Group on Concerns about Falling', we recommended that clinicians working in falls prevention services should regularly assess CaF. Here, we expand upon these recommendations and argue that CaF can be both 'adaptive' and 'maladaptive' with respect to falls risk. On the one hand, high CaF can lead to overly cautious or hypervigilant behaviours that increase the risk of falling, and may also cause undue activity restriction ('maladaptive CaF'). But concerns can also encourage individuals to make appropriate modifications to their behaviour to maximise safety ('adaptive CaF'). We discuss this paradox and argue that high CaF-irrespective of whether 'adaptive' or 'maladaptive'-should be considered an indication that 'something is not right', and that is represents an opportunity for clinical engagement. We also highlight how CaF can be maladaptive in terms of inappropriately high confidence about one's balance. We present different routes for clinical intervention based on the types of concerns disclosed.

Instructor and client views of a community falls prevention service and the impact of the COVID-19 pandemic: A qualitative exploration of a service in England.

Falls are the most common cause of injury related deaths in people over 75 years. The aim of this study was to explore the experience of providers (instructors) and service users (clients) of a fall's prevention exercise programme and the impact of the COVID-19 pandemic in Derbyshire, UK. Ten one-to-one interviews with class instructors and five focus groups with clients (n=41). Transcripts were analysed using inductive thematic analysis. Most clients were initially motivated to attend the programme to improve their physical health. All clients reported improvements in their physical health as a result of attending the classes; additional benefits to social cohesion were also widely discussed. Clients referred to the support provided by instructors during the pandemic (online classes and telephone calls) as a 'life-line'. Clients and instructors thought more could be done to advertise the programme, especially linking in with community and healthcare services. The benefits of attending exercise classes went beyond the intended purpose of improving fitness and reducing the risk of falls, extending into improved mental and social wellbeing. During the pandemic the programme also prevented feelings of isolation. Participants felt more could be done to advertise the service and increase referrals from healthcare settings.

QI initiative to reduce the number of inpatient falls in an acute hospital Trust

Inpatient falls are one of the most frequent concerns to patient safety within the acute hospital environment, equating to 1700 falls per year in an 800-bed general hospital. They are...

Patients' experience with a community pharmacy fall prevention service

BackgroundPharmacists can contribute to fall prevention, by offering services such as fall risk screenings, counselling, and medication reviews. Patient acceptance of the role of pharmacists in fall prevention is crucial. Objective(s)The aim of this study was to explore patients' experience with a community pharmacy fall prevention service. MethodsInterviews were conducted with patients one month after they participated in a pharmacy fall prevention service, in the Netherlands. Patient inclusion criteria for the service were: age ≥ 70 years, use of ≥5 drugs including ≥1 fall risk-increasing drug. The service included a fall risk screening followed by counselling and a medication review. The semi-structured interview guide was based on the consolidated framework for implementation research and included the following topics: outcomes, patient's motivation, and contact with the pharmacy technician. ResultsOf the 91 participants of the fall prevention service, 87 patients were interviewed with a median age of 78.0 years (first quartile [Q1] – third quartile [Q3]: 74.0–84.75) and 46.3% were female. Many patients expressed positive feedback about receiving a medication review. Most patients whose medication was deprescribed expressed to be positive about this. Others were reassured about the appropriateness of their medication use. Patients reported that the service enhanced their awareness about fall prevention. Only a few patients were motivated to adapt their lifestyle. Patients appreciated the attention and contact. ConclusionsPatients see a potential benefit for a community pharmacy falls prevention service, including a medication review. Patient education appeared to enhance their fall risk awareness.

“It’s all about the money”: an interpretive description of embedding physical therapy-led falls prevention group exercise in long-term care

BackgroundFalls prevention interventions are effective for community dwelling older adults however, the same cannot be said for older adults living in long-term care (LTC). The Staying UpRight (SUp) randomized controlled trial was designed to test the effectiveness of a progressive strength and balance group exercise program delivered to LTC residents. This paper explores the factors impacting LTC providers’ decisions to continue the program on completion of the funded trial period.MethodsA qualitative study using an Interpretive Description approach. Semi-structured interviews and focus groups were conducted with 15 LTC staff involved in the randomized controlled trial. Data were analysed using conventional content analysis.ResultsPractice change occurred following participation in the trial with some facilities starting exercise groups, some increasing the number of exercise groups offered and physical therapists selecting elements of the program to adopt into their practice. Decisions about continuing with SUp as designed were constrained by organizational decisions regarding funding and resources. Three factors were identified which informed decision-making: business models and philosophies, requirements for evidence, and valuing physical therapy.ConclusionsManagers and facilitators adapted SUp by selecting and delivering components of the program in response to the changes they had observed in participating residents. However, our findings highlight that while SUp was valued, the tight financial environment created by the current funding model in New Zealand did not support funding physical therapist delivered falls prevention exercise programs in LTC. This study may provide policy makers with important information on changes needed to support falls prevention service delivery in LTC.Trial registrationThis study is a sub-study of a randomized controlled trial which was registered to the Australian New Zealand Clinical Trials Registry ACTRN12618001827224 on 09/11/2018. Universal trial number U1111-1217-7148.

Establishing a community pharmacy-based fall prevention service - An implementation study.

Community pharmacists are in the position to contribute to fall prevention, but this is not yet common practice. The aim of this study was to evaluate the implementation of a community pharmacy-based fall prevention service. A fall prevention service, consisting of a fall risk screening and assessment including a medication review, was implemented in pharmacies during three months. A preparative online training was provided to the pharmacy team to enhance adoption of the service. Included patients were aged ≥70 years, using ≥5 drugs of which ≥1 fall risk-increasing drug. The implementation process was quantitively assessed by registering medication adaptations, recommendations, and referrals. Changes in patient scores on the Short Fall Efficacy Scale-International (FES-I) and a fall prevention knowledge test were documented at one month follow-up. Implementation was qualitatively evaluated by conducting semi-structured interviews with pharmacists before and after the project, based on the consolidated framework of implementation research. The service was implemented in nine pharmacies and 91 consultations were performed. Medication was adapted of 32 patients. Patients' short FES-I scores were significantly higher at follow-up (p=0.047) and patients' knowledge test scores did not differ (p=0.86). Pharmacists experienced the following barriers: lack of time, absence of staff, and limited multidisciplinary collaboration. Facilitators were training, motivated staff, patient engagement, and project scheduling. The service resulted in a substantial number of medication adaptations and lifestyle recommendations, but many barriers were identified that hamper the sustained implementation of the service.

Care and support networks of community-dwelling frail individuals in North West London: a comparison of patient and healthcare workers' perceptions.

Evidence suggests that successful assessment and care for frail individuals requires integrated and collaborative care and support across and within settings. Understanding the care and support networks of a frail individual could therefore prove useful in understanding need and designing support. This study explored the care and support networks of community-dwelling older people accessing a falls prevention service as a marker of likely frailty, by describing and comparing the individuals' networks as perceived by themselves and as perceived by healthcare providers involved in their care. A convenience sample of 16 patients and 16 associated healthcare professionals were recruited from a community-based NHS 'Falls Group' programme within North-West London. Individual (i.e., one on one) semi-structured interviews were conducted to establish an individual's perceived network. Principles of quantitative social network analysis (SNA) helped identify the structural characteristics of the networks; qualitative SNA and a thematic analysis aided data interpretation. All reported care and support networks showed a high contribution level from family and friends and healthcare professionals. In patient-reported networks, 'contribution level' was often related to the 'frequency' and 'helpfulness' of interaction. In healthcare professional reported networks, the reported frequency of interaction as detailed in patient records was used to ascertain 'contribution level'. This study emphasises the importance of the role of informal carers and friends along with healthcare professionals in the care of individuals living with frailty. There was congruence in the makeup of 'patient' and 'provider' reported networks, but more prominence of helper/carers in patients' reports. These findings also highlight the multidisciplinary makeup of a care and support network, which could be targeted by healthcare professionals to support the care of frail individuals.

A framework for the elderly first aid system by integrating vision-based fall detection and BIM-based indoor rescue routing

The occurrence of falls among older adults may result in life-threatening injuries and accidental deaths due to their vulnerability. As such, an advanced first aid system is significantly necessary to accurately detect falls and provide prompt assistance. However, current research primarily focused on fall prevention, fall detection, and first aid services after falling, thus lacking studies dealing with a systematic solution. To address this issue, the present research proposes an integrated framework for the elderly first aid system in an indoor environment using computer vision and building information model (BIM) techniques, which consists of three primary components: a vision-based module for fall detection, a cloud server (internet), and a BIM-based module for rescue routing. The experimental results showed that the proposed method could achieve 94.1% precision in identifying the fall status of older adults (i.e., falling or non-falling). Also, the proposed method enabled to automatically generate a rescue route in consideration of the routing accessibility for first aid in a BIM environment. The framework proposed in this study will improve the efficiency of the elderly first aid when falls occur, with shortening the rescue time to mitigate injury severity.

Examining utility and feasibility of implementing patient-reported outcome measures in occupational therapy primary care practice

Introduction Occupational therapists are increasingly part of interprofessional primary care teams, helping to expand primary care to meet client needs. Effectiveness of occupational therapy services is difficult to determine with currently collected data, and little is known about the best tools to use or how to integrate tools into practice. We explored the utility and feasibility of implementing patient-reported outcome measures (PROMs) within occupational therapy primary care practice. Method We integrated pre-test/post-test and exploratory qualitative designs. Over 7 months, nine occupational therapists administered two PROMs to clients receiving falls prevention services, addressing falls efficacy and participation in daily occupations. Subsequent interviews with therapists explored the utility and feasibility of using the tools. We assessed pre-to-post change in PROM scores and thematically analyzed interview data. Results The occupational therapists valued measuring function and participation in daily occupations to inform practice, communicate with team members, and demonstrate effectiveness. The falls efficacy scale appeared to capture change over time and was feasible to implement at pre-test. Conclusion PROMs appear useful within occupational therapy primary care falls prevention services and can be feasible with attention to administration processes. Further development and testing of PROMs is needed to support occupational therapy primary care practice.

Assessing the scalability of an integrated falls prevention service for community-dwelling older people: a mixed methods study

BackgroundThere is growing acknowledgement of the need for a phased approach to scaling up health interventions, beginning with an assessment of ‘scalability’, that is, the capacity of an individual intervention to be scaled up. This study aims to assess the scalability of a multi-component integrated falls prevention service for community-dwelling older people and to examine the applicability of the Intervention Scalability Assessment Tool (ISAT). The ISAT consists of 10 domains for consideration when determining the scalability of an intervention, and each domain comprises a series of questions aimed at examining readiness for scale-up.MethodsMultiple methods were used sequentially as recommended by the ISAT: a review of policy documents, results from a service evaluation and falls-related literature; one-to-one interviews (n = 11) with key stakeholders involved in management and oversight of the service; and a follow-up online questionnaire (n = 10) with stakeholders to rate scalability and provide further feedback on reasons for their scores.ResultsThree of the ISAT domains were rated highly by the participants. Analysis of the qualitative feedback and documents indicated that the issue of falls prevention among older people was of sufficient priority to warrant scale-up of the service and that the service aligned with national health policy priorities. Some participants also noted that benefits of the service could potentially outweigh costs through reduced hospital admissions and serious injuries such as hip fracture. The remaining domains received a moderate score from participants, however, indicating considerable barriers to scale-up. In the qualitative feedback, barriers identified included the perceived need for more healthcare staff to deliver components of the service, for additional infrastructure such as adequate room space, and for an integrated electronic patient management system linking primary and secondary care and to prevent duplication of services.ConclusionsPlans to scale up the service are currently under review given the practical barriers that need to be addressed. The ISAT provides a systematic and structured framework for examining the scalability of this multi-component falls prevention intervention, although the iterative nature of the process and detailed and technical nature of its questions require considerable time and knowledge of the service to complete.

Falls prevention in China: time for action

Falls prevention in China: time for action

215 WHAT IMPACT CAN ‘EMERGENCY DEPARTMENT IN THE HOME’ (EDITH) HAVE ON THE OLDER ADULT POPULATION PRESENTING WITH FALLS?

Abstract Background EDITH is a frailty response service providing medical and occupational therapy input to older adults living within the catchment area of a level 4 acute hospital. EDITH aims to reduce avoidable Emergency Department (ED) attendances and utilise alternative care pathways. Falls are common among older people and are often associated with poorer outcomes. Traditionally, older patients who have had a fall and contact emergency services for assistance are transferred to the ED and this can be associated with elevated risks. Additionally, older patients who have had a fall and are discharged on scene by the emergency services are at greater risk of recurring falls in the absence of immediate onward referral to community falls prevention services (Nowak and Hubbard 2009). Methods Paper count method data collection was completed. Inclusion criteria included referrals from the National Ambulance Service within the last 6 months. Results 75 patients met the inclusion criteria; 34 males, 41 females with an average age of 82. 11 patients were conveyed to hospital, giving a conveyance rate of 14.6%, the average conveyance rate for the EDITH service is 7.2%. 3 patients were conveyed to ED, while 8 patients were conveyed to the Medical Assessment Unit (MAU) in the local level 3 hospital. This resulted in 72% of patients that required hospital conveyance being streamed to the MAU; traditionally 100% of these patients would have presented to ED. Overall, 85.4% of patients seen remained at home. Conclusion EDITH are providing targeted medical and occupational therapy assessment(s) for older adults in their homes with successful outcomes. Implementation of alternative care pathways, reduction in avoidable ED attendances and prolonged independence in the home for this patient profile are some of the favourable findings. Reference 1. Nowak A, Hubbard RE. (2009) Falls and frailty: lessons from complex systems. Journal of the Royal Society of Medicine. 102(3):98–102.

Bridging the gaps in secondary fracture prevention at a single center in Pakistan—compliance with the IOF best practice framework

The International Osteoporosis Foundation (IOF) formulated a set of best practice framework as an international benchmark for secondary fracture prevention (SFP) and fracture liaison services (FLS), delineating essential elements of service delivery. The aim of this audit was to assess compliance with the IOF standards for patients ≥ 50years presenting with fragility hip fractures at a tertiary care center in Pakistan. A retrospective sample of hip fracture cases from Jan 2019 to Dec 2019, treated at the section of Orthopedic Surgery, Aga Khan University, Karachi, was conducted. After excluding high energy trauma cases and patients younger than 50years of age, medical records were audited, using a pre-structured Performa based on IOF standards. Compliance level of 0, 1, 2, and 3 was recorded as defined by IOF. Microsoft excel was used for data analysis. A compliance level of 3 was recorded for patient identification and fall prevention services, whereas level 1 was attained for database maintenance for 25 (100%) cases. For medication initiation, level 0 was recorded for all the cases; however, 8 (32%) cases were prescribed calcium and vitamin D supplements. For the standards, including post-fracture assessment timing, evaluation of secondary causes of osteoporosis, multifaceted assessment, medication review, communication strategy, and long-term management, a level 0 was noted for 25 (100%) cases. Moreover, no recommended assessment guidelines were followed uniformly. The care gaps identified require substantial efforts to ensure adequate implementation of the overall best practice standards for SFP, necessitating the need for FLS initiation and establishment of fracture care pathway.