Care of older people: Falls in late life and their consequences---implementing effective services

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Abstract
This is the last in a series of four articles A new national service framework published last week has set out clear standards of care for older people throughout England.1 I consider here the basis for and the implications of the inclusion in the framework of a defined service model for falls and their consequences. Consideration of the service implications of current evidence has become relevant not only in the United Kingdom but wherever demographic and epidemiological trends identify falls as an important health issue. #### Summary points Falls and their consequences are a major public health and economic issue Falls are often a sensitive signal of unidentified and unmet health risk and healthcare need in individual older people Evidence exists that falls can be prevented Evidence exists that skilled and well organised clinical management after falls and fractures improves services and so benefits patients The justification and impetus for a defined service model for treating and managing falls is both well founded and timely. Each year in Britain a third of the population aged over 65 has a fall, and half of these people fall at least twice.2–5 Women are at greater risk (particularly those living alone) than men, with half of all women aged over 85 in any one year having a fall.3–6 As most surveys depend on patients' recall, these figures are probably an underestimate.7 Mortality associated with falls in older people is high.8–11 In 1997, 67% of accidental deaths in females aged over 65 were due to falls.11 Fractured femur is associated with a 33% mortality within one year (probably also an underestimate because of the widespread failure to certify femoral fracture as a cause of death12).10 Patients aged over 75 admitted after an …