Drinking, smoking and badminton – reaching a consensus on falls prevention

Daniel MacIntyre, Public Health England, is Chair of the National Falls Prevention Coordination Group.

I began working for Public Health England (PHE) just over four years ago, one year after it was established. Given the level of organisational change and complexity involved in setting up a national public health body, I think it is fair to say that in its first few years PHE was finding its feet in terms of ways of working, both internally and with the huge range of stakeholders that make up the health and care system. In some ways, this situation was mirrored in my own job with PHE’s national Healthcare Public Health team. Piloting a methodology developed by Sir Muir Gray, one of the most influential figures in British public health, I was exploring whether it was possible to define a falls and fracture prevention system with a set of measurable outcomes.

Falls and fracture prevention had been chosen as topics due to the burden they place on older people and services and - according to Muir – because it was the most complex heath and care system that he had ever come across. I therefore set about exploring whether it was possible to define a falls and fracture prevention system with a set of measurable outcomes. Working with people from a wide range of professions and organisations, we developed a set of defined outcomes that were both broad in scope – ranging from life course risk factor reduction to collaborative care for severe injury – but that could be agreed to a greater or lesser extent by most  people working in this area.

Measurement was more problematic.

While I was carrying out this piece of work I met many people involved in falls and fracture prevention and this led to discussions about the lack of coordination at a national level. As a result of this, in 2016 PHE set up the National Falls Prevention Coordination Group. The first thing the group did was draft a Consensus Statement outlining priority actions recommended for local areas – the previous policy push in this area having taken place eight years previously. When drafting the Consensus Statement, we used the falls and fracture system as a basis for our discussions and this included the role of life course risk factor reduction.

I spoke about some of the opportunities and challenges created by the Consensus Statement at the BGS 19th International Conference on Falls and Postural Stability. One of the areas where I think the Consensus Statement can provide fantastic opportunities is in taking public health approaches to falls risk factors. Many of these are strongly aligned with public health priorities such as physical activity, high alcohol use and smoking, and as a public health professional, it is second nature to me to start looking at possible population and prevention approaches when presented with a health issue.

Muscle weakness and poor balance are key risk factors for falls. I have long thought that if we would work out a population approach this would be a great step forward in the area of falls prevention. However I have had some difficulty in working out what this might look like. A recent publication might provide some clues to this. Last year Public Health England and the Centre for Ageing Better commissioned a group of academics overseen by the Chief Medical Officer’s (CMO) expert group on physical activity to review the evidence underpinning the muscle and bone strengthening and balance components of the CMO physical activity guidelines. The group were asked to search for evidence in a number of areas.

These included:

  • The health benefits of this type of physical activity.
  • How different physical activities impact on the different domains of muscle strength, bone strength and balance.
  • The impact on different sub-populations including older people living with frailty, people with osteoporosis and people with cognitive impairment.
  • Barriers and enablers.

The report can be found here and the reviews underpinning the report are published in a special issue of the Journal of Frailty, Sarcopenia and Falls

The focus on different types of physical activity is particularly interesting as it looks at the benefits of a range of physical activities - racquet sports, circuits and progressive resistance training - which do particularly well across all domains. This provides research grounded in the real world of service provision and - more importantly - daily activity for individuals. This has massive implications for areas such as leisure service provision, exercise professionals and physical activity promotion, as it expands the range of possibilities open to older people, and the general population in terms of falls prevention that is both enjoyable and grounded in daily living. And that has got to be a good thing.   

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