Are falls a problem?

02 October 2019

Clare Bostock is a Consultant Geriatrician, NHS Grampian, Aberdeen. Clare has a special interest in falls, polypharmacy and work-life balance. She wrote this blog for #FallsPreventionWeek

Are falls a problem? I know what you're thinking... "Don't be daft, of course falls are a problem!" I'm certainly not denying the importance and impact of falls. I know that falls and fall-related injuries account for more bed days than myocardial infarction and stroke combined. I also know that in Scotland alone, falls and fall-related fractures cost £470 million per year. And in 2010, falls in the over 65s cost the NHS £4.6 million per day.

But my focus and reading on work-life balance has taught me the difference between a problem and a dilemma. Work-life balance is not a problem, it is a dilemma. A problem has a solution. And if you apply a solution to a problem it is solved. In contrast, dilemmas are not solved - they are managed through choices and consequences. As we start the season of autumn or fall, we celebrate Fall Prevention Awareness Week, 23-29th September 2019, I realise that falls are not a problem. Falls do not have a simple or single solution - I wish they did! I feel that as sure as the autumn leaves fall from the trees, that people will fall over - although I have been criticised for stating that we cannot prevent all falls. I now understand that falls are a dilemma, not a problem - and all fall prevention strategies have consequences.

If falls were a problem, then we could solve this by making everyone lie on the floor all day (see cartoon, top of page 7 here). No one would fall i.e. inadvertently come to rest on the ground, if they were already lying there! I'm being facetious, but you can imagine the consequences of lying on the floor all day: pressure sores, loss of function and death - to name but a few. And sadly, I remember times in my early training when people were sedated and nursed in bed. I genuinely don't remember anyone falling over in hospital, but people did die from bronchopneumonia.

Thankfully now, when looking after older people, the focus is to keep people moving. Getting people up, dressed and moving carries a risk of falls, but I know that it is the right thing to do - and typically what people want. We can feel under so much pressure from our organisations and governing bodies to reduce falls, but we must not lose sight of the dilemma and consequences. I feel that all strategies to reduce the risk of falls need to be person-centred, enabling and maximise independence.

Like all complex dilemmas in healthcare, we need to understand and openly talk about the choices, risks and benefits of falls prevention. So next time you are challenged about the problem of falls, please consider this dilemma and how we can all help.


Thanks Clare for a thought-provoking blog.

This very subject came up in discussions on patient safety in the NHS on a course I'm doing. Although you're being facetious when you say the way to cure the problem of falls is to lay every one down on the floor, the reality is many people admitted to hospital are strongly encouraged to stay still (at least until physiotherapy review) because of the drive to reduce falls. This often leads to people left in chair or bed from Friday until Monday, with all the dangers this relative immobility brings. Part of the issue, I feel, is that falls are an easily quantifiable harm whereas immobility, loss of confidence, sarcopenia and institutionalisation are far less easy to quantify (though they are to my  mind the far greater risk). We need to get better at encouraging risk assessment and management rather than blaming people for falls occurring. Nursing colleagues might argue this is not their job, but not every patient on the AMU is referred to physiotherapy; this suggests they are already carrying out such risk assessments, albeit imperfectly.

Thanks again for this blog! Much work to be done.


Excellent - you have captured so much of what i have been thinking but wastn articulate enough to put into words - thanks for doing that for me - i'll quote you and i love the cartoon - will use that too. 


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