2018 NICE impact report on falls and fragility fractures
NICE impact reports review how NICE recommendations for evidence-based and cost-effective care are being used in priority areas of the health and care system, helping to improve outcomes where this is needed most.
NICE provides evidence-based guidance and advice to improve health and social care services. The uptake of NICE guidance is influenced by close relationships with partners in the system, such as NHS England and Public Health England (PHE).
In 2017, member organisations of the National Falls Prevention Coordination Group, along with PHE, produced a falls and fracture consensus statement and resource pack with the aims of reducing falls and fracture risk and improving management of fracture, including secondary prevention.
Leading on from this, NHS RightCare, in collaboration with PHE and the National Osteoporosis Society, developed a Falls and Fragility Fractures Pathway which defines 3 priorities for optimisation. In the report, NICE focused on what we know about the uptake and impact of our recommendations which are linked to these priorities.
NICE first published guidance on assessing the risk of fragility fractures in 2012 and this was followed by guidance on falls prevention in 2013. Quality standards for these areas have also been published. However this is a complex topic and so, in this report, we have looked at a broader range of NICE guidelines, such as multimorbidity, medicines optimisation and medicines adherence.
NICE routinely collects data which gives information about the uptake of its guidance. To produce this report, NICE worked with national partners to select data which indicates how NICE guidance might be making a difference in priority areas of preventing and managing falls and fragility fractures.
These data also highlight areas where there remains room for improvement.
Commenting on the report, Gillian Leng, deputy chief executive and director of health and social care at NICE writes on the National Health Executive blog:
In 2013, NICE published guidance on falls in older people, and in 2015 we went on to issue a quality standard on this topic. Since their publication, monthly survey data revealed a reduction in the proportion of people experiencing a fall while in care and an increase in the recognition of the importance of frailty. The data also found that the proportion of trusts using fall risk prediction tools has reduced since NICE issued a recommendation that they should not be used in hospitals. These tools have not been shown to accurately predict the risk of falling. Instead, all patients over 65, and those aged 50 to 64 who may have a relevant underlying condition, should be considered as being at risk. They should be offered a multifactorial risk assessment taking account of things like any history of falls, medication they are on and visual impairment.
But there is still more work to be done.
For example, strength and balance training programmes have been shown to reduce the rate of falls. Our report found that although people are being referred to these programmes, uptake needs to improve. Also, while there is evidence that multifactorial risk assessments are being carried out in hospitals, the quality of content varies, which signals another area for improvement.
Falling should not become an inevitable part of ageing. At NICE we will continue to support professionals to make a positive impact on the prevention and management of fractures, falls and frailty. But, as a health and social care system, we must keep up the momentum and ensure those most at risk of falling remain at the very heart of evidence-based improvements.