Hip fractures are the most frequent fragility fracture caused by falls and the commonest cause of accident related death, but are often not managed well.

Falls present a significant cost to the individual; the consequences can range from distress and loss of confidence, loss of independence and quality of life, and occasionally, death. There are also considerable financial costs associated with falls in terms of local health and care services.

Good clinical practice can reduce death and disability resulting from hip fractures and prevent future falls and fragility fractures, but despite evidence-based guidance on preventing and treating falls in older people there is an inconsistent approach to recognition, diagnosis and management of those at risk across the county.

Exercise is the only intervention that by itself reduces falls among older adults. However, multi-factorial interventions e.g. a combined programme of exercise, vision assessment, and fall prevention education, can also increase older people’s ability to continue to live safely and independently. Simple early interventions can provide effective results.

At least a third of people aged over 65 will fall each year nationally. In Cornwall and the Isles of Scilly, which has a significantly higher number of older people than the UK average, this means up to 58,000 people are likely to fall every year, with up to 2,900 requiring hospital treatment.

Understanding why we fall is key to prevention. The natural process of ageing can often place older adults at an increased risk of having a fall. There are three reasons for this which are outlined below.

1. Older people are more likely to have chronic health conditions, such as heart disease, dementia, or low blood pressure (hypotension). Dizziness is a common. symptom of low blood pressure. These conditions can increase the risk of a fall
2. Older people are more likely to have impairments, such as poor vision, or muscle weakness.
3. Older people are more likely to have disabilities that can affect their balance

Among older adults, some of the most common reasons for accidental falls include:

• falling, or slipping, in the bathroom
• falling, or slipping, due to dim light
• falling, or slipping, on rugs, or carpets, that are not properly secured, or on floors that were wet, or recently polished
• falling, or slipping, when reaching for storage areas, such as cupboards
• falling, or slipping, down the stairs

Another common cause, particularly among older men, is falling from a ladder while carrying out home maintenance work.

Falls can also sometimes occur as a result of health reasons. Some common health reasons linked to falling include:

• loss of balance due to disability, or muscle weakness
• a sudden episode of dizziness
• a sudden, brief loss of consciousness, due to an underlying health condition, such as a heart condition, or low blood sugar (a brief loss of consciousness is known as a drop attack)
• low blood pressure (hypotension)
• visual impairment

Falls can sometimes be particularly troublesome for older women, as osteoporosis (thinning and weakening of the bones) is a common problem in this population. Osteoporosis is caused by hormonal changes that occur during the menopause (when a woman’s periods stop).