Transcript Slide 1

An integrated approach to injury
prevention in Hertfordshire
Raymond Jankowski
Deputy Director of Public Health
Hertfordshire County Council
Falls prevention in older people
Falls - Nationally
• 33% of people over 65 years and 50% of those over 85
years old fall
• Costs estimated £2.2B per annum…….and Rising
• No1 Serious incident in hospitals
• No1 precipitating factor for long-term care
Falls – Hertfordshire
• No.1 reason for 999 ambulance calls in Hertfordshire
(22%)
• Cost £40-50M per annum in Hertfordshire
• Hip fracture rate in Watford worst in England in 2009/10
• Hip fractures and falls admissions rising
• 180 X variation in 999 calls from care homes
In Hertfordshire, falls in one year…..
45-50 deaths
1,194 hip fractures
5,100 emergency admissions
22,000 emergency ambulance calls
Estimated 60,000 falls in > 65 year olds
Forecasts of rise in hip fractures in older people in
Hertfordshire
80%
Projected % increase in population aged 65+ and yearly number of hospital
admissions due to hip fractures in Hertfordshire
% increase in predicted yearly number of
70%
hospital admissions due to hip fractures
(FROM AVERAGE 05/06 to 11/12)
60%
60%
57%
40%
38%
36%
33%
31%
28%
26%
21%
23%
18%
21%
16%
18%
13%
16%
14%
11%
9%
6%
0%
1%
4%
45%
43%
36%
26%
4%
6%
48%
42%
39%
23%
0%
0%
50%
47%
31%
10%
53%
44%
29%
10%
8%
55%
52%
34%
20%
57%
49%
% increase in population aged 65+
30%
11%
60%
55%
% increase in predicted yearly number of
hospital admissions due to hip fractures
(FROM 2011/12)
40%
13%
65%
62%
% increase in predicted yearly number of
hospital admissions due to hip fractures
(FROM 2007/08)
50%
70%
67%
15%
18%
20%
22%
25%
27%
29%
32%
34%
36%
39%
41%
43%
46%
48%
50%
53%
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Population projections source: ONS 2010-based population projections
Projected hip fractures data: NHS Hertfordshire SUS
Forum of Fractures Falls Fragility
• Whole system for population of 1.1M
• Prevention in the community through to acute care
• Many stakeholders
DH Systematic approach to falls and fracture
care & prevention: four key objectives
NSF, TA161, CG21,
Blue Book & NHFD
NSF, TA161, CG21
& Blue Book
NSF, TA160
& CG21
NSF, LTC
programmes
Social care
Hip
fracture
patients
Non-hip fragility
fracture patients
Individuals at high risk
of 1st fragility fracture
or other injurious falls
Objective 1: Improve outcomes and
improve efficiency of care after hip
fractures – by following the 6 “Blue
Book” standards
Objective 2: Respond to the first
fracture, prevent the second – through
Fracture Liaison Services in
acute and primary care
Objective 3: Early intervention to restore
independence – through falls care
pathway linking acute and urgent
care services to secondary falls
prevention
Objective 4: Prevent frailty, preserve
bone health, reduce accidents –
Older people
through preserving physical
activity, healthy lifestyles and
reducing environmental hazards
PRIMARY OBJECTIVES
• Prevent further falls, and the injuries and loss of
independence that are often associated with them.
– Identify people at risk of a first or subsequent fragility
fracture,
– Assess individuals’ risks and establish appropriate
interventions to significantly reduce their risks.
• To be achieved through integrated working links between
the East of England Ambulance Service, acute trusts,
primary and secondary health care teams and the health
and social care teams across Hertfordshire.
Source: DWP
Some of the key components of falls fracture and fragilities
in Hertfordshire
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Community Falls Liaison service
Community pharmacy medication reviews
Community safety service
Falls car (National Health and Social care award 2010)
2 Fracture and Falls Liaison nurses (in acute sector)
Use of DH best tariff
Multidisciplinary assessments and interventions
Raising awareness in the wider community
Key factors in success
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Clear strategy based on evidence and cost effectiveness
Using commissioning opportunities
Team work
Business plan
Innovation with Evaluation
Willingness to review and adapt
Leadership beyond authority
Hospital admissions due to falls in persons aged 65 and over, DSR per 100,000,
Herfordshire GP registered population, 2009/10 to 2012/13
Directly standardised rate per 100,000
2,500
2,000
1,500
2,205
2,042
1,000
2,047
1,605
500
0
2009/10
2010/11
2011/12
Financial Year
2012/13
Percentage of class participants reporting >= 3 point increase in
balance, functional capacity and confidence
100
1
90
0.9
80
0.8
70
0.7
%
%
60
0.6
50
0.5
40
0.4
30
0.3
20
0.2
10
0.1
0
5
66
77
class number
stability
Postural Block
number
May 2012 - June 2013
88
Respondents’ comments after attending exercise class
“Brilliant! Thank you.”
“Gave me confidence.”
“I found this class fantastic,
exciting, helpful and a follow-on
“Gave me confidence
class would be great and
in all ways. Course
helpful.”
was run with humour,
friendliness and
“A follow on course would be very helpful.”
inspired confidence.”
“Very happy with the
whole experience and
“I haven’t fallen
“I wish the course was longer.” personally believe that since I have
every senior would
started the
benefit from this.”
course and
cannot thank you
enough for
helping.”
DH Systematic approach to falls and fracture
care & prevention: four key objectives
Hip
fracture
patients
Non-hip fragility
fracture patients
Individuals at high risk
of 1st fragility fracture
or other injurious falls
Objective 1: Improve outcomes and
improve efficiency of care after hip
fractures – by following the 6 “Blue
Book” standards
Objective 2: Respond to the first
fracture, prevent the second – through
Fracture Liaison Services in
acute and primary care
Objective 3: Early intervention to restore
independence – through falls care
pathway linking acute and urgent
care services to secondary falls
prevention
Objective 4: Prevent frailty, preserve
bone health, reduce accidents –
Older people
through preserving physical
activity, healthy lifestyles and
reducing environmental hazards
Promote physical activity in people aged 40 years and older
Health and Wellbeing Strategy: Life Course in Hertfordshire
Starting well
Up to 5 yrs*
* From pre-conception
Developing well
5-18 yrs
Living well
18yrs+
Working well
Aging well
65 years+