7 Stop Falling Before it Starts: Increasing Access to Multifactorial Falls and Fracture Risk Assessment and Intervention for Older People At Risk of Falls or Early in Their Falls Career Via Proactive Case Finding

Background Target population: patients from 6 (of 43) Newcastle upon Tyne General Practices, age 65 – 75, mild frailty on electronic frailty index, who had fallen or noticed a balance problem in the previous year. Introduction Usually multifactorial falls and fracture prevention services target frailer older people and intervention begins after a fall or fracture has occurred. There is limited provision of community-based strength and balance exercise. Intervention New service model ‘Stop Falling Before It Starts (SFBIS)’: proactive case finding by postal questionnaire; multifactorial falls and fracture risk assessment by specialist nurse; interventions recommended to General Practitioner (GP); community-based exercise offered to all, predominantly new 15 week ‘Steady On’ strength and balance classes suitable for fitter older people. Methods Data collection: patient characteristics, physical performance (Timed up and Go (TUG), 30 second sit to stand (STS)) before starting and on completion of Steady On classes, service process measures, patient and GP experience. Results 157 patients assessed. 80 (51%) fallen in previous year. 9 (6%) history of syncope / pre-syncope. 18 (11%) orthostatic hypotension. 124 (79%) culprit medications. Recommendations: GP review of history 6 (4%) or medications 13 (8%); referral to secondary care falls service 1 (0.5%); optician assessment 58 (37%); DXA 13 (8%). 131 (83%) referred to Steady On; 119 (91%) attended first class, 61 (51%) completed classes. Mean initial TUG 11 seconds, mean improvement 3 seconds. Mean initial STS 11 repetitions, mean improvement 3 repetitions. Mean patient feedback score 14.6/15 (15 best). GP feedback positive. Conclusions SFBIS was effective in identifying the target population and engaging them in community-based strength and balance exercise classes. Meaningful improvements in physical performance were demonstrated. A smaller number of additional risk factors were identified. There was a high level of satisfaction from patients and GPs. Wider implementation would increase participation in evidence-based community exercise.