In fact, some wait until they have fallen several times before seeking medical advice, because they believe they are experiencing an inevitable part of growing older.
The consistent failure of many pensioners to report their accidents and seek help is one of the issues being tackled in a two-year falls initiative in the health service.
Since 2007 NHS Quality Improvement Scotland (QIS) has been developing a national programme to raise the profile of falls and fracture issues among the people at risk and those responsible for their care.
Falls can make a dramatic difference to the quality of life of the elderly, and preventing them is likely to become even more important in the context of an ageing population.
Though the danger of suffering a debilitating fall is not limited to the elderly, the programme has focused its efforts with them, as they are generally more at risk and the effects can be more severe.
“As you get older falls become more frequent and the consequences of falls become more serious,” said programme manager Ann Murray.
More than a third of people aged 65 and over will fall at least once every year. That figure climbs to more than 50% of people aged above 80 years. And unsurprisingly, as the average age of the population increases, the rate of falls is also expected to surge.
However a series of focus groups with the elderly and their carers last year revealed that people who fall are often reluctant to come forward and seek help.
“Some were experiencing seven or eight falls before they turned up at the doctor or A&E with an injury,” said Ms Murray. “We want to get across the message that this is not an inevitable consequence of ageing. There is much you can do to prevent falls.”
Gathering information on the number of accidents going unreported is not easy but Birmingham-based falls specialist Dr Jonathan Treml of the Royal College of Physicians estimates that around 50% of older people who fall will not tell a healthcare professional.
Many elderly people consider such an accident to be a “recognition of frailty” and could be the first step towards a life of higher dependency on care services.
Even when an accident is reported, often it may not be acted upon, Dr Treml warns. Where a doctor knows that a person who falls has already sought treatment or advice, they may not take action over a further incident.
Those who care for elderly people may also assume that accidents in the home are inevitable, or that there is nothing that can be done.
The programme is attempting to tackle these and other misperceptions. “It’s everybody’s business,” said Ms Murray. “A carer might be in a position to identify someone who was at risk, even though they wouldn’t maybe think it was part of their duty.”
In fact, a range of interventions can help reduce the risk, and the falls team is calling for better assessments when health workers think someone may be at risk of future falls. These include strength and balance exercises, checking medication to ensure that side effects such as dizziness are not part of the problem, and home assessments to see if physical changes might help make someone safer.
Nationwide training for careworkers and other professionals about falls has been “patchy”, Ann says, and the team have been looking at ways to improve its quality.
Edinburgh doctor Jean Murray is calling for improvements in the care of falls patients as a result of the poor treatment her own mother received following two serious accidents. Dr Murray’s mother was hospitalised twice in one year after suffering falls in her Edinburgh home.
The long journey back to recovery was made more difficult because of a lack of support for the elderly woman or her family and an absence of communication between different medical and social work departments, Dr Murray says.
After the first fall in spring last year her mother was initially diagnosed with an injured wrist, but doctors eventually recognised a fractured sternum.
The return home from hospital was also a trying experience for the family, with unsatisfactory communications between hospital staff and community workers leading to a duplication of efforts. “It was just silly”, says Dr Murray, “two people from different teams were coming in at the same time to do things. They were very well meaning but they were not talking to each other.”
After a second fall a year later Dr Murray’s mother was diagnosed at hospital with a fractured pelvis, one of the most serious falls suffered by the elderly in domestic accidents.
Her daughter sought further help after promised physiotherapy treatment failed to materialise. “At the time it was just awful,” said Dr Murray. “It needs someone to coordinate the aftercare. To have one number you can ring if a physio doesn’t turn up.”
Dr Murray’s mother suffered from osteoporosis, a condition which can severely aggravate the impact of an accident.
“Osteoporosis is very common in older people,” said Ann Murray. “A lot can be done to manage osteoporosis and reduce people’s risk of breaking bones. If you have a problem with your bones, when you fall you are more likely to have a fracture.”
The National Osteoporosis Society (NOS) is also trying to raise awareness of the fact that broken bones, as a result of the condition, are not inevitable. Earlier this year NOS launched a manifesto challenging politicians to improve prevention, diagnosis and treatment of osteoporosis.
A broken hip is one of the most common, and troublesome injuries for older people who suffer an accident. More than 6,000 people in Scotland will break their hip every year, costing the NHS around £73million, not including any treatment once a patient returns home.
“Nearly all broken hips are preceded by a fall,” said Ms Murray. “It can have a huge impact on someone’s quality of life and often results in the loss of their independence.”
One of the first goals of the QIS programme was to gather as much information as possible about existing research and guidance.
The information and research gathered has been compiled into a comprehensive document entitled Up and About, which maps out the care journey of an elderly person and identifies the key stages of fall prevention.
It also includes more than 30 examples of best practice from across Scotland to inspire and encourage falls professionals. They include a management programme in Falkirk linking people with access to improved treatment if they have suffered more than one fall.
Health professionals are encouraged to communicate with each other and share advice through an online community, launched in April 2008 as part of the overarching falls programme.
More than anything, focusing on services for a person who is at risk of a fall or has become a persistent sufferer is about improving their quality of life, says Ann. “It’s about people having a more active, healthy lifestyle,” she says. “Making them stronger, safer and more confident.”
FALLS FACTFILE
Falls are the most common accidental cause of death among the over 65s.
Between 10-25% of older people who fall will sustain a serious injury.
Doctors in Scotland treat more than 6,000 broken hips every year at a cost of £73million.
10% of people who suffer a hip fracture will die within 30 days, and 30% die within a year.
Eight out of ten elderly women would rather die than experience the reduced quality of life perceived to follow a hip fracture and subsequent admission to a nursing home, according to the National Osteoporosis Society.
The number of hospital bed days for falls and fractures in people aged over 65 is four million every year in England (figures for Scotland unavailable).
