The National Falls and Bone Health Audit: implications for UK emergency care.

INTRODUCTION: The National Clinical Audit of Falls and Bone Health, coordinated by the Royal College of Physicians, assesses progress in implementing integrated falls services across the UK against national standards and enables benchmarking between service providers. Nationally, falls are a leading contributor towards mortality and morbidity in older people and account for 700,000 visits to emergency departments and 4 million annual bed days in England alone. METHODS: Two rounds of national organisational audit in 2005 and 2008 and one national clinical audit in 2006 were carried out based on indicators developed by a multidisciplinary group. RESULTS: These showed that management of falls and bone health in older people remains suboptimal in emergency departments and minor injury units and opportunities are being missed in carrying out evidence-based risk assessment and management. CONCLUSIONS: Older people attending emergency departments in the UK following a fall are receiving a poor deal. There is an urgent need to ensure more effective assessment and management to prevent further falls and fractures.

Is urinary continence considered in the assessment of older people after a fall in England and Wales? Cross-sectional clinical audit results.

OBJECTIVES: To investigate adherence to the urinary function assessments of the national falls guidelines for England and Wales. STUDY DESIGN: Secondary data analysis of the 2006 National Clinical Audit of Falls and Bone Health. SETTING: Acute hospitals in the UK. PARTICIPANTS: Patients aged 65 years and older with a fragility fracture as a result of a fall. MAIN OUTCOME MEASURES: Data were analysed to determine whether patients with fragility fractures received an assessment of urinary function including continence status; whether impairment was detected and if action was taken to prevent continence related falls. RESULTS: 63% (2009) of 3184 patients were assessed for urinary continence following a hip fracture and 41% (817) of these identified a problem. 21% (1187) of 5642 patients with nonhip fragility fractures were assessed and a problem was found in 27% (316). Hip fracture patients were more likely (p<0.0001) to receive a continence assessment and have problems detected. Only about half of those with problems had any intervention or a referral to a continence service. Admission to hospital for nonhip fracture patients was a strong predictor of being assessed (p<0.0001). CONCLUSION: Rates of assessment and action for those with who fall and have continence problems are low despite current national guidelines.