Label Info
1.00 Fall +/-  
1.10 Case finding for falls & fractures  

If 1 fall & no gait / balance problems no action (NICE). Tx in this pathway for all fracture pts eg wrist / arm / vertebra / ankle
1.20 Incidence & Prevalence   Needs sufficient service provsion to reduce falls & fractures & related admissions & expenditure at population level
1.30 Primary Prevention & Self Care  

Alarm raising or training on how to get up

Reporting proformas / systems for non call to services but where an old  fragility fracture may be present

Passage of information critical from home to health & social services

1.40 Local Falls Service   e.g.Local Enhanced Service (LES)

Prescribe calcium & vit D in care homes. Case management for frequent flyers who are often frequent fallers
1.60 Escalation thresholds & decision aids  
1.70 Red Flags  
2.00 Initial Assessment  

Currently no QOF incentives for falls / fractures / fragility

Assessment can happen in a variety of settings as long as professionals have appropriate skills training supervision & ability to refer to other services 

Medical assessment eg pulse, BP. Previous fragility fracture

Assess home hazards & footwear 

 
2.10 Decision aids  

DXA scan protocol for direct access - further action depends on finding of initial assessment use local protocol for specialist assessment
2.20 Diagnostics (Dx)   2.2.3 DXA scan result should also come with specialist clinical advice
2.30 Decision aids  
2.40 Treatments (Tx)   2.4.1 Reassurance may include psychological support
2.50 Pro-active PCT & patient led ongoing prevention strategies  

PCT may benefit from commissioning regular proactive review & adjustment of medication plus GP input

Skills sets to run group exercise with frail older adults are required REPS
2.60 Escalation Thresholds & Remote advice   Consider need for specialist investigations / assessments
2.70 Red Flags  

Possible exit to

eye clinic / orthopaedics /

psychiatry / neurology / ENT
3.00 Specialist Falls Assessment & Treatment  

Service can be MDT / physio led / fracture liason service

Secondary prevention for bone # should be part of this service. The service may be an integrated falls & bone health service
3.10 Decision aids   FRAX if not used at 2.10
3.20 Diagnostics (Dx) & Assessments (Ax)  

3.2.2 ECS European Cardiac society guidelines on investigation & management of syncope

Tests may include tilt table testing, carotid sinus studies, loop recorders for selected pts
3.30 Treatment thresholds  
3.40 Definitive Treatments (Tx)  

3.4.5 Drug therapy for specific conditions eg parkinsons, epilepsy, dementia
3.50 Compliance support  
3.60 Escalation thresholds & decision aids  
4.00 Specialist Bone Health Assessment & Treatment Service  

Include:

- Painful multiple vertebral fractures & other bone diseases eg Paget's & oesteomalasia

- Non responders to osteoporosis Tx ( Primary Tx)

- Complex causes of oesteoporosis eg malabsorption, post transplantation, endocrine causes
4.10 Decision aids  
4.20 Diagnostics (Dx)   4.23 British Pain Society
4.30 Treatment thresholds & decision aids  
4.40 Definitive Treatments (Tx)   4.42 Second line therapies for complex / non responsing disease eg IV bisphosphonate, subcut parathyroid hormone peptides & strontium orally
4.50 Rehabilitation, Review & QoL measurement   Link to ProFaNE for examples of local PCT strategies for falls & bone health
5.00