Long-term conditions including frailty, cognitive disorder and multimorbidity

LTP Priority: Falls

Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service

Type of Interventions: Long-term conditions including frailty, cognitive disorder and multimorbidity

Major driver of health inequalities in your area of work

Falls, frailty and multimorbidity are strongly associated with deprivation. Despite the availability of cost-effective interventions national audits demonstrate variation in the quality and availability of falls prevention programmes. This means that there is unwarranted variation in the access to and quality of falls prevention programmes across England which should be addressed to reduce regional inequalities.

Target groups

Deprivation and Protected Characteristics: Older People


Falls prevention in accordance with NICE CG 161.


A falls and fracture prevention programme aims to ensure recognition that falls in older people are recognised not as isolated incidents but are an important public health issue associated with morbidity and mortality. Approximately 30% of people older than 65 years and 50% of people older than 80 years fall at least once a year. An audit by the Royal College of Physicians estimated that falls and fractures in people aged over 65 accounts for approximately 4 million hospital bed days in England each year. The ultimate goal of falls and fracture prevention is to support older people to remain mobile, have their needs met and continue to learn, develop, maintain relationships and contribute to society, and effective interventions exist to support this. A Cochrane systematic review of the impact of falls risk assessment and intervention found that the risk of falls was reduced by 24%. Effective commissioning for falls and fracture prevention will reduce demand and improve outcomes. Key components of falls prevention: 1. Addressing risk factors, in particular physical activity (aerobic, strength and balance) and nutrition; 2. Case finding – assessment of fracture risk; 3. Risk assessment; 4. Strength and balance exercises; 5. Assessment of home environment, 6. Fracture liaison services and collaborative approaches to managing severe injury. Workforce training and competency in risk assessment is key.

Despite the availability of a range of cost-effective falls prevention interventions, national audits demonstrate patchy coverage and variable quality of these interventions. Commissioners should be aware of this variation and seek to address this through evidence-based falls prevention programmes to reduce inequalities in service provision. There may be opportunities for joint commissioning across NHS and public health, and between community and acute services.


Guidance for Commissioners