Reduction of frailty-related falls and fractures
For older people living with frailty, a fall or fracture can result in a rapid deterioration in health and significant loss of independence. There are approximately 65,000 hip fractures taking place in the UK each year, costing the health and social care system around £2billion. It is imperative that systems are in place to help identify people who are at risk of falls and fractures to ensure there are appropriate treatment and services that meet their needs.
The Health Innovation Manchester project aims to reduce falls and fractures related to frailty across Greater Manchester through early intervention, treatment and management of at-risk patients. The project will support primary care by finding at-risk patients so that they can be treated with appropriate bone-sparing therapies, including medication to strengthen bones, and supported with services in the community to help manage their condition.
Through early and increased identification of osteoporosis and other high-risk patients, the established use of fracture risk assessment tools in primary care and patient behavioural and lifestyle changes through education programmes, it is hope there will be a reduction in fractures and associations costs.
Phase one is being undertaken in Tameside and Glossop Locality with the Dukinfield, Stalybridge and Mossley Frailty Multidisciplinary Team (MDT) pilot launched on 31 January 2018. It has been set up as a vehicle to support the identification, review and management of severely frail patients using the electronic Frailty Index and fracture and falls risk assessment IT tools.
Once a patient is identified as being severely frail the MDT members discuss and agree on a set of appropriate outcomes and actions to suit the needs of the patient which can include several clinical and non-clinical interventions such as referrals to community groups, physiotherapy, Community Response Service, Extensivist service, social prescribing, prescription of bone strengthening medication, etc. Eight weeks after the MDT meeting a follow up is carried out to ensure that all agreed outcomes and actions have been achieved.