Changes urged in NHS care of elderly patients with fractures

The study by the Royal College of Physicians examined the treatment of nearly 10,000 patients and found major variations between hospitals, as well as in services available to vulnerable patients in the community.

It found older patients with fractures were not routinely receiving key aspects of care for falls prevention or bone health, needlessly exposing them to a greater risk of further falls and fractures.

Neither emergency departments nor fracture clinics were assessing future risks to patients, suggesting they were focused on treating injuries and not their cause or reducing the chances of further serious injuries.

The audit makes a string of recommendations for improvements amid evidence problems affecting the elderly will increase in coming years as the population ages.

Falls and fractures among over-65s already cost £2bn a year, often leading to disability and loss of independence but experts say better organisation can prevent falls, reducing disabilities and deaths.

The audit says NHS services must respond to a first fracture in a patient to prevent a second.

But it warns: “Older people cannot currently be assured that their local NHS services will do this.”

Among its findings, it says only 30 per cent of hip fracture patients receive a basic care package including adequate pain relief in their first hour in hospital, care to prevent pressure sores in the first four hours and provision of intravenous fluids in the first 12 hours.

Only a third of patients with fractures of the wrist, arm, spine or pelvis have assessments for future falls risk, compared to two thirds of hip fracture patients.

Despite 94 per cent of hospitals saying they carry out a standard gait, balance and mobility assessment, only 34 per cent of non-hip fracture patients and 72 per cent of hip fracture patients receive one.

Among variations between hospitals in the region, it found at least nine in 10 hip fracture patients were mobilised as recommended within 24 hours at Scarborough, South Tees, Doncaster and Rotherham trusts but only one in five in Leeds.

No hip fracture patients from Chesterfield, Barnsley or the Calderdale and Huddersfield trust took part in an exercise programme within 12 weeks, compared with all of those treated at the South Tees trust.

Despite some improvements since the last audit in 2007, it found nationally only a third of non-hip fracture patients and two thirds of hip fracture patients received appropriate treatment for osteoporosis.

Juliette Brown, of the National Osteoporosis Society, said: “Whilst it is encouraging to see that there has been some improvement, these findings show unacceptable gaps in the provision of care that will result in needless pain, disability and premature deaths.

“As well as the human cost, we know that dedicated services to assess fracture patients for fragile bones can save the NHS money. By assessing people early, the huge cost of treating further fractures can be avoided.”

The report calls on local NHS services to commission fracture liaison services which are seen as the best way to prevent further fractures in at-risk patients.

There should also be provision of exercise programmes for falls prevention and clinics for those who have fallen or are at risk. Hospitals should also review and improve procedures for the immediate care of hip fracture patients.