Falls and Fractures
Falls and Fractures: Information for Optometrists.
Falls are a major cause of accidental injury in the elderly. In the UK one in three people over 65 years of age will fall every year (Falling Standards*) and 90% of hip fractures are due to falls. It is accepted that falls are caused by a number of contributory factors which include gait and balance problems, underlying systemic conditions (arthritis, postural hypotension, stroke, diabetes and Parkinson’s disease), those taking sedatives, those taking multiple medications and POOR VISION. (Focus on falls**)
Role of the Optometrist
Prevention of falls requires a multidisciplinary approach to patient care. Optometrists have regular direct access to the elderly and can advise on falls prevention in relation to vision.
Optometrists can adapt their history and symptoms questioning, to include the following:***
-identify patients who present with concerns about falling/balance or who have a history of falls.
-find out when patients wear their spectacles and if they feel their mobility is affected by bifocal/
PAL wear, on stairs for example.
Management of patients at risk of falls might include;
-advising regular eye tests.
-ensuring that the correct spectacles are worn, with written advice if necessary, for carers.
-conservative changes in prescriptions (not greater than +/-0.75DS).
-avoidance of prescribing new bifocal/PALs to “at risk” patients.
-consideration of single vision distance or low add multifocals for walking around.
-refer patients who are visually impaired to have an assessment by the local falls and fracture prevention
-advise on early cataract removal or second eye surgery.
What to do if you feel a patient is at risk of falling?
Most CCG areas are developing ways to prevent falls by referring at risk patients to local Falls Teams for assessment. The Falls Team might include specialist nurses, occupational therapists and physiotherapists.
Locally “East Sussex Better Together “ which is a programme aiming to integrate health and social care in EHS, H&R, and HWLH CCGs and local groups in Brighton & Hove are developing improved services to support falls and fracture prevention in the community.
The College of Optometrists has several useful sources of information for the patient and optometrist regarding vision and falls. The College maintains a Falls directory of contact details of local Falls Teams. An information leaflet “ VISIBLE” is available, which has excellent sources of information for Opticians and other professional groups (see pdf)
Local procedures and contacts
1. Hastings & Rother, Eastbourne CCGs
Opticians can use the self referral Falls Prevention Leaflet to give to patients at risk of falls; the leaflet signposts patients to appropriate services. This is a simple effective procedure.
A referral can also be made via the HSCC (Health & Social Care Connect) website www.eastsussex.gov.uk using the HSCC Referral Form for professionals.
2. Brighton & Hove
A referral can be made by any professional with concerns. A referral form can be downloaded from the following website:
Brighton & Hove Osteoporosis and Falls Prevention Service
3. High Weald, Lewes & Haven:
A referral can be made via the HSCC (Health & Social Care Connect) website www.eastsussex.gov.uk using the HSCC Referral Form or the patient can complete a self assessment
at www.eastsussex.gov.uk/hscc .
Falls references & information
1.**The College of Optometrists www.college-optometrists.org/falls for patient leaflets and references.
Focus on Falls Report 2014
2.DOCET: The Ageing Eye
3.* Falling Standards, broken promises: report of the national audit of falls and bone health in older
people. (Royal College of Physicians ( 2011)
4. Age UK: Tel: 0800 1696565 Request “Staying Steady” leaflet
or www.ageuk.org.uk/ (under Health and Wellbeing section)
5.***Falls and vision impairment: guidance for the optometrist. David B Elliott Optometry in Practice
2012 Vol 13 Issue 2 65-76
6. NHS Choices: www.nhs.uk/conditions/Falls/Pages/Prevention.aspx
7. EHS, H&R, HWLH CCGs: Social Care Direct (SCD) Tel: 0345 6080191
For further details on services provided by SCD see