Quality statement 8: Strength and balance training

Quality statement

Older people living in the community who have a known history of recurrent falls are referred for strength and balance training. [2015]

Rationale

Balance impairment and muscle weakness caused by ageing and lack of use are the most prevalent modifiable risk factors for falls. Strength and balance training has been identified as an effective single intervention and as a component in successful multifactorial intervention programmes to reduce subsequent falls. It is important that strength and balance training is undertaken after a multifactorial falls risk assessment has been completed.

Quality measures

Structure

Evidence of local arrangements to ensure that older people living in the community who have a known history of recurrent falls are referred for strength and balance training.

Data source: Local data collection.

Process

a) Proportion of older people living in the community with a known history of recurrent falls reporting to their GP who are referred for strength and balance training.

Numerator – the number in the denominator referred for strength and balance training.

Denominator – the number of older people living in the community with a known history of recurrent falls reporting to their GP.

Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises: report of the national audit of falls and bone health includes questions on strength and balance training within the section on Organisational audit results, section 5.4: Interventions for falls prevention. Contained within the Royal College of Physicians' Fracture Liaison Service Database.

b) Proportion of older people living in the community who report recurrent falls to a healthcare practitioner in hospital who are referred for strength and balance training.

Numerator – the number in the denominator referred for strength and balance training.

Denominator – the number of older people living in the community who report recurrent falls to a healthcare practitioner in hospital.

Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises: report of the national audit of falls and bone health includes questions on strength and balance training within the section on Organisational audit results, section 5.4: Interventions for falls prevention.

Outcome

Rates of recurrent falls in older people.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as specialist falls services, district general hospitals, community health providers, independent sector providers and charities) ensure that staff are trained to deliver and monitor strength and balance training programmes for older people living in the community who have a known history of recurrent falls.

Health and social care practitioners are aware of local referral pathways for falls and ensure that older people living in the community who have a known history of recurrent falls are referred to a service that has staff who are trained to deliver and monitor a strength and balance training programme.

Commissioners (clinical commissioning groups and local authorities) ensure that they commission services that have the capacity and staff who are trained to deliver and monitor strength and balance training programmes for older people living in the community who have a known history of recurrent falls.

Older people living in the community (for example, in their own home or in sheltered or supported accommodation) who have fallen more than once in the past year have the opportunity to see an expert who will help them start a programme of exercises (sometimes called 'strength and balance training') to build up their muscle strength and improve balance. These exercises will be designed specifically for them, and the expert will check how they are getting on.

Source guidance

Definitions of terms used in this quality statement

Fall

A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground, or an object below knee level.

[NICE's clinical knowledge summary on falls – risk assessment]

Older people living in the community

Community settings include:

  • people's own homes and other housing, including temporary accommodation

  • extra care housing (such as warden supported, sheltered or specialist accommodation)

  • Shared Lives Scheme (formerly Adult Placement Scheme) living arrangements

  • supported living.

[Expert opinion]

Recurrent falls

Recurrent falls is defined as falling twice or more within a time period of 1 year.

[Expert consensus]

Strength and balance training

A strength and balance training programme should be individually prescribed and monitored by an appropriately trained professional.

[NICE's guideline on falls in older people: assessing risk and prevention, recommendation 1.1.4.1, and expert consensus]