Background
Falls are a challenge for older people and a significant and costly cause of injury. The original AFFINITY project commenced in 2013 to deliver the vision described in the National Strategy for Prevention of Falls and Fractures in Ireland’s Ageing Population. The senior stakeholders agreed in the latter half of 2016 that the project needed to be re-focused in light of changes in HSE structures and the need to significantly scale up implementation of falls and fracture prevention.
AFFINITY 2018-2023 has been set up to bring renewed focus, coordination and clear direction to the spectrum of falls and fracture prevention service improvement initiatives currently underway in the community and within acute services across the country.
Aim
Reducing harm form falls requires not just a single discipline or service but rather a whole community and a range of services including health services. The aim of the AFFINITY National Falls and Bone Health Project (2018-2023) is to coordinate the development of a comprehensive falls and fracture prevention system. Such a system involves all parties focussing on a common agenda of reducing falls and fractures and their impacts by bringing together & integrating primary prevention, secondary prevention and rehabilitation as well as measuring outcomes collectively.
The intent is to increase awareness of the preventable nature of falls and to enable older people, communities and health and social care providers to reduce the risk and rate of falling where possible, to reduce the severity of injuries and to promote the best possible outcomes for people who have suffered a fall-related injury.
An integrated falls and fracture prevention system incorporates the following elements.
- Promotion of falls prevention activities in well older people e.g. evidence-informed community-based exercise programmes that address balance and strength.
- Building community capacity for identifying and responding to those people within or moving into the at-risk group for falls
- Development of an integrated clinical care pathway for assessment and treatment of those who have fallen
- Evidence of prevention for older persons at high risk of falls such as in continuing care/ residential and acute services.
Lifelong optimisation of bone health and fracture liaison services for secondary fracture prevention
Governance
The AFFINITY National Falls Bone Health Working Group was convened in September 2017 and has met on a monthly basis since. The group is chaired by Social Care and includes representatives nominated by:
- the National Directors of Primary Care, Health and Wellbeing, Quality Improvement, Primary Care, Social Care and Acute Hospital Division
- the National Clinical Programme for Older People
- Age-Friendly Ireland
- State Claims Agency
There is an on-going collaboration with the State Claims Agency (SCA) with day to day linkages facilitated through Irene O’Byrne Maguire, the SCA nominee to the Working Group.
Given the cross-divisional nature of the project, the steering function of the work is provided by the Integrated Care Programme for Older People (ICPOP) in preference to setting up a stand-alone steering group. This will ensure the work on falls and bone health is embedded with other aspects of integrated care for older persons.
Work plan
The programme of work is being progressed through AFFINITY project work streams as well as through strategic collaborations e.g. collaboration with the Clinical Programmes for Trauma & Orthopaedics and Rheumatology for scaling of fracture liaison services and collaboration with Age Friendly Ireland.
The work streams are feeding into the overall project deliverables which include:
- A coordinated scoping / gap analysis of existing services.
- The development of a Framework for Prevention of Falls and Harm from Falls for CHO’s and Hospital Groups.
- Identification of key development prevention priorities for falls and bone health nationally.
- Engagement with stakeholders including service users to ensure co-design.
The work streams underway include:
- Community Residential
- Independent Living / Community Supported
- Communications
Communications
Stakeholder analysis and a communication plan have been completed and are being progressed in collaboration with Director of Communications for Social Care.
Links are established with Scottish and New Zealand national falls projects to explore any transferable learning from their journey in preventing harm from falls.
The HSE, together with the State Claims Agency hosted a Symposium on the 30th October 2018 and also on the 18th September 2019 to showcase the pioneering work in falls prevention and bone health
Conclusion
If we join forces and work in partnership we can further and faster together in preventing harm from falls and supporting older people in Ireland to remain independent and to live well in their own homes- the purpose of AFFINITY is to facilitate those partnerships.
Further information on AFFINITY 2018 - 2023 is available from:
Janette Dwyer, Assistant National Director, Services for Older People, Change & Innovation,
HSE Community Services, Rathass, Tralee, Co Kerry, V92 YA25
Telephone: 066 7199762
Email: olderpeople.strategy@hse.ie
