According to the National Institute for Health and Care Excellence, the over-65s is the group at the highest risk of falling, with more than half of the over-80s collapsing at least once a year.
In 2016, healthcare think tank the King’s Fund estimated that falls accounted for nearly 40% of all ambulance callouts for people aged 65 and over.
With an ageing population and falls being one of the main reasons older people occupy a hospital bed, London Ambulance Service NHS Trust (LAS) decided it was time to improve support for this patient group and reduce pressure on both hospitals and the ambulance service.
The issue
Each year, falls make up around 11% of the reason behind calls to LAS. The ambulance service calculates that every ‘call-out and convey to hospital’ costs around £300.
LAS says an ageing population means falls are among the ‘most common reasons’ people call the ambulance services, explaining that the total number of calls related to falls are expected to increase to around 133,400 by 2023 — a 10% increase on 2017/18.
The solution
Partnering with national voluntary organisation the Royal Voluntary Service, LAS designed a pilot to cut emergency calls and A&E admissions in two London boroughs – Merton and Hackney – chosen for their high patients demand.
The ‘active ageing pilot’ ran for seven months, from November 2017 to May 2018. Under the scheme, older people who were more likely to fall and call 999 were referred to the Royal Voluntary Service, which in turn paired them with local volunteers.
A total of 34 volunteers were enlisted to visit patients and work with them at home for six to eight weeks. The volunteers conducted one-on-one chair exercises and advised patients on how to stay hydrated and adopt a good diet.
The exercises comprised two tests; sit to stand (STS) and timed up and go (TUG), which, an LAS spokesperson comments, are standard ways to measure physical function.
LAS explains that an STS test measures the number of sit to stand exercises a patient can do in 30 seconds providing, a ‘good measure of lower extremity function and ability to do personal care tasks such as going to the toilet’.
The TUG test is a timed activity that requires participants to stand up from a chair, walk a length of three meters and return to sitting down.
After the volunteers’ visits, the patients were supported to transition into community-based exercise programmes or other local activities to help them ‘build and maintain their social connections’, LAS says.
The outcome
A total of 76 referrals were received from LAS and community falls teams working in partnership with the ambulance service. At the end of the pilot period, participants reported improved physical function and greater wellbeing, resulting in fewer emergency calls and A&E admissions.
Among the patients that took part, 31 very frail patients – the majority of whom were over 85 – completed the full programme.
Key findings (among the 31 patients, six weeks prior to and following the volunteers’ intervention):
- 61% had fallen once or several times. This decreased to 19%.
- 58% had called 999 due to one or more falls. This dropped to 13%.
- 48% had visited A&E. This fell to 19%.
- 60% improved on a 30-second STS test.
- 70% found it easier to walk and gained gait speed in the TUG activity.
- More than one in four felt their health had improved.
- Over a third said they were happier and more confident.
- One in four felt less lonely.
Based on the standard cost of sending an ambulance from hospital to a patient’s home in London, preventing just nine patients (referring to the drop from 48% to 19% among the 31 patients) from going to A&E saved around £2,700.
The future
LAS says it is ‘currently developing a volunteering strategy’. The spokesperson adds: ‘It’s our hope that this type of model, working with third sector partners, developing local community volunteers, will be something that is developed going forwards.’
Commenting on the pilot, LAS deputy director of nursing and quality Briony Slope says: ‘Recruiting local volunteers to support frail, often socially isolated people within their community has been extremely rewarding for everyone involved.
‘By working in a partnership like this, that works across traditional, organisational boundaries, we are able to better connect communities and improve people’s quality of life.’
London Ambulance Service is the busiest emergency service in the UK, employing around 5,500 people in 70 ambulance stations across London.
Royal Voluntary Service is one of the country’s largest volunteering charities, with more than 20,000 volunteers supporting thousands of people every month in hospital and in the community.
