Falls

Falls and fractures are a common and serious health issue faced by older adults. Around one in three people aged 65+ and half of people aged 80+ will have at least one fall per year.  Having a fall can cause a person to lose their independence and may even lead to a need for long-term care. After a fall, the fear of falling can also lead to greater inactivity, loss of strength, loss of confidence and a greater risk of further falls (National Institute for Health and Care Excellence). 

In 2024, there were 22 million people (2 in 5 people) aged over 50 in England, a number that is rapidly increasing. This number is expected to rise by 19.3% between 2024 and 2044 (an increase of 4.3 million people), with those aged 85+ increasing most rapidly (State of Ageing Report, 2024). 

The impact of falls on healthcare costs is significant. In the UK, falls are estimated to cost the NHS more than £2.3 billion per year (Source: NICE). In England alone, over 200,000 people aged 65 and over are admitted into hospital per year because of a fall, and nearly 60,000 people are admitted because of hip fractures (Source: BMJ).  The causes of having a fall are multifactorial, but many can be prevented. Key risk factors for falls include: a history of falls, muscle weakness, poor balance, visual impairment, polypharmacy, the use of certain medicines, and environmental hazards. 

The most common places for older people to fall are in their home, in hospitals, or at a place of residential care. The risk of falls can be mitigated by a number of interventions including: strength and balance exercise programmes, home hazard assessments and interventions, vision assessment and referral, or a medication review with modification/withdrawal of medicines (Source PHE). 

• NICE Guideline: Falls: assessment and prevention in older people and in people over 50 at higher risk [NG249]  – (Published April 2025) reviews risk of falls and interventions to prevent falls in all people aged 65 and over, and people aged 50 to 64 who are at higher risk of falls. It aims to reduce the risk and incidence of falls, and the associated distress, pain, injury, loss of confidence, loss of independence and mortality. 

• NHS RightCare Frailty Toolkit; provides resources to support common risks of falls and supporting older people living with frailty. 

• Office for Health Improvement & Disparities (OHID)- Falls: applying All Our Health – GOV.UK. (Updated 25 February 2022) Guidance on falls prevention best practice. 

• Lincolnshire Older Peoples Five Year Strategy_2023_28 incorporates falls prevention and frailty among the key considerations for supporting older adults in Lincolnshire. 

• Embedding prevention into all pathways across health and care forms one of several cross-cutting themes within the Lincolnshire Joint Health & Wellbeing Strategy. Physical activity is one of 7 key priorities within the strategy. 

The estimated population of Lincolnshire in 2025 was just less than 790,000, with just under 190,000 (24%) people aged 65+ (Source: ONS). Around 51,000 people in Lincolnshire are expected to experience a fall each year, a figure projected to rise by 39% over the next 20 years due to the county’s ageing population, which already has a large proportion of residents over 65 (Source: Projecting Older People Population Information System (POPPI)). The number of emergency admissions for falls (65+) has increased in recent years, however, remains significantly lower than the England level. Within Lincolnshire between 2023/24, there were 1,873 (per 100,000) emergency admissions due to a fall, lower than the England level of 1,984 per 100,000 (Source: Fingertips | Department of Health and Social Care). However, hip fractures in the 65+ is currently significantly higher than the England level (per 100,000). In 2023/24, hip fractures in Lincolnshire increased from 569 per 100,000 (2022/23), to 594, taking it significantly higher than the England level of 547 per 100,000. The Lincolnshire level has not been below England since 2015/16 (Source: Fingertips | Department of Health and Social Care). 

People living in more deprived areas are more likely to have multiple long term conditions, a lower level of physical activity, and unsuitable housing conditions, all of which contribute to an increased risk of falls (Source OHID). Risk factors such as: visual impairment; cognitive impairment; sedentary lifestyle, or multiple medications (polypharmacy) are more likely to be present in people with learning difficulties than the general population of similar age, placing this group at increased risk of experiencing a fall (Source: Public Health England).  

Prevention 

Across Lincolnshire there are a number of preventative plans and services in place to support the awareness and avoidance of falls occurrence. 

The Lincolnshire Older People’s Five-Year Strategy (2023-2028) has been developed to proactively address the needs of the aging population, particularly those living with frailty. The strategy aims to enhance the quality of life for older adults by providing integrated, proactive care and addressing the specific needs of the aging population in Lincolnshire. 

Key Objectives 

• Proactive Care: emphasise preventive measures to reduce health inequalities and promote healthy aging, ensuring that older adults receive personalised, patient focused care closer to their homes. 
• Integrated Services: create a seamless experience for older adults, allowing for easier access to necessary support and assessments.
• Collaboration: health, social care, public health, and third-sector organizations working together to deliver comprehensive care tailored to the needs of older individuals.

Strength and Balance is a 24-week programme, to support older adults who are risk of falling to improve their mobility, strength and confidence, through a range of evidence-based exercises using a Falls Managed Exercise (FaME) model. The programme is delivered by the Integrated Lifestyle Service provider and is delivered across the county in a range of community settings. 

The programme began as a two-year pilot in 2023, before forming part of the main integrated lifestyle service for Lincolnshire. Delivered by trained Postural Stability Instructors (PSIs) the programme has already supported over 500 adults, with evaluation findings demonstrating significant improvements in functional movement tests, quality of life, and a reduction in falls and fear of falling. 

Connect to Support provides people with a range of options on how healthcare, support, and community services can be accessed. The site includes an online directory of providers and services (like local exercise classes) alongside information and advice to support prevention and self-care. 

Within the Lincolnshire Integrated Care System (ICS), falls prevention forms part of the Ageing Well programme, and is linked to the Neighbourhood Frailty programme and the ‘Enhanced Health in Care Homes’ (EHCH) programme. 

The Falls programme seeks to proactively identify and manage the needs of those at risk of falling, and improve the response following a fall, to reduce harm. The proactive falls element of the programme is delivered through the Frailty Neighbourhood teams to identify and risk stratify those at risk of falling in the person’s own home and in care home, and proactively assess and manage their needs to reduce risk of falls. Focused work in care homes will progress through the EHCH programme.  Through this approach, the proactive falls pathway will be embedded across Primary Care Networks (PCNs), using data and intelligence to map variation and identify improvement opportunities. The responsive falls element seeks to standardise the responsive falls pathway by optimising and aligning existing service offers. 

Response 

There are also a range of responsive services available across Lincolnshire. 

Since October 2021, Lincolnshire Community Health Service has offered two-hour urgent community response to adults who are at immediate risk of hospital admission, in line with the NHS national standards. Falls with no apparent injury, but where care support is required within two hours to prevent hospital admission, are among the common clinical conditions that may lead to a patient needing this service. The multi-disciplinary team consists of Advanced Clinical Practitioners, Paramedics, Nurses, Physiotherapists, Occupational Therapists, Therapy Assistant Practitioners and Therapy Assistants, and covers the whole of Lincolnshire, operating 7 days a week.

Staff at care homes are offered support through the dedicated phone number to Clinical Assessment Service (Enhanced CAS) in unpredictable circumstances like falls (when a patient is no longer on the floor). CAS teams can provide advice to staff, issue remote prescriptions, refer to GP or A&E department, or contact the ambulance service, if required. 

LIVES 

The Falls Response Service, delivered by a commissioned service Lincolnshire Integrated Voluntary Emergency Service (LIVES), provides vital assistance to people who have experienced a fall. Operating across Lincolnshire, three dedicated falls teams are deployed to respond to incidents. Each team consists of two highly trained responders travelling in specially equipped vehicles. 

These vehicles are staffed by responders trained to at least First Response Emergency Care (FREC level 3), with additional training in fall-specific competencies including, referrals, manual handling and wound care.

The Falls responders are supported by a range of services including Community Emergency Medicine Service (CEMS), East Midlands Ambulance Service (EMAS) and the Clinical Assessment Service (CAS). This enables the patient to be seen by the right service at the right time and ensures that patients receive the most appropriate and effective treatment and follow-up after a fall.

AGE UK

Age UK Lincolnshire provide a rapid falls response through two key services: 

• HART (Hospital Avoidance Response Team) offers up to 72 hours of home-based support, including assistance with bed transfers, bathing, catheter care, medication management, and non-injury falls lifting using specialist equipment, aimed at preventing unnecessary hospital admissions or enabling safe discharge.  This is an out of hours service offered through the UCR/EMAS/CAS Team. 
• Response Service operates 24/7, responding to personal alarm (Lifeline) activations. Staff attend to non-injury falls, conduct initial wellbeing checks, and escalate appropriately if medical review is needed. This is a private service paid by the individual. 

These services can help to maintain independence and prevent escalation. 

Ongoing support 

The Wellbeing Service is a countywide service supporting adults in Lincolnshire to live independently through a range of supporting offerings for eligible adults. 

These could include small aids and minor alterations for daily living, support to manage and maintain a warm and safe home, opportunities to learn and develop life skills, such as budget planning, digital skills and using technology. This could also include potential education, training and identifying opportunities to work, including voluntary work, and building social networks. 

The service provides assistance to those living with long term health conditions, to help them maintain and improve their quality of life. 

Wellbeing Response is an additional service that brings 24 hour support to people who have telecare monitoring but no relative or friend who could respond to a telecare activation (Fees apply to this service). 

Falls Ambassador Programme – Lincolnshire Care Association (LinCA) currently provide a falls ambassador programme, to support health and care professionals with championing good practice within their settings for falls response and providing a forum to support idea sharing and communication with other like-minded professionals. Across 2024/25, this programme saw over 300 ambassadors complete the one-day course. 

East Midlands Ambulance Service (EMAS) is the primary emergency medical provider delivering emergency 999 care and clinical assessment telephone services in Lincolnshire. There are several additional partnership services and projects responding to people who may have experienced a fall in the county. 

Lincolnshire County Council Adult Care provides support for people with ongoing, long lasting health issues or disabilities, with the aim to maintain or increase independence. The Occupational therapy service can advise of actions to take in order to make a home safer by installation of minor adaptations like handrails or ramps. Depending on individual financial circumstances, funding may be available for major adaptations through Disabled Facilities Grants (DFGs). 

Community Physiotherapy and Occupational Therapy provide assessment, diagnosis and treatment for those with complex needs that are best met within their home environment. Interventions include falls assessment, exercise programmes, home risk assessment and the provision of equipment. The Musculoskeletal Physiotherapy Service supports recovery after an accident or surgery. 

Vision assessment is a key intervention in falls prevention and can be offered by a wide range of community opticians (NHS). The Lincolnshire Sensory Service provides specialist information, guidance, and support for anyone in Lincolnshire living with sight and/or hearing loss. The ophthalmology department at United Lincolnshire Teaching Hospitals NHS Trust (ULTH) diagnoses and treats a wide range of eye conditions. The Trust employs Eye Clinic Liaison Officers (ECLO) across the Lincolnshire sites to provide advice and support for anyone affected by sight loss. 

Urinary incontinence is also associated with increased risk of falls. In Lincolnshire, the continence service is provided by the Lincolnshire Community Health Service.

Community and stakeholder views are embedded across many aspects of the falls prevention work programmes, with ongoing work taking place to ensure ongoing conversations and communication. 

As part of an evaluation conducted by the National Institute for Health and Care Research (NIHR) Public Health Intervention Responsive Studies Team (PHIRST), the Strength and Balance programme in Lincolnshire was reviewed and evaluation completed in October 2024. The evaluation used the views of participants who took part in the programme, the commissioners and delivery partners to discover the impact and effectiveness of the programme in preventing falls and improving fitness and quality of life for those aged 65 and over. Over the 24-week programme, functional measures improved, completers saw a reduction in falls and fear of falling and a significant improvement in quality of life was seen. 

There have also been a number of falls prevention events taking place across the county, many of which were co-produced with local residents, in an effort to raise awareness and educate local communities on the risks associated with falls and the support available to help reduce likelihood and frequency of falls. 

Conversations and engagement events have been taking place on an ongoing basis in care homes across Lincolnshire since Spring 2025, capturing feedback from staff and teams on existing access of services, including hospital avoidance and responsive and proactive elements of the existing falls pathway. This engagement will help to shape and inform the development of the pathway, to reinforce and raise awareness of services that are available to support care homes and their staff.

With the Lincolnshire population of adults aged 65+ estimated to see a substantial rise across the next 20 years, and the number of falls anticipated to increase by up to 36%, there is a clear need to continue to expand and develop existing services to support falls prevention across the county. (Source: DPH Annual Report, 2023) 

As part of the evaluation completed by the PHIRST programme in October 2024, the recommendations from this can be used to shape any future potential offers for falls prevention interventions.

There is currently ongoing work with neighbourhood frailty teams across Lincolnshire, supporting early identification and proactive management of residents deemed at risk of falls and frailty.

• Lincolnshire County Council have commissioned a Strength and Balance falls prevention programme as part of the current Integrated Lifestyle Service, commencing from September 2025 until the end of September 2026. 
• The Falls Ambassador Programme, as set up by LinCA, will continue to be available, with existing Falls Ambassadors meeting on a regular basis to discuss ideas for innovation and improvement across different care settings. 
• A research pilot will be taking place across the next four years to establish learnings in Domiciliary Care and supporting carers in response to falls. The pilot will be led by the University of Nottingham working with domiciliary care providers, including representation from Lincolnshire. 
• There will be significant learning from Population Health Management to be applied across the system to inform future work to prevent falls. 
• Digital resources with information and advice for both professionals and public will continue to be developed in the county. 
• There is a recognised need to arrange services and support into a seamless pathway ensuring ongoing personalised care that addresses a wide range of patients’ needs in an integrated way. This will also be supported by Neighbourhood teams and Primary Care Networks (Neighbourhood Frailty Model) 
• The Lincolnshire Older People’s Strategy 2023-28 will be implemented across the next 3 years to maintain continued development of work to support older adults across the county. 
• There will be a sustained roll out and review of the Falls Pathway for Lincolnshire among Health and Care professionals to support a joined up approach to falls prevention and response.