Re-contact rates with a UK ambulance service following paramedic referral to a falls prevention service for those aged ≥ 65 years: a retrospective cohort study

BACKGROUND: Falls in older populations constitute a large proportion of the workload for UK ambulance services, and cost the NHS over £2.3 billion per year. A large proportion of older fallers are not conveyed to an emergency department (ED), representing a vulnerable group of patients. New pathways have been developed for paramedics to refer this group directly to falls prevention services. OBJECTIVES: This study aimed to investigate the re-contact rates and characteristics of service users aged ≥ 65 years who fell and were referred to a falls prevention service by paramedics, and to describe the characteristics of those who re-contacted the ambulance service after referral. METHODS: A retrospective cross-sectional cohort study was carried out in the geographical area covered by the South Eastern division of the Northern Ireland Ambulance Service (NIAS) between 1 July and 30 September 2017. The primary outcome was the rate of subsequent contacts with the ambulance service following referral. RESULTS: There were 1079 incidents of falls in service users aged ≥ 65 years. A referral rate of 7% (n = 75) was reported, constituting the study cohort. Re-contact rates were 37.3% (n = 28) within 1 month and 70.7% (n = 53) within 6 months. Women and those exposed to a ‘long lie’ were more likely to re-contact, while those with cognitive impairment appeared particularly vulnerable to falls and repeat falls. Repeat falls were common. Documentation by attending clinicians was generally poor. CONCLUSION: Future research should investigate the efficacy of paramedic referral to falls prevention services. Interventions targeted at reducing long lies and investigating optimal interventions for those with cognitive impairments should also be explored. Improving clinical documentation will facilitate future research.