The fear of falling can very real for fragile elderly people living alone.

ANDREW HITCHON reports on two new schemes designed to ease such worries

It was a perfectly ordinary day for Lilian Eden, until she made one simple slip that was to cast a shadow over her life for most of a year. Lilian, who is 77 and partially-sighted, was walking up the steps at the side of her home when she trod on something - a cobble, perhaps - and fell on the asphalt steps.

"It was so horrendous," she said. "A lady came and helped me up and I struggled into the house.

"That was about 4pm. I was suffering until about 9pm, when I rang my daughter and she got me to call an ambulance."

It turned out she had suffered three fractures - two to her knee and one to her hand.

Lilian, from Acomb in York, spent a week in York District Hospital recovering. But the pain of her broken bones and subsequent treatment paled beside what happened next.

Just days after getting out of hospital she was sitting at home when a growing pain in her back became so unbearable that she had to call an ambulance again. The result was another three weeks of treatment in the YDH - this time for a thrombosis which may have been caused by her original accident.

She said: "I was in terrific pain. I thought I was dying, I have never been in so much pain."

Lilian has nothing but praise for the treatment she received while at the hospital. She says she made a rapid recovery from her original injuries and was determined to exercise and regain her independence. But she still suffered a loss of confidence, and a depression which lasted about nine months. "I could cry at the drop of a hat," she said.

It wasn't until last Christmas that the cloud finally lifted. "It was like having a pair of curtains closed over you, then all at once they moved and I felt free," said Lilian.

Lilian is a vigorous and independent 77-year-old. But her story illustrates how easy it is for an elderly person to sustain serious injury from a simple fall.

District Nurse and fall prevention co-ordinator Sue Brown says while for young people the consequences of a fall can be shrugged off quickly, for elderly people they can be much more serious - with repercussions far beyond the immediate pain of their injuries.

Experts say the fragility of elderly people's bones makes serious breaks more likely. Elderly people who suffer serious fractures of the hip may end up needing a hip replacement - a major operation. Even those for whom the consequences are not so severe could find themselves developing a painful thrombosis - effectively a blood clot in a vein - as a result of their enforced immobility.

Because of the serious consequences of a fall, the fear of falling itself can put a real blight on elderly people's lives, Sue says. That's why two new York initiatives to reduce the risk of falling and ease the fear are so important.

In one pilot scheme which began this month, Sue Brown will spend the next nine months working with patients of two GP practices in the Clifton area to find practical ways to prevent accidents.

Meanwhile, another pilot scheme due to finish in late spring focuses on exercises for elderly people which build up muscle strength and confidence and improve balance.

In the first scheme, Sue will visit elderly people's homes to assess the risks they face, using a checklist drawn up from national evidence on accident causes. It can focus on personal health, and risks in the home environment.

The checklist also includes fire and security hazards, befitting a joint project involving different groups with common objectives. Remedies can include referrals for medical treatment, providing mobility aids, or improvements such as hand rails on stairs.

The pilot, funded by York Primary Care Group (PCG), the Health Education Authority and the Clifton Regeneration Project, is part of the Better Government for Older People initiative in York. If successful, it could be extended across the city.

Jeff Wheelwright, project director for the Better Government for Older People Initiative, said part of the project's ethos was making sure action followed once a problem was identified.

"It's about making a difference, it's about being proactive rather than just waiting to pick up the pieces," he said.

Meanwhile, in a separate joint initiative between City of York Council leisure services and the North Yorkshire specialist health promotion service, exercises to help build up muscle strength and confidence and improve balance are being run at sites in Fulford, Tang Hall, Clifton and Acomb.

Health promotion adviser Janet Flanagan, who is also on the steering group for the fall prevention scheme, said national evidence suggested risk assessment and intervention could reduce falls by 50 to 60 per cent - important when between a third and a half of over-65s had at least one fall a year.

Age Concern worker Carol Knight, who has introduced the exercises into some of her day clubs, said if people improved their fitness and co-ordination, they would suffer fewer injuries after a fall.

Taken together, the new initiatives could see fewer elderly people such as Lilian ending up in hospital as a result of unnecessary falls.

For more information about the home visit scheme write to Sue Brown at the Clementhorpe Health Centre, Cherry Street, York YO23 1AP. For information about how to prevent falls contact your local GP.

PICTURE: Lilian Eden at the point where she fell near her home in Acomb