Falls Assessment, Prevention and Management
Falls and fear of falling can have a significant impact on an older person’s health and wellbeing, ability to participate in social activities, and overall quality of life. People aged 65 and over have the greatest risk of falling, with 30% of those older than 65, and 50% older than 80 falling at least once a year (NICE, 2013). Falls are not an inevitable part of ageing, but older people are more vulnerable and likely to fall especially if they have a long-term health condition. The likelihood of having a long-term health condition increases with age, and a fall can be a symptom of frailty. It is therefore important to have effective falls assessment, prevention and management processes and pathways in place.
The Falls Risk Assessment Tool (FRAT) is a first level screening tool of 5 questions relating to falls risk. A positive response to three or more questions indicates the need for further assessment. The FRAT should be completed for older people aged 65 years and over, and reviewed in Primary Care at least annually, or sooner if there is a change in the person’s physical or medical status that is likely to increase their risk of falling.
Completion of the FRAT or a clinician’s clinical judgement may indicate that a person is at risk of falls and requires further assessment. A multifactorial falls risk assessment identifies an older person’s individual risk factors for falling. It is likely that there will be a combination of risk factors that will contribute to the falls risk. For registered healthcare professionals in Primary Care, refer to the Collaborative Care and Support Planning (CCSP) template for the falls risk assessment, and considerations for advice and interventions to support reducing a person’s risk of falls and associated injury or long lie.
The NICE Falls Guidance (NICE Clinical Guideline 161, 2013) highlights that a multifactorial falls risk assessment may include the following:
- Falls history
- Assessment of gait, balance, mobility and muscle weakness
- Assessment of osteoporosis risk
- Assessment of perceived functional ability and fear of falling
- Assessment of visual impairment
- Assessment of cognitive impairment and neurological examination
- Assessment of urinary incontinence
- Assessment of home hazards
- Cardiovascular examination and medication review