Evidence
Surveillance decision
We will update the guideline on falls in older people: assessing risk and prevention (NICE guideline CG161).
The following table gives an overview of how evidence identified in surveillance might affect each area of the guideline, including any proposed new areas.
|
Section of the guideline |
New evidence identified |
Impact |
|
Preventing falls in older people |
||
|
Case/risk identification |
Yes |
Yes |
|
Multifactorial interventions |
Yes |
Yes |
|
Strength and balance training |
Yes |
Yes |
|
Exercise in extended care settings |
Yes |
Yes |
|
Home hazard and safety intervention |
Yes |
Yes |
|
Psychotropic medications |
Yes |
Yes |
|
Cardiac pacing |
No |
No |
|
Encouraging the participation of older people in falls prevention programmes |
No |
No |
|
Education and information giving |
No |
No |
|
Interventions that cannot be recommended |
Yes |
Yes |
|
Interventions that cannot be recommended because of insufficient evidence |
Yes |
Yes |
|
Preventing falls in older people during a hospital stay |
||
|
Predicting patients' risk of falling in hospital |
Yes |
No |
|
Assessment and interventions |
Yes |
No |
|
Information and support |
No |
No |
Reasons for the decision
This section provides a summary of the areas that will be updated and the reasons for the decision to update.
Preventing falls in older people
We identified new evidence in several areas that indicates a need for an update including:
-
Falls risk assessment tools – new evidence suggests that tools based on clinical characteristics lack sensitivity, specificity or both. However, the addition of new technologies to measure gait may improve on assessments based on clinical risk factors. Additionally, topic experts indicated a need to include frailty and previous fragility factors as risk factors for falls. Knowing about these characteristics may not increase prediction of future falls, yet this information is important because people with these characteristics may have more severe consequences if they fall.
-
Multifactorial interventions – new evidence indicates they may not be effective. This finding contradicts current recommendations to offer multifactorial interventions. Evidence indicated that offering interventions based on individual risk factors may not be effective but offering all interventions irrespective of individual risk factors may be effective. However, the quality of evidence was rated by the authors of a Cochrane review as low or very low across analyses. Consideration of multifactorial interventions will also impact on recommendations about the individual components of interventions such as home hazard assessment and modifications.
-
Exercise interventions – which appear to be effective using a wider range of types of exercise than are currently recommended. New guidance on physical activity from the Chief Medical Officer is expected in 2019. The update should consider how to encourage people at risk of falls to undertake the recommended levels of physical activity safely, and how to maintain benefits after prescribed exercise programmes end. The identified evidence addressed people living in the community and people living in residential care, indicating that the update should also consider practical ways to include people in extended care settings in exercise programmes.
-
Vitamin D – which evidence suggests may be associated with fewer falls, although conversely, high doses of vitamin D may increase falls risk. The update should consider the role of vitamin D in falls prevention alongside the guideline on vitamin D supplement use in specific population groups.
Although we did not identify new published evidence for some sections of the guideline, namely cardiac pacing, encouraging participation in falls programmes and education and information giving, we decided that these should be considered in the update so that the updated guideline can reflect any changes in services since the original guideline was published.
Preventing falls in older people during a hospital stay
We identified new evidence that was consistent with current recommendations on assessing risk of falls and interventions for people in hospital. However, we decided that the update should include this section of the guideline to ensure that recommendations support continuity of care across settings.
For further details and a summary of all evidence identified in surveillance, see appendix A.
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