New guideline will help cut falls and related hospital admissions for older and at-risk people
Personalised assessments that consider factors including the hazards in a person’s home, and their previous medical history will help reduce falls in older and at-risk people, according to a new NICE guideline.
As well as making recommendations on hazards in a person’s home, the updated guidance published today also covers residential care homes, hospitals and other healthcare settings in the community, for the first time.
It recommends checks are carried out by an occupational therapist or an appropriately trained healthcare professional, therapy assistant or technician with supervision. These assessments should check for things in the home or garden that might cause a fall, like uneven flooring or poor lighting, and could recommend installing handles, grab rails or other equipment to reduce the risk of a fall. The person’s physical and cognitive capacity to get around safely would also be checked and their previous medical history taken into account.
Conditions that increase the risk of falling include long-term health conditions such as arthritis, learning disabilities, dementia, or Parkinson’s disease.
Falls can occur at any age but are increasingly common as people get older. Around a third of people aged 65 and over, and around half of people aged 80 and over fall at least once a year.
In 2022/23 there were around 210,000 emergency hospital admissions in England related to falls for people aged 65 and over. Around 146,700 of these admissions were people aged 80 and over. Falls are the most common cause of fragility fractures and the consequences of fracture are significant, with between 18% and 33% dying one year after a hip fracture.
The total annual cost of fragility fractures to the UK has been estimated at £4.4 billion which includes £1.1 billion for social care; hip fractures account for around £2 billion of this sum.
The updated guideline recommends offering a comprehensive falls assessment and management for people who have fallen in the past year and are living with frailty, were injured in a fall, experienced loss of consciousness related to the fall, have been unable to get up independently after a fall, or have had two or more falls.
The assessment can include physical examinations, checking a person's balance and gait and asking them about possible dizziness. It also considers how each person’s risk factors can be resolved, improved, or managed to reduce their risk of falling.
Following the falls assessment a range of different interventions can be recommended, including a falls prevention exercise programme.
Falls present a major, growing public health problem that can have devastating effects on older people and those at-risk due to medical conditions, often resulting in a loss of independence, chronic pain, and reduced quality of life.
This useful and useable guideline has been updated to ensure people identified as being at greatest risk get help and support tailored to their individual needs so they can live full and active lives.
Fewer people suffering falls will result in a drop in the number of hospital visits and the need for ongoing treatments which will reduce pressure on the NHS.
Dr Tom Downes, NHS national clinical director for older people, said: "Falls are the leading cause of hospital admissions in older people and can have serious consequences, including being a primary reason in a person losing their independence later on in life."
Identifying those at greatest risk of falls and providing them with the preventative help and support they need will not only improve people’s lives, but it will also free up clinical time and resource too.
The updated guidelines also recommend healthcare professionals consider carrying out a review to help identify any medicines that may increase a person’s risk of falls and consider adjusting their medicines to reduce any risk.
The guideline continues to recommend evidence-based falls prevention exercise in community settings. However, a notable update includes the recommendation to improve access to exercise for older and at-risk groups who do not need a comprehensive assessment.
It recommends that people, including those in hospital and residential care, are encouraged to remain active, unless they have been advised not to.