Falls and Osteoporosis

Evidence summary

  • Screening and early detection of people at high risk of falling is a key component to an integrated falls service.  Many older people who fall do not seek medical help but they may be identified as being at risk through the presence of risk factors (NICE, 2004 and 2013).
  • Older people considered at risk of falling should be observed for balance and gait deficits and considered for their ability to benefit from interventions to improve strength and balance (NICE, 2004 and 2013).
  • Healthcare professionals should routinely ask older people whether they have fallen in the last year and about frequency, context and characteristics of the fall/s (NICE, 2004 and 2013).  Many older people do not volunteer that they are falling.
  • Individuals at risk of falling, and their carers, should be offered information verbally and in writing about what measures they can take to prevent further falls (NICE, 2004 and 2013).
  • All healthcare professionals dealing with patients known to be at risk of falling should develop and maintain basic professional competence in falls assessment and prevention (NICE, 2004 and 2013).
  • As falling appears to increase with the number of risk factors, it is suggested that multifactorial interventions are the most effective strategy to reduce decline in function and independence and also to prevent the associated costs of complications.
    • Older people that present for medical attention because of a fall, or report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance, should be offered a multifactorial falls risk assessment (NICE, 2004 and 2013). 
    • All older people with recurrent falls or assessed as being at increased risk of falling should be considered for an individualised multifactorial intervention which should include:
      • Strength and balance training
      • Home hazard assessment, follow-up and intervention
      • Vision assessment and referral
      • Medication review and modification/withdrawal
      • Cardiac pacing where indicated.
  • Inadequate recording of falls and related injuries impacts on the commissioning process.  The lack of reliable data makes it difficult to prove that falls and fractures are a local public health problem and as such, may not be seen as a commissioning priority. This is particularly important given that services which deliver quicker, health economic outcomes may be prioritised over falls and fracture prevention services (NOS, 2012).

Last updated Friday, 22nd April 2016