Diagnosis

• Risk identification: older person in contact with healthcare professional ask if fallen in past year, and observe for balance or gait deficit
• Conduct multifactorial falls risk assessment if present with fall, balance or gait deficit, considering:
  • Falls history
  • Gait, balance and mobility, and muscle weakness
  • Osteoporosis risk
  • Perceived functional ability and fear relating to falling
  • Visual impairment
  • Cognitive impairment and neurological examination
  • Urinary continence
  • Hazards at home
  • Cardio-vascular examination
• In hospital also consider:
  • Footwear that is unsuitable or missing
  • Syncope syndrome

Investigation

• Regard the following groups of inpatients to be at risk in hospital:
  • All patients >65 years
  • Patients 50-64 years judged by clinician to be at higher risk due to underlying condition
• Do not use fall risk prediction tools to predict inpatients’ risk of falling in hospital

Management

• All older people with recurrent falls or assessed as being at increased risk of falling should be considered for an individualised multifactorial intervention, comprising:
  • Strength and balance training: muscle strengthening when appropriate
  • Home hazard assessment and intervention
  • Vision assessment and referral
  • Medication review with modification/withdrawal, especially psychotropic medications
• Cardiac pacing should be considered for cardioinhibitory carotid sinus hypersensitivity
• Discuss what changes patient willing to make, and address potential barriers
• Do not recommend brisk walking: may increase risk
• Little evidence for:
  • Low intensity exercise combined with incontinence programmes
  • Group exercise (untargeted)
  • Cognitive/behavioural interventions
  • Referral for correction of visual impairment
  • Vitamin D
  • Hip protectors

NICE Source: CG161 Falls in older people: assessing risk and prevention. Summary compiled by Dr D P Sheppard MBBS.