National Institute for Health and Clinical Excellence (NICE)
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NICE-recommended risk assessments 'help prevent falls in elderly'

Carrying out NICE-recommended risk assessments among the elderly could limit the numbers who have falls, a review in the British Medical Journal (BMJ) suggests.

Falls are a common occurrence in older people and are the leading cause of injury-related admissions to hospital in those over the age of 65.

The BMJ clinical review says that despite evidence showing risk assessments can prevent falls, they are not being regularly carried out.

Furthermore, it states "many people who could benefit from falls and fracture interventions are not receiving guideline care".

The report cites NICE guidelines on the assessment and prevention of falls in older people, alongside guidelines from other countries such as America and Australia.

The NICE guideline recommends that older people who are in contact with healthcare professionals should be identified and risk-assessed for the likelihood that they will suffer a fall. In particular, they should be routinely asked whether they have fallen in the past year; about the number of falls they have had and what the characteristics of these falls have been.

Additionally, older people who report a fall or are at risk of falling should be observed for problems with balance and the way they walk. This is so that consideration can be given to whether they will gain from interventions to improve their strength or balance.

Gait and balance can be assessed using standard tests mentioned in the report such as the "timed up and go" test, which is commonly used to determine stability.

Here, a healthcare professional measures the time it takes for a person to rise from a chair, walk a small distance at normal pace, turn, return to the chair and sit back down again.

If it takes more than between 10 and 14 seconds for a person to complete this test, then this suggests impaired functioning and an increased risk of falls.

The NICE guideline also recommends that if an elderly person presents for medical attention due to one or several falls, or abnormal balance and/or gait then they should be given a risk assessment as part of an overall plan of action (known as a multifactorial intervention).

This should be done by healthcare professionals who have the appropriate experience in a specialist falls setting.

The assessment should determine several factors, including what the history of falls have been, an appraisal of gait, balance, mobility and muscle weakness, and an assessment of osteoporosis.

The BMJ review, led by Consultant Geriatrician Jacqueline Close from the University of New South Wales, concluded: "Despite the evidence supporting fall risk factor assessment and intervention, fall risk assessment is still not routinely undertaken, and many people who could benefit from falls and fracture interventions are not receiving guideline care.

"This may be due, in part, to some healthcare professionals being unaware of effective approaches to intervention."

It adds that fall risk assessments should be "a key part of guideline care of older people" as evidence shows that they can prevent falls by tackling identified risk factors.

The NICE guideline on falls in older people was recently reviewed, with the review group deciding not to update the original recommendations but to extend the guideline to include inpatient settings and service delivery.

A full version of the guideline including more details of common tests for risk assessment, and a version written for patients and carers are also available from our website.


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