Levels of evidence (I-IV) and grading of recommendations (A-D and GPP) are defined at the end of the "Major Recommendations" field.
Case/Risk Identification
C - Older people in the care of healthcare professionals should be asked routinely whether they have fallen in the last year and asked about the frequency, context, and characteristics of the fall.
C - Older people reporting a fall or considered at risk of falling should be observed for balance and gait deficits and considered for their ability to benefit from interventions to improve balance and mobility. (Tests of balance and gait commonly used in the UK are detailed in the original guideline document.)
Multifactorial Falls Risk Assessment
C - Older people who 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 assessment of risk. This assessment should be performed by a healthcare professional or professionals with appropriate skills and experience, normally in the setting of a specialist falls service. This assessment should be part of an individualised, multifactorial intervention.
C - Multifactorial assessment may include the following:
- Identification of falls history
- Assessment of gait, balance and mobility, and muscle weakness
- Assessment of osteoporosis risk
- Assessment of the older person's perceived functional ability and fear relating to falling
- Assessment of visual impairment
- Assessment of cognitive impairment and neurological examination
- Assessment of urinary incontinence
- Assessment of home hazards
- Cardiovascular examination and medication review
Multifactorial Interventions
A - All older people with recurrent falls or assessed as being at increased risk of falling should be considered for an individualised multifactorial intervention.
A - In successful multifactorial intervention programmes the following specific components are common (against a background of the general diagnosis and management of causes and recognised risk factors):
- Strength and balance training
- Home hazard assessment and intervention
- Vision assessment and referral
- Medication review with modification/withdrawal
A - Following treatment for an injurious fall, older people should be offered an assessment to identify and address future risk and individualised intervention aimed at promoting independence and improving physical and psychological function.
Strength and Balance Training
A - Strength and balance training is recommended. Those most likely to benefit are older community-dwelling people with a history of recurrent falls and/or balance and gait deficit. A muscle strengthening and balance programme should be offered. This should be individually prescribed and monitored by an appropriately trained professional.
Exercise in Extended Care Settings
A - Multifactorial interventions with an exercise component are recommended for older people in extended care settings who are at risk of falling.
Home Hazard and Safety Intervention
A - Older people discharged from hospital following a fall should be offered a home hazard assessment and safety intervention/modifications by a suitably trained healthcare professional. This should normally be part of discharge planning and be carried out within a timescale agreed by the patient or carer and appropriate members of the healthcare team.
A - Home hazard assessment is shown to be effective only in conjunction with follow-up and intervention, not in isolation.
Psychotropic Medications
B - Older people on psychotropic medications should have their medication reviewed, with specialist input if appropriate, and discontinued if possible to reduce their risk of falling.
Cardiac Pacing
B - Cardiac pacing should be considered for older people with cardioinhibitory carotid sinus hypersensitivity who have experienced unexplained falls.
Encouraging the Participation of Older People in Falls Prevention
D - To promote the participation of older people in falls prevention programmes the following should be considered:
- Healthcare professionals involved in the assessment and prevention of falls discussing which changes a person is willing to make to prevent falls.
- Information should be relevant and available in languages other than English.
- Falls prevention programmes should also address potential barriers such as low self-efficacy and fear of falling and encourage activity change as negotiated with the participant.
D - Practitioners who are involved in developing falls prevention programmes should ensure that such programmes are flexible enough to accommodate participants' different needs and preferences and should promote the social value of such programmes.
Education and Information Giving
D - Healthcare professionals involved in falls prevention should be educated about falls assessment and prevention.
D - Individuals at risk of falling and their carers should be offered information orally and in writing about:
- What measures they can take to prevent further falls
- How to stay motivated if referred for falls prevention strategies that include exercise or strength and balancing components
- The preventable nature of some falls
- The physical and psychological benefits of modifying falls risk
- Where they can seek further advice and assistance
- How to cope if they have a fall, including how to summon help and how to avoid a long lie
Definitions:
Evidence Categories
I: Evidence from meta-analysis of randomised controlled trials or at least one randomised controlled trial
II: Evidence from at least one controlled trial without randomization or at least one other type of quasi-experimental study
III: Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case–control studies
IV: Evidence from expert committee reports or opinions and/or clinical experience of respected authorities
Recommendation Grades
Grade A - Directly based on category I evidence
Grade B - Directly based on category II evidence or extrapolated recommendation from category I evidence
Grade C - Directly based on category III evidence or extrapolated recommendation from category I or II evidence
Grade D - Directly based on category IV evidence or extrapolated recommendation from category I, II, or III evidence
Good Practice Point (GPP) - Recommended good practice based on the clinical experience of the Guideline Development Group (GDG)
