About this guideline

NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales.

NICE guidelines are developed in accordance with a scope that defines what the guideline will and will not cover.

This guideline was developed by the NICE Internal Clinical Guidelines Programme. The Internal Clinical Guidelines Programme worked with a Guideline Development Group, comprising healthcare professionals (including consultants, GPs and nurses), patients and carers, and technical staff, which reviewed the evidence and drafted the recommendations. The recommendations were finalised after public consultation.

The methods and processes for developing NICE clinical guidelines are described in the guidelines manual.

Update information

This guideline extends and replaces NICE guideline CG21 (published November 2004).

Labelling of recommendations

New recommendations have been added about preventing falls in older people during a hospital stay (labelled [2013]).

The original recommendations from NICE guideline CG21 are incorporated unchanged (except for minor wording changes for the purposes of clarification only). These are labelled [2004] or [2004, amended 2013].

Strength of recommendations

Some recommendations can be made with more certainty than others. The Guideline Development Group makes a recommendation based on the trade-off between the benefits and harms of an intervention, taking into account the quality of the underpinning evidence. For some interventions, the Guideline Development Group is confident that, given the information it has looked at, most patients would choose the intervention. The wording used in the recommendations in this guideline denotes the certainty with which the recommendation is made (the strength of the recommendation).

For all recommendations, NICE expects that there is discussion with the service user about the risks and benefits of the interventions, and their values and preferences. This discussion aims to help them to reach a fully informed decision (see also Patient-centred care).

Interventions that must (or must not) be used

We usually use 'must' or 'must not' only if there is a legal duty to apply the recommendation. Occasionally we use 'must' (or 'must not') if the consequences of not following the recommendation could be extremely serious or potentially life threatening.

Interventions that should (or should not) be used – a 'strong' recommendation

We use 'offer' (and similar words such as 'refer' or 'advise') when we are confident that, for the vast majority of patients, an intervention will do more good than harm, and be cost effective. We use similar forms of words (for example, 'Do not offer…') when we are confident that an intervention will not be of benefit for most patients.

Interventions that could be used

We use 'consider' when we are confident that an intervention will do more good than harm for most patients, and be cost effective, but other options may be similarly cost effective. The choice of intervention, and whether or not to have the intervention at all, is more likely to depend on the patient's values and preferences than for a strong recommendation, and so the healthcare professional should spend more time considering and discussing the options with the patient.

Wording of 2004 recommendations

NICE began using this approach to denote the strength of recommendations in guidelines that started development after publication of the 2009 version of 'The guidelines manual' (January 2009). This does not apply to any recommendations ending [2004] (see 'Labelling of recommendations' box above for details about how recommendations are labelled). In particular, for recommendations labelled [2004], the word 'consider' may not necessarily be used to denote the strength of the recommendation.

Other versions of this guideline

The full guideline, 'Falls: assessment and prevention of falls in older people' contains details of the methods and evidence used to develop the guideline. It is published by the Internal Clinical Guidelines Programme.

The recommendations from this guideline have been incorporated into a NICE Pathway.

We have produced information for the public about this guideline.


Implementation tools and resources to help you put the guideline into practice are also available.

ISBN: 978-1-4731-0132-6

  • National Institute for Health and Care Excellence (NICE)