Falls: assessment and prevention in older people and in people 50 and over at higher risk

  • NICE guideline
  • NG249
  • Published: 
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Context

A fall is 'an unexpected event in which the participants come to rest on the ground, floor, or lower level'. Although falls can occur at any age, they become increasingly common as people get older. Around a third of people aged 65 and over, and around a half of people aged 80 and over, fall at least once a year. The impact of falls, especially in people aged 65 and over, includes distress, pain, injury including fractures, loss of confidence, loss of independence, and mortality. The consequences of fractures are significant, with a 1‑year mortality rate of 31% after a hip fracture.

Between 2019 and 2020, there were around 234,800 emergency hospital admissions in England related to falls among people aged 65 and over. Around 157,370 (67%) of these admissions were among people aged 80 and over.

There are a large number of risk factors for falls. These include:

  • a history of falls

  • lower levels of strength because of a decline in muscle mass

  • impaired balance because of declines and changes in sensory systems, the nervous system, and muscles

  • polypharmacy and the use of psychotropic and antiarrhythmic medicines

  • visual impairment

  • environmental hazards

  • frailty.

There is an increased risk of falling among some people under 65, including those with underlying conditions such as Parkinson's disease and diabetes. This updated guideline reviews methods of identifying people aged 50 to 64 who are at risk of falls in all settings (including homes and social care settings) and would benefit from preventative measures.

Falls can occur in any setting but are the most reported patient safety incidents in acute hospitals and mental health trusts in England and Wales. Therefore, the identification of people at risk of falls and measures to prevent falls in these settings, requires special consideration. This update reflects changes in evidence related to falls in hospital, to encourage the uptake of similar measures at home and in social care settings, and to reflect national developments, such as the work of the National Falls Prevention Coordination Group.