Quality statement 1: Identifying people at risk of falling

Quality statement

Older people are asked about falls when they have routine assessments and reviews with health and social care practitioners, and if they present at hospital. [new 2017]

Rationale

A history of falls in the past year is the single most important risk factor for falls and is a predictor of further falls. Health and social care practitioners have regular contact with older people across a wide range of settings, including in people's homes. By asking questions in routine assessments and reviews about falls and their context, health and social care practitioners can identify older people who may be at risk of falling. If there is concern that a person is at risk of falling, they can be referred to, or advised to see, a healthcare professional or service to further assess their risk.

Quality measures

Structure

a) Evidence of local arrangements to ensure that older people are asked about falls when they have routine assessments and reviews with primary care services.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that older people are asked about falls when they have routine assessments and reviews with community health and social care practitioners.

Data source: Local data collection.

c) Evidence of local arrangements to ensure that older people are asked about falls when they present at hospital.

Data source: Local data collection.

Process

a) Proportion of older people asked about falls during routine assessments and reviews with primary care services.

Numerator – the number in the denominator where the person was asked about falls.

Denominator – the number of older people who have had a routine assessment or review by a primary care service.

Data source: Local data collection based on reviews of individual care records.

b) Proportion of older people asked about falls during routine assessments and reviews with community health and social care practitioners.

Numerator – the number in the denominator where the person was asked about falls.

Denominator – the number of older people who have had a routine assessment or review with a community health or social care practitioner.

Data source: Local data collection based on reviews of individual care records.

c) Proportion of older people asked about falls when they present at hospital.

Numerator – the number in the denominator where the person was asked about falls.

Denominator – the number of older people who have presented at hospital.

Data source: Local data collection based on reviews of individual care records.

Outcome

Number of older people alerted to a risk of falling.

Data source: Local data collection based on reviews of individual care records.

What the quality statement means for different audiences

Service providers (such as primary, community and secondary healthcare services and social care providers) ensure that routine assessments, reviews and health checks for older people include questions about falls and their context; hospitals ensure that attendance procedures include questions about falls for older people; and community health and social care providers ensure that protocols and training are in place for health and social care practitioners to ask older people about falls and their context as part of assessments and reviews.

Health and social care practitioners (such as GPs, practice nurses, pharmacists, district nurses, physiotherapists, occupational therapists, social workers and care home workers) ask older people whether they have fallen in the past year; about the frequency, context and characteristics of any falls; and if they ever lose their balance or feel unsteady on their feet. If a person's answers suggest they are at risk, practitioners refer them to, or advise them to see, a healthcare professional or service to further assess their risk. In all settings, practitioners communicate in a way that recognises that some older people are reluctant to admit to falling, and do not repeat questions about falls if a person has recently been asked.

Commissioners (such as clinical commissioning groups, NHS England and local authorities) ensure that they commission services that address falls prevention as part of routine assessments and reviews for older people.

Older people who are seen by a health or social care practitioner are asked about falls when they have regular check-ups or if they attend hospital. This should include being asked if they have fallen in the past year, how many times this has happened, what caused them to fall, what happened when they fell, and whether they ever lose their balance or feel unsteady on their feet.

Source guidance

Falls in older people: assessing risk and prevention (2013) NICE guideline CG161, recommendation 1.1.1.1

Definitions of terms used in this quality statement

Fall

A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground, or an object below knee level.

[NICE's clinical knowledge summary on falls – risk assessment]

Older people

Older people are those aged 65 and over living in their own home or in an extended care setting such as a nursing home or supported accommodation.

[Adapted from NICE's guideline on falls in older people: assessing risk and prevention]

Routine assessments and reviews

Routine assessments and reviews are defined as planned, recurring appointments with health and social care practitioners where a person is assessed or reviewed. These include reviews for chronic conditions such as diabetes, hypertension, heart failure or chronic obstructive pulmonary disease; medication reviews; annual flu vaccinations; NHS Health Checks; assessments of care and support needs; and reviews of care and support plans.

[Expert opinion]

Present at hospital

Attending hospital for assessment or treatment that does not involve an overnight stay. This includes day case admissions, outpatient attendances and A&E attendances but excludes inpatient admissions.

[Adapted from NICE's guideline on falls in older people: assessing risk and prevention]

Equality and diversity considerations

Some subgroups of the population (such as people who are not registered with a GP, people in traveller communities or people who are homeless) may not be in regular contact with health and social care services. Practitioners should take every opportunity to ask about falls history when people from these groups present, so that they can make every contact count.