Quality statement 2: Multifactorial risk assessment for older people at risk of falling

Quality statement

Older people at risk of falling are offered a multifactorial falls risk assessment. [new 2017]

Rationale

There are over 400 risk factors associated with falling, and the risk of falling appears to increase with the number of risk factors. A multifactorial falls risk assessment allows interventions to be targeted at a person's specific risk factors to help prevent future falls. This assessment is often carried out by a specialist falls service, but it can also be undertaken in other settings that have appropriate governance arrangements and professionals with skills and experience in falls prevention. Individual components of the assessment may be undertaken by different healthcare professionals, but each element has to be combined to form a single multifactorial assessment. This assessment should form part of an individualised multifactorial intervention to prevent further falls.

Quality measures

Structure

a) Evidence of local arrangements to ensure that older people at risk of falling are referred to healthcare professionals with skills and experience in carrying out multifactorial falls risk assessment.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that multifactorial assessment comprises multiple components to identify individual risks of falling.

Data source: Local data collection.

c) Evidence of local arrangements for access to a specialist falls service comprising a multidisciplinary team with access to diagnostic, assessment and intervention facilities.

Data source: Local data collection.

Process

a) Proportion of older people at risk of falling presenting to a healthcare professional who are referred for multifactorial falls risk assessment.

Numerator – the number in the denominator where the older person was referred for a multifactorial falls risk assessment.

Denominator – the number of older people presenting to a healthcare professional who are considered to be at risk of falling.

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

b) Proportion of older people at risk of falling who have a multifactorial falls risk assessment following referral by a healthcare professional.

Numerator – the number in the denominator where the older person has had a multifactorial falls risk assessment.

Denominator – the number of older people at risk of falling referred for a multifactorial falls risk assessment by a healthcare professional.

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

Outcome

a) Number of older people alerted to their specific risks of falling.

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

b) Proportion of older people with underlying health problems identified.

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

c) Rate of falls in older people.

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

d) Injuries due to falls in people aged 65 and over (age-sex standardised rate of emergency hospital admissions for injuries due to falls in people aged 65 and over per 100,000 population).

Data source: Public health outcomes framework (available at local authority level) and CCG improvement and assessment framework (available at clinical commissioning group level).

What the quality statement means for different audiences

Service providers (such as specialist falls services) ensure that protocols are in place to receive referrals of older people at risk of falling; and that assessments are undertaken by staff with skills and experience in falls prevention, that they comprise multiple components to assess individual risk factors and form part of a multifactorial intervention. Outside of specialist falls services, providers ensure that referral pathways are in place for specialist assessment when needed.

Healthcare professionals (such as consultants, GPs, nurses, physiotherapists and occupational therapists) work in a collaborative local context that enables assessments to be undertaken by staff with skills and experience in falls prevention in an appropriate care setting, with local referral pathways to support specialist assessment when needed. Professionals undertaking the assessment identify individual risk factors that can be addressed through multifactorial intervention.

Commissioners (such as clinical commissioning groups and NHS England) commission services that perform multifactorial falls risk assessments in appropriate care settings with local referral pathways to support specialist assessment when needed, using professionals with skills and experience in falls prevention working in a collaborative local context.

Older people at risk of falling are offered an assessment to identify if they have fallen in the past year or if they have problems with balance or walking. This assessment will show if there is anything that might make them more likely to fall and whether there are things that can be done to prevent this.

Source guidance

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]

At risk of falling

People aged 65 years and over who have had 2 or more falls in the past 12 months, or demonstrate abnormalities of gait or balance.

[Adapted from NICE's guideline on falls in older people: assessing risk and prevention, recommendation 1.1.2.1, and clinical knowledge summary on falls – risk assessment]

Multifactorial falls risk assessment

An assessment with multiple components that aims to identify a person's risk factors for falling. This assessment should be performed by a healthcare professional with appropriate skills and experience. It should be part of an individualised, multifactorial intervention. A multifactorial falls risk assessment may include the following:

  • identification of falls history

  • assessment of gait, balance and mobility, strength and muscle weakness

  • assessment of osteoporosis risk

  • assessment of fracture risk

  • assessment of 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.

[Adapted from NICE's guideline on falls in older people: assessing risk and prevention, recommendations 1.1.2.1 and 1.1.2.2, and expert consensus]