Quality statement 3: Multifactorial intervention

Quality statement

Older people assessed as being at increased risk of falling have an individualised multifactorial intervention. [new 2017]

Rationale

The causes of falls are multifactorial, and the risk of falling appears to increase with the number of risk factors. Multifactorial falls risk assessment allows a person's risk factors to be identified. Multiple interventions can then target these specific risk factors and reduce several components of falls risk.

Quality measures

Structure

Evidence of local arrangements to ensure that older people assessed as being at increased risk of falling have an individualised multifactorial intervention.

Data source: Local data collection.

Process

Proportion of older people assessed as being at increased risk of falling who have an individualised multifactorial intervention.

Numerator – the number in the denominator where the older person has received an individualised multifactorial intervention.

Denominator – the number of older people assessed as being at increased risk of falling.

Data source: Local data collection. Numerator sourced from individual patient records. Denominator sourced from information collected in multifactorial falls risk assessments.

Outcome

a) Rates of falls in older people.

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

b) 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).

c) Proportion of older people who have received a multifactorial intervention for falls who feel able to manage activities of daily living.

Data source: Local data collection based on surveys of older people who have had a multifactorial intervention for falls.

What the quality statement means for different audiences

Service providers (such as specialist falls services) ensure that systems and governance structures are in place to provide interventions to address people's individual risk factors when they are identified through multifactorial risk assessment; to coordinate interventions across different professionals and settings; and to ensure that appropriate staff perform the interventions.

Healthcare professionals (such as consultant geriatricians, nurses, physiotherapists, occupational therapists and primary care practitioners) identify interventions to address an older person's specific risk factors established through a multifactorial falls risk assessment; discuss the interventions with the person and how they can be tailored to their needs; deliver the interventions; and document them in the patient's record.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services so that older people who are assessed as being at increased risk of falling receive an individualised multifactorial intervention based on multifactorial falls risk assessment.

Older people who have had an assessment that shows they are at increased risk of falling develop a plan with a healthcare professional to stop them from falling. This plan may include treating health problems, making changes at home, exercises to help their strength and balance, having their eyes checked and looking at whether any medicines they take should be changed.

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]

Assessed as being at increased risk of falling

People identified as being at increased risk of falling through a multifactorial falls risk assessment, which is an assessment with multiple components to identify a person's risk factors for falling.

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

Individualised multifactorial intervention

An individualised multifactorial intervention is an intervention with multiple components that aims to address the risk factors for falling that are identified in a person's individual multifactorial assessment. Specific components common in successful multifactorial interventions are:

  • strength and balance training

  • home hazard assessment and intervention

  • vision assessment and referral

  • medication review with modification or withdrawal.

The following interventions are not recommended to address falls risk factors due to insufficient or conflicting evidence, although they may result in other health benefits:

  • low intensity exercise combined with incontinence programmes

  • group exercise (not individually prescribed)

  • cognitive behavioural interventions

  • referral for correction of visual impairment as a single intervention

  • vitamin D

  • hip protectors

  • brisk walking.

[Adapted from NICE's guideline on falls in older people: assessing risk and prevention, recommendation 1.1.3.1, and clinical knowledge summary on falls – risk assessment]