Quality statement 7: Multifactorial risk assessment for older people presenting for medical attention

Quality statement

Older people who present for medical attention because of a fall have a multifactorial falls risk assessment. [2015]

Rationale

When older people present for medical attention because of a fall it provides their healthcare practitioner with a good opportunity to begin the process of undertaking a multifactorial falls risk assessment. A multifactorial falls risk assessment aims to identify a person's individual risk factors for falling. This will enable practitioners to refer the person for effective interventions targeted at their specific risk factors, with the aim of reducing subsequent falls.

Quality measures

Structure

Evidence of local arrangements to ensure that older people who present for medical attention because of a fall have a multifactorial falls risk assessment.

Data source: Local data collection.

Process

a) Proportion of older people who present for medical attention to their general practice because of a fall who have a multifactorial falls risk assessment.

Numerator – the number in the denominator who have a multifactorial falls risk assessment.

Denominator – the number of older people who present for medical attention to their general practice because of a fall.

Data source: Local data collection. Contained within the Royal College of Physicians' Fracture Liaison Service Database.

b) Proportion of older people who present for medical attention at hospital because of a fall who have a multifactorial falls risk assessment.

Numerator – the number in the denominator who have a multifactorial falls risk assessment.

Denominator – the number of older people who present for medical attention at hospital because of a fall.

Data source: Local data collection. Royal College of Physicians (2011) Falling standards, broken promises: report of the national audit of falls and bone health, Organisational audit results, section 5.1: Multifactorial falls risk assessment.

c) Proportion of older people who present for medical attention at walk-in health centres because of a fall who have a multifactorial falls risk assessment.

Numerator – the number in the denominator who have a multifactorial falls risk assessment.

Denominator – the number of older people who present for medical attention at walk-in health centres because of a fall.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as general practice, specialist falls services, community and secondary care services) ensure that staff are trained to undertake multifactorial falls risk assessments for older people who present for medical attention because of a fall.

Health and social care practitioners undertake a multifactorial falls risk assessment for older people who present for medical attention because of a fall, or refer them to a service with staff who are trained to undertake this type of assessment.

Commissioners (clinical commissioning groups) ensure that they commission services that have the capacity and staff who are trained to undertake multifactorial falls risk assessments for older people who present for medical attention because of a fall.

Older people who are seen by a healthcare professional (such as their GP or a nurse) because of a fall have an assessment that aims to identify anything that might make them more likely to fall, and to see whether there are things that can be done to help them avoid falling in future. This assessment will be done by a specialist healthcare professional.

Source guidance

Falls in older people: assessing risk and prevention (2013) NICE guideline CG161, recommendations 1.1.2.1 (key priority for implementation) and 1.1.2.2

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]

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]

Present for medical attention

Older people who fall may present for medical attention in a variety of settings and to different healthcare practitioners. Examples of settings include general practice, emergency departments, inpatient wards, walk-in health centres and community services.

[Expert consensus]