Citation

Mayor S. Br. Med. J. BMJ 2004; 329(7477): 1258.

Copyright

(Copyright © 2004, BMJ Publishing Group)

DOI

10.1136/bmj.329.7477.1258-e

PMID

15564252

PMCID

PMC534478

Abstract

Elderly people should be asked about falls and those at risk should be offered multifactorial assessment and appropriate interventions, a clinical guideline published this week for the NHS in England and Wales recommends.

The guideline, developed by the National Institute for Clinical Excellence (NICE), and the National Collaborating Centre for Nursing and Supportive Care (based at the Royal College of Nursing), makes recommendations about the care of elderly people in the community or extended care for those either who have had a fall or who are considered at risk of falling.

It acknowledges that the major risk factors for falling are diverse, but it suggests that many of them -- balance impairment, muscle weakness, excessive or suboptimal medication use, and environmental hazards -- can be changed. Local health communities are asked to review their existing practice for the assessment and management of falls against the guideline.

The first priority in the guideline is to improve the identification of elderly people who have had or are at risk of a fall. It suggests that when elderly people present for health screening appointments or with other problems in primary, community, or secondary care, they should be asked whether they have fallen in the past year.

Elderly people who present for medical attention because of a fall, report recurrent falls in the past year, or show abnormalities of gait and/or balance, should be offered a falls risk assessment by healthcare professionals with appropriate skills and experience; this assessment should normally take place in the setting of a specialist falls service. This may include assessment of gait, balance and mobility, and muscle weakness; osteoporosis risk; visual impairment; and home hazards. It may also include a cardiovascular examination and a medication review.

Elderly people with recurrent falls or who are assessed as being at increased risk of falling should then be considered for individualised, multifactorial interventions. Evidence based interventions recommended by the guideline include strength and balance training; help with preventing hazards at home; referral for help with visual problems; and modification or withdrawal of drugs. The guideline notes that there is no evidence to indicate that brisk walking reduces the risk of falling and finds insufficient evidence to recommend correction of vitamin D deficiency or use of hip protectors to reduce fractures associated with falls.

The guideline suggests that measures to reduce the risks of falls are worth while as falls are a major cause of disability and the leading cause of mortality resulting from injury in people aged over 75 in the United Kingdom. In 1999 there were 647 721 attendances in accident and emergency departments and 204 424 admissions to hospital for fall related injuries in the UK population aged 60 years or over.

The associated cost of these falls to the NHS and personal social services was estimated at £908.9m ($1.7bn; €1.3bn), with 63% of this cost incurred from falls in people aged 75 years and over.

The NICE guideline on assessing and preventing falls in elderly people is available at : www.nice.org.uk/CG021NICEguideline