UK: Catch Me Before I Fall: Improving Understanding And Management Of Falls In Older People

Last Updated: 5 February 2015
Article by Karen Taylor

Most Read Contributor in UK, August 2017

Returning from a weekend skiing gave me cause to reflect on one of the principal risks encountered, namely falling, and the impact of fluctuating temperatures at this time of year on the risk of falling here in the UK.

The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and even mortality. Falling also affects the family members and carers of people who have fallen and is estimated to cost the NHS more than Ł2.3 billion per year. Additional costs include the health and social care required after treatment and, if the fall occurred on NHS premises, settling any litigation claims made against the NHS.1

The risk of falling increases with age, with 30 per cent of people older than 65 and 50 per cent of people older than 80 falling at least once a year. Falls, fall-related injury and fear of falling are therefore important public health problems in an ageing society. Indeed, falls and mobility problems are the most common causes of referrals to intermediate care services. Yet the issue of people in later life falling over is all too often dismissed as an inevitable part of the ageing process.2

Older people are more likely to experience recurrent falls, defined as those occurring at least three times a year. Comorbidity is a serious problem both in terms of contributing to the cause of the fall and to the outcome. Falls can be devastating to the affected individual, in particular, when associated with fractures and broken bones, as they carry a high morbidity and mortality (falls are the most common cause of mortality in people aged over 75 in the UK). Even smaller falls lead to loss of self-confidence and reduced quality of life. This can also have significant economic consequences because of the cost of inpatient care and the likelihood of needing residential care (around 50 per cent of older patients who live independently before sustaining a hip fracture are unable to do so afterwards).3

The main reason older people fall include:

  • chronic health conditions such as heart disease, dementia and low blood pressure which can cause dizziness and a brief loss of consciousness
  • impairments such as poor vision or muscle weakness
  • conditions that affect balance such as labyrinthitis ( inflammation of the inner ear)
  • osteoporosis, especially in older women, where thinning and weakening of the bones is a widespread problem.

Among older people the most common reasons for accidentally falling or slipping include:

  • wet or recently polished floors especially in bathrooms and kitchens and rugs or carpets that are not properly secured stairs
  • poor lighting and reaching for storage areas, such as cupboards
  • stairs and using ladders and steps while carrying out home maintenance work.

The above demonstrates that the etiology of falls is complex and multifactorial. Consequently the most effective prevention of falls requires a multidisciplinary, holistic and patient-specific approach, taking into account the person's medical conditions, social circumstances and psychological factors. Completely abolishing falls among older people is impossible and attempts to do so would be unacceptable since this would place undue restriction on their activity and autonomy. An acceptable balance between prevention and living with risk therefore needs to be struck. Over the last 15 years several national policy initiatives for the elderly have included the need to reduce falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen. Recent guidance from the National Institute for Health and Care Excellence have re-stated the importance of this.4

The sort of interventions identified as having an impact include: exercise and physical activity programmes, identification bracelets, alarm systems and risk assessments. It is also helps to address adverse environmental factors including investing in non-slip mats in the bathroom, removing clutter and ensuring that all areas of the home are properly lit. While wearing well fitted clothing and shoes and slippers that support the ankle are also advisable. At the same time there should be a review of medication and attempts made to improve the management of any medical conditions, as well as getting eyesight tested regularly. This range of interventions needs to be coordinated, to respond to the individual patient's risk, and be focused across the patient's pathway.

Older people in contact with healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the frequency, context and characteristics of the fall(s). Older people who present for medical attention because of a fall, or report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should be offered a multifactorial falls risk assessment performed by a healthcare professional with appropriate skills and experience, normally in the setting of a specialist falls service.

Hospitals can also be a high risk area for falls with accidental falls the most commonly reported patient safety incidents (some 350,000 or 26 per cent of all patient safety incidents in hospitals in 2011). Falls are also a frequent factor in extending length of stay of patients and subsequent need for long-term care. Falls in hospital are also difficult to prevent without unacceptable restrictions to patients' independence, dignity and privacy. Research, however, shows that falls can be reduced by 20-30 per cent through multifactorial assessments and interventions which aim to identify and treat underlying reasons for falls. The aim of these assessments and interventions are to identify and treat underlying reasons for falls such as muscle weakness, cardiovascular problems, dementia, delirium, incontinence and medication. However, national audits have found low levels of implementation of these assessments and interventions in UK hospitals.

Several multifactorial studies have included adjustments to the ward environment (such as improved lighting, changes to flooring, furniture, handholds, walking routes, lines of sight and signposting), but the impact of these changes has rarely been evaluated. There is a need to understand which improvements to the inpatient environment are the most effective and cost-effective for preventing falls and injuries in hospital, and the factors that architects should take into account when designing new hospitals. There is much to gain by preventing falls, perhaps this is the year to make this difference.



2. Ibid

3. Prevention of falls in the elderly. See also:


The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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