Older people and falls

Falls

Resources for nursing professionals on the prevention, treatment and management of falls in older people

Older people who experience falls are frequently in contact with nurses in all sectors of health care. You can use these pages to find out about the falls-related projects the RCN is involved in and the guidance and resources available to you on falls and older people.

Falls and fractures in older people are a costly and often preventable health issue. Reducing falls and fractures is important for maintaining health, wellbeing and independence amongst older people.

A fall is defined as an event which causes a person to, unintentionally, rest on the ground or lower level, and is not a result of a major intrinsic event (such as a stroke) or overwhelming hazard. Having a fall can happen to anyone; it is an unfortunate but normal result of human anatomy. However, as people get older, they are more likely to fall over. Falls can become recurrent and result in injuries including head injuries and hip fractures.

Falls are events resulting from the presence of risk factors. The likelihood and severity of injury resulting from an event is related to bone health. People with low bone mineral density are more likely to experience a fracture following a fall. One of the main reasons why people have low bone mineral density is osteoporosis.

Over 3 million people in the UK have osteoporosis and they are at much greater risk of fragility fractures. Hip fractures alone account for 1.8 million hospital bed days and £1.9 billion in hospital costs every year, excluding the high cost of social care.

Causes of falls

The causes of having a fall are multifactorial – a fall is the result of the interplay of multiple risk factors. These include:

having a history of falls
muscle weakness
poor balance
visual impairment
polypharmacy - and the use of certain medicines
environmental hazards and a number of specific conditions.

Please see Public Health England's Falls- applying All Our Health.

The RCN is involved in the following projects:

  • The RCN is on the steering group of the Acute Frailty Network which aims to improve clinical journeys for people living with frailty, of which falls is a 

  • The RCN is a member organisation of the National Falls Prevention Coordination Group Public Health England and has produced Falls and fractures: consensus statement. This document outlines approaches to interventions and activities helping prevent falls and fractures to improve health outcomes for older people.

Falls resources

COVID-19 related resources

CQC. Updates for health professionals: COVID-19, 6 May 2020 and COVID-19, 7 May 2020.

DHSC & NHIR: COVID-19 technology for strength and balance. Delivery of strength and balance exercises for falls prevention amongst older people using digital technologies to replace face-to-face contact during COVID-19 home isolation and physical distancing. 

Keep on Keep up app. This app help reduce the high risk of falls and physical decline in older people self-isolating during the COVID-19 Lockdown.

Public Health England et al. Active at home. A guide to being active at home during the coronavirus outbreak.

NICE guidance

NICE (2019) Surveillance of falls in older people: assessing risk and prevention (NICE guideline CG161).

NICE (2017) Falls in older people. This updated quality standard covers assessment after a fall and preventing further falls (secondary prevention) in older people living in the community and during a hospital stay.

NICE (2017) Falls in older people pathway.This pathway covers the assessment and prevention of falls in older people both in the community and during a hospital stay.

Further resources

NHS Improvement. Patient Safety Collaboratives – Making care safer for all. Supporting trusts to  reduce falls is a priority for NHS Improvement. Case study – Safety huddles reduce falls by as much as 60 per cent (page 10)

NIHR. Falls Management Exercise (FaME) Implementation Toolkit. This toolkit provides a suite of resources that commissioners can use to plan, implement and monitor the FaME programme.

Public Health England. Falls: applying All Our Health. Updated information on preventing falls and fractures. See also: e-LfH - Falls and fractures prevention e-learning module.

Public Health England and Centre for Ageing Better (2018) Muscle and bone strengthening and balance activities for general health benefits in adults and older adults. Summary of a rapid evidence review for the UK Chief Medical Officers’ update of the physical activity guidelines.

Public Health England. Falls prevention: cost-effective commissioning. The return on investment tool pulls together evidence on the effectiveness and associated costs for interventions aimed at preventing falls in older people living in the community. 

Royal College of Physicians. Falls and Fragility Fracture Audit Programme (FFFAP). The Falls and Fragility Fracture Audit Programme is a national clinical audit designed to audit the care that patients with fragility fractures and inpatient falls receive in hospital and to facilitate quality improvement initiatives.

Royal College of Physicians (2017) Bedside vision check for falls prevention: assessment tool. The National Audit of Inpatient Falls (NAIF) has collaborated with partners to produce a new vision assessment tool which enables ward staff to quickly assess a patient’s eyesight in order to help prevent them falling or tripping while in hospital.

Royal College of Physicians (2017) National Audit of Inpatient Falls Audit report 2017. Although prevention of inpatient falls across hospitals in England and Wales has improved slightly many patients are not receiving the required assessments which can help prevent falls in hospitals.

Royal College of Physicians (2016) Falls Prevention in Hospital: a Guide for Patients, their Families and Carers. This guide is designed to help prevent serious injury and unnecessary cost to the NHS caused by older people tripping or falling when they are in hospital. 
 
Royal College of Physicians (2015) FallSafe resources. FallSafe was a quality improvement project that helped frontline staff to deliver evidence-based falls prevention. 

Scotland

Scottish Government (2014) The Prevention and Management of Falls in the Community: A Framework for Action for Scotland 2014/15. This framework aims to support a more consistent approach to falls prevention and management and in doing so improve experiences and outcomes for older people, their families and carers; and to accelerate the pace of implementing integrated falls and fragility fracture pathways.
 
Scottish Patient Safety Programme (SPSP). Acute Adult - Falls. SPSP aims to support National Health and Wellbeing Outcome 7: People using health and social care services are safe from harm. The Acute Adult aim continues to be to reduce harm and mortality in hospitals. One of the workstreams covers falls.
 
SIGN (2020). Management of osteoporosis and the prevention of fragility fractures. This guideline provides recommendations based on current evidence for best practice in the management of osteoporosis and prevention of fractures.

Wales

Ageing Well In Wales. Falls prevention. The work of the Falls Prevention network aims to help older people to maintain their health and wellbeing, live longer in their own homes and remain active in their communities.
 
Public Health Wales. Steady on… Stay SAFE. Public Health Wales is encouraging people aged 50 plus to ‘Steady on.. and stay safe’ to reduce their risk of falling.

Page last updated - 05/10/2020