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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 are multifactorial in nature and can be a marker of other conditions. For people who experience falls there can be an erosion of independence and confidence. 

For the wider health and social care community there is a cost in resources and for nurses there is a need to understand the best evidence based intervention in prevention, treatment and management. 

The number of people aged 65 and over is projected to rise by over 40 per cent in the next 17 years to more than 16 million (Office for National Statistics, 2015). Thirty percent of people aged 65 and over will fall at least once a year. For those aged 80 and over it is 50 per cent (NICE, 2013).


The RCN is involved in the following projects:

  • The RCN is working with the Joint Royal Colleges Ambulance Liaison Committee to produce guidance for paramedics to ensure thorough assessment of factors relating to falls and that the appropriate support and referrals are in place if the person is not conveyed to hospital, this guidance will be published shortly.
  • 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 marker. 
  • The RCN sits on the steering group of the National Audit of Intermediate Care which collects data to benchmark service provision for patients who require intermediate care, many of whom experience falls. This ensures that appropriate nursing data is collected and the voice of nursing is shared. The National Audit of Intermediate Care aims to take a whole system view of the effectiveness of intermediate care, to develop quality standards and patient outcome measures and to assess local performance against the agreed, national standards. Identification of potential productivity gains in intermediate care and linked potential cost savings in secondary care are key outputs of the project.
  • Disseminating a bedside vision screening tool for nurses as part of work undertaken with NHS England, see: Bedside vision check for falls prevention: assessment tool. This tool allows nurses to undertake a bedside vision assessment for people who have experienced falls. The screening tool promotes appropriate referral and informs the plan of care. 

Falls resources

NICE guidance

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 (2107) 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.

NICE (2013) Falls in older people. Assessing risk and prevention.This guideline covers assessment of fall risk and interventions to prevent falls in in people aged 65 and over. It aims to reduce the risk and incidence of falls and the associated distress, pain, injury, loss of confidence, loss of independence and mortality.

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)

Public Health England. 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. The RCN is a member organisation of the National Falls Prevention Coordination Group. 

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 (2015) National Audit of In-patient falls (NAIF) “Inpatient falls are common and remain a great challenge for the NHS. Falls in hospital are the most commonly reported patient safety incidents, with more than 240,000 reported in acute hospitals and mental health trusts in England and Wales every year.”

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. 

Royal Society for the Prevention of Accidents. Stand up stay up: National falls prevention programme. See also the January 2017 bulletin. The aim of the bulletin will be to update people with the latest innovations and activities in falls prevention as well as highlighting the work in partner areas as it develops.

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.

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.

Public Health Wales (2012) The burden of injury in Wales. Falls are the leading cause of both deaths and hospital admissions due to injury, accounting for approximately a quarter of deaths and half of all injury related admissions in Wales.

Non UK resources

Centre of Research Excellence in Patient Safety. 6-PACK falls prevention project (Australian). The 6-PACK program is a targeted, nurse delivered, falls prevention program, designed specifically for acute hospital wards. It consists of a nurse assessment of a patient's risk, using a nine-item risk assessment tool and the delivery of one or more of the six 6-PACK interventions (including the use of low-low beds) applied to patients classified as high-risk by the tool. 

Hospitals in Pursuit of Excellence. Preventing patient falls (American). This guide describes the types of risks that lead to patient falls, the root causes for those risks and the solutions designed to reduce them. Several case studies in the guide highlight individual hospitals and their experiences preventing falls.

RAND Corporation (2016) Evaluation of an intervention to prevent falls (American). This report evaluates the effectiveness of an intervention designed to prevent falls in the elderly, with a particular focus on fall-related injuries and on health care costs.