Synopsis
Treat a fall as an event requiring acute injury and cause assessment, reconstruct baseline and circumstances through collateral, and deliver a personalised multifactorial prevention plan that improves strength, balance, confidence, bone health and home safety.
- A fall is an event, not a diagnosis: reconstruct what happened before, during and after and compare current mobility with the stable baseline.
- First-line acute assessment is ABCDE, glucose, injury and head-impact review, pain relief, medication check and evaluation for syncope, stroke and illness.
- Ask about falls in the past year, near-falls, ability to get up, long lie, footwear, alcohol, continence urgency, vision, hearing and fear.
- NICE advises comprehensive falls assessment for people who fell in the last year and have frailty, injury, loss of consciousness, inability to rise or multiple falls.
- Do not use a fall-risk prediction score to decide who receives assessment or intervention; identify and treat the person's actual modifiable factors.
- Assessment covers gait, balance, strength, cognition and delirium, cardiovascular status including lying-standing pressure, medicines, vision, feet, continence, bone health and home hazards.
- First-line prevention is tailored progressive exercise targeting balance, coordination, strength and power, delivered by appropriately trained professionals and reviewed for progression.
- Perform structured medication review and cautiously reduce fall-risk-increasing medicines where net benefit permits; never stop withdrawal-prone treatment abruptly.
- Home hazard assessment and intervention should be completed by a trained professional and linked to the person's function and routines.
- After any fragility fracture, initiate fracture liaison or equivalent bone assessment promptly rather than waiting for another fall.
Key red flags
Head strike, anticoagulant or antiplatelet use, vomiting, amnesia, focal deficit or reduced consciousness requires urgent head-injury assessment.
New inability to weight bear, shortening, rotation, focal bony tenderness or pain with passive movement requires fracture imaging despite limited bruising.
Syncope, exertional collapse, palpitations, abnormal ECG, murmur or family sudden death history needs urgent cardiovascular evaluation.
Long lie with hypothermia, pressure injury, dehydration, dark urine or weakness requires CK, renal, electrolyte and safeguarding assessment.
Fever, hypoxia, delirium, hypoglycaemia or acute functional loss may reveal systemic illness rather than a mechanical trip.
Recurrent unexplained injury, fear of a carer, poor home conditions or unavailable essential support raises safeguarding concern.
Delirium, hypoxia, fever, glucose disturbance or new functional loss indicates illness-triggered instability.
Inability to weight bear, head symptoms or focal tenderness directs urgent imaging even after a low-energy event.
Investigation priorities
Identify immediate illness and trauma.
Management branches
An older adult presents after a fall or near-fall.
- Stabilise, check glucose, treat pain and evaluate head, hip and other injury and acute illness.
- Obtain witness and baseline collateral and assess syncope, seizure, medicines, gait, cognition, vision and environment.
- Create a personalised prevention plan with exercise, medication, home, cardiovascular and bone actions and named review.