Synopsis
Recognise frailty and falls as potentially reversible syndromes, identify time-critical injury or illness, complete multifactorial assessment and coordinate strength-based prevention without equating risk with age.
- Frailty is reduced physiological reserve with vulnerability to stressors; it is not synonymous with age, disability, dementia or inevitable decline.
- After a fall, first identify head injury, fracture, bleeding, sepsis, stroke, arrhythmia, acute coronary syndrome, hypoglycaemia and inability to rise safely.
- NICE NG249 covers falls assessment and prevention for people aged 65 or over and people aged 50 to 64 at higher risk because of an underlying condition.
Key red flags
Head injury, inability to weight bear, focal neurology, physiological instability, anticoagulant-associated concern or prolonged lie needs urgent assessment.
Loss of consciousness, exertional event, palpitations, chest pain or absent protective response should not be relabelled as a simple trip.
Reasoning priorities
Detect fracture, head injury and acute medical cause.
Escalate on clinical concern; absence of external injury does not exclude intracranial or occult hip injury.
Worked reasoning
An 82-year-old living with frailty fell walking to the toilet two days after an antihypertensive increase and now fears standing.
- Assess ABCDE, observations, head strike, anticoagulation, pain, weight bearing, neurological status and time on the floor; escalate immediately if injury or acute illness is suspected.
- Reconstruct the event and baseline, measure lying and standing blood pressure with symptoms, review urgency, lighting, gait and the complete medicine list; reason that the dose change may contribute but is not proven to be the only cause.
- Take the final action: address injury, discuss an individual medicine adjustment with the prescriber, arrange comprehensive falls assessment and targeted strength-and-balance and home-hazard input, preserving necessary blood-pressure treatment.
- Verify recovery and safety by naming who reviews blood pressure and symptoms, confirming referral receipt, checking confidence and further falls and providing an urgent deterioration and recurrent-fall plan.