WIREDGOV

We are seeking views from healthcare professionals and the public on draft recommendations covering assessments and interventions to reduce the risk of falls in older people. In particular, the proposed recommendation that home hazard assessments should be carried out by an occupational therapist.

The draft updated guidance on assessing and preventing falls in older people and people aged 50 and over at higher risk opens for public consultation today (18 October).

This is a full update of our 2013 guideline which, for the first time, includes specific recommendations for those in residential care, as well as updated recommendations on the assessment and care of people in hospital and community settings. 

The updated guideline recommends offering a comprehensive falls assessment and management for people who have fallen in the past year and are living with frailty, were injured in a fall, experienced loss of consciousness related to the fall, have been unable to get up independently after a fall, or have had two or more falls.  

The comprehensive falls assessment can include physical examinations, checking a person's balance and gait and asking them about possible dizziness. It also considers how each person’s risk factors can be resolved, improved, or managed to reduce their risk of falling.  

Following the falls assessment interventions that can be recommended include a falls prevention exercise programme and considering a home hazard assessment. 

NICE guidelines previously recommended home hazard assessments were carried out by a healthcare professional. However, the new draft guideline now recommends they should be carried out by an occupational therapist. 

We are particularly keen to hear feedback on this recommendation change as part of the consultation, noting that there may be a shortage of occupational therapists in some areas. 

Our independent guideline committee reviewed evidence and economic modelling which showed there were fewer falls when home hazard interventions were carried out by an occupational therapist.  

The home hazard assessment can include checking for potential trip hazards to reduce the risk of falls and practical interventions such as installing handrails. 

Conditions that increase the risk of falling include long-term health conditions such as heart disease, dementia, or hypotension. 

Falls can occur at any age but are increasingly common as people get older. Around a third of people aged 65 and over, and around half of people aged 80 and over fall at least once a year.  

In 2022/23 there were around 210,000 emergency hospital admissions in England related to falls for people aged 65 and over. Around 146,700 of these admissions were people aged 80 and over. The consequences of fracture are significant, with a mortality of between 18% and 33% one year after a hip fracture.   

The total annual cost of fragility fractures to the UK has been estimated at £4.4 billion which includes £1.1 billion for social care; hip fractures account for around £2 billion of this sum.

Professor Jonathan Benger, chief medical officer and deputy chief executive at NICE, said:

Falls present a major, growing public health problem which can have devastating consequences for older people, their families, and the healthcare service. 

This useful and useable guideline has been updated to help identify those people at greatest risk and provide them with the help and support they need to maintain their independence and live full, active lives. 

Fewer people suffering falls will result in a drop in the number of hospital visits and the need for ongoing treatments which will reduce pressure on the NHS. 

We recognise that recommending people at the greatest risk of falls should be offered a home hazard assessment carried out by an occupational therapist would be a change to current practice, so we want to hear from clinicians and others in the health and care system to get their views as part of the consultation.

The consultation closes on Thursday, 28 November.

Associated guidance and resources

Falls: assessment and prevention in older people and people 50 and over at higher risk (update)