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

What this guideline says

GMJ summary

This NICE guideline (NG249) provides comprehensive recommendations for falls assessment and prevention in people aged 65 and over, and those aged 50-64 with risk factors. It covers identification of at-risk individuals, comprehensive falls assessment, and tailored interventions across community, hospital inpatient, and residential care settings.

The guideline recommends against using falls risk prediction tools, instead favouring case-finding through asking about falls history and offering comprehensive assessment to those who have fallen and meet specific criteria (living with frailty, injured in a fall requiring medical treatment, loss of consciousness, unable to get up independently, or had 2+ falls in the last year). Core interventions include medication review (especially psychotropic medicines), home hazard assessment and modification, falls prevention exercise programmes focusing on balance, coordination and strength, and surgical interventions for cataracts or cardiac pacing where appropriate.

The guideline emphasizes individualised, multifactorial interventions that address identified risk factors, maximising participation through supervised group exercise where possible, and providing tailored information and education. In hospital and residential settings, all eligible people should receive comprehensive assessment with interventions tailored to what can be achieved during their stay, emphasizing maintaining activity levels and addressing modifiable risk factors.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. Do not use falls risk prediction tools to predict a person's risk of falling; instead, ask about falls history opportunistically and assess gait and balance where indicated.
2. Offer comprehensive falls assessment and management to people who have fallen in the last year and: are living with frailty, were injured requiring medical treatment, had loss of consciousness, were unable to get up independently, or had 2 or more falls.
3. Comprehensive falls assessment should include: cardiovascular examination (lying and standing blood pressure), cognition and mood, gait/balance/mobility and muscle strength, medication review, neurological examination, footwear and foot condition, visual and hearing impairments, and osteoporosis risk assessment.
4. For medication review, consider adjusting medicines that increase falls risk; for people taking psychotropic medicines, review and discuss increased falls risk, and plan withdrawal as appropriate, potentially liaising with specialist mental health services.
5. Offer home hazard assessment and intervention using a validated tool, ideally carried out by an occupational therapist (or appropriately trained healthcare professional or supervised therapy assistant/technician).
6. Falls prevention exercise programmes should be progressive and tailored, delivered by appropriately trained professionals, focusing on functional components related to falls risk (balance, coordination, strength, power), and delivered to bring about behaviour change.
7. In hospital inpatient and residential care settings, offer comprehensive falls assessment and management to all eligible people; encourage remaining active by reassuring people they can still get up, helping them be less sedentary, and encouraging physical activity.
8. Maximize participation in falls prevention by discussing and agreeing changes the person is willing to make, ensuring interventions are flexible to individual needs and preferences, offering choice in delivery (individual or group exercise), and enabling social contact and support where possible.

Criteria for comprehensive falls assessment and management in community settings

Table extracted from the guideline

Source: National Institute for Health and Care Excellence (UK), Falls: assessment and prevention in older people and in people 50 and over at higher risk. Reproduced in summary form.

What changed in this edition

Versus the previous edition

• This guideline updates and replaces NICE guideline CG161 published in June 2013.
• Recommendation against using falls risk prediction tools is new, reflecting evidence that they do not reach acceptable thresholds of sensitivity or specificity.
• Expanded guidance on identifying people aged 50-64 at higher risk of falls, including those with underlying conditions such as Parkinson's disease and diabetes.
• Updated recommendations for hospital inpatient and residential care settings reflecting changes in evidence and national developments such as the National Falls Prevention Coordination Group.
• New emphasis on maximising ongoing participation through supervised exercise, social contact, and addressing barriers to adherence.
• Enhanced recommendations on information and education tailored to different settings (community, hospital, residential care).

From the guideline

Verbatim

“Offer a comprehensive falls assessment and comprehensive falls management to people who have fallen in the last year and meet any of the following criteria: Are living with frailty; Were injured in a fall and needed medical treatment; Have experienced a loss of consciousness related to a fall; Have been unable to get up independently after a fall; Have had 2 or more falls in the last year.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

Related on GMJ

Interconnected resources

GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.