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NICE says nurses should routinely ask older patients about falls

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Older people should be asked about falls when they have routine assessments and reviews with health and social care practitioners, and if they present at hospital, states updated guidance.

In addition, older people at risk of falling should be offered a multi-factorial falls risk assessment and those assessed as being at increased risk given an individualised multi-factorial intervention.

“Asking older people about falls on a regular basis will identify those who are most at risk”

Gillian Leng

The National Institute for Health and Care Excellence has today published an update to its quality standard to help prevent falls in older people. The original version was published in 2015.

The updated version, which contains three new quality statements, now calls for healthcare professionals to ask patients aged 65 and over about falls during routine primary care appointments, when they attend hospital and during home visits.

NICE highlighted that around 30% of people aged 65 and up will fall at least once a year, based on a review published in the Journal of Gerontology in 2001.

The update stated that patients should be asked whether they have had falls in the last year, or consider themselves to be at risk of falling – for example, if they ever lose their balance or feel unsteady on their feet.

“We recognise that regular questions about falls may seem intrusive or repetitive”

Cameron Swift

If an older person is then deemed to be at risk, healthcare professionals should refer the older person to the appropriate service, according to the quality statement.

Also new to the updated standard are that older patients who are deemed to be at risk of falling are offered a multi-factorial falls risk assessment, and those flagged as being at an increased risk should be given a managed intervention individual to their needs.

Professor Gillian Leng, deputy chief executive at NICE, said: “We know that prevention is better than cure when it comes to falls, particularly in older people.

“Asking older people about falls on a regular basis will identify those who are most at risk,” she said.

“Through this simple intervention, those people can then be referred to the right health care professional or service to stop them falling in the future,” she added.

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Gillian Leng

Professor Cameron Swift, from King’s College London School of Medicine and a NICE specialist committee member, reinforced the value of routinely enquiring about falls incidents.

“We recognise that regular questions about falls may seem intrusive or repetitive, but older people often think episodes of falling or unsteadiness unimportant, or that to raise them could threaten future independence,” he said.

“By contrast, effective measures are now known to reduce the risk of falls, maintain independence and promote ongoing health,” he said. “It’s vital, therefore, that these are offered to those who need them.”

The revised quality standard from NICE follows a raft of similar initiatives revealed in January that are aimed at reducing falls and fracture risk among older people.

For example, the NICE recommendation on routine questioning echoes a joint statement on falls reduction published last week by the National Falls Prevention Coordination Group, which includes Public Health England and the Royal College of Nursing.

Older people coming into contact with nurses and other health professionals should be asked “routinely” about falls, said the falls and fracture consensus statement, which covers actions that the health and social care and housing sectors can take to help prevent falls and fractures.

Meanwhile, a new tool for hospital nurses and other professionals to quickly assess a patient’s eyesight and help prevent them from falling was also launched last week at NHS trusts and local health boards in England and Wales.

NICE noted that annual statistics showed that around 255,000 older people were admitted to hospitals in England annually due to falls and that falls cost the NHS more than £2.3bn a year.

Its quality standards, though not mandatory, are designed to to help commissioners, healthcare professionals, social care and public health practitioners to improve quality of care.

They comprise prioritised statements – usually six to eight in number – designed to drive measurable quality improvements within a particular area of health or care, which are derived from evidence-based guidance, such as existing NICE guidelines.

NICE quality statements on falls

  • Statement 1 Older people are asked about falls when they have routine assessments and reviews with health and social care practitioners, and if they present at hospital [new 2017]
  • Statement 2 Older people at risk of falling are offered a multifactorial falls risk assessment [new 2017]
  • Statement 3 Older people assessed as being at increased risk of falling have an individualised multifactorial intervention [new 2017]
  • Statement 4 Older people who fall during a hospital stay are checked for signs or symptoms of fracture and potential for spinal injury before they are moved [2015]
  • Statement 5 Older people who fall during a hospital stay and have signs or symptoms of fracture or potential for spinal injury are moved using safe manual handling methods [2015]
  • Statement 6 Older people who fall during a hospital stay have a medical examination [2015]
  • Statement 7 Older people who present for medical attention because of a fall have a multifactorial falls risk assessment [2015]
  • Statement 8 Older people living in the community who have a known history of recurrent falls are referred for strength and balance training [2015]
  • Statement 9 Older people who are admitted to hospital after having a fall are offered a home hazard assessment and safety interventions [2015]

 

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