How should GPs assess falls risk?
Falls risk assessments
Ask opportunistically - annually if possible - about the number and characteristics of any falls in older patients, especially those aged over 75 years.
Patients with a fragility fracture who present with a fall are at highest risk of subsequent falls and should undergo a falls risk assessment. Those at highest risk are those with two or more falls in the previous year or a single fall plus a disorder of gait and/or balance (such as a postural instability, a failed 'get up and go' test, regular use of a walking aid, a history of stroke or Parkinson's disease), and those with a fall resulting in injury (such as a fracture). These should be offered a falls service referral but many will decline and the GP may have to pragmatically address the obvious risk factors for falls noted in the initiation section of this website. Another group that should be offered specialist assessment are those with a falls associated with syncope or with loss of consciousness to exclude underlying cardiac or neurological causes.
The key components of falls risk assessment in general practice would include medication review, visual acuity, vitamin D status, cognitive function, exercise recommendations, environmental check, check for postural hypotension and mobility assessment e.g. timed 'get up and go' test.
For more information, refer to:
- NICE: Falls in older people quality standard (QS86)
- Public Health England Falls and fractures: consensus statement and resources pack
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