Adult Social Care Glossary, v 0.6

A fall is defined as an event which causes a person to, unintentionally, rest on the ground or other lower level.

For the purpose of this CKS topic, a simple fall is defined as one occurring as a result of a chronic impairment of cognition, vision, balance, or mobility. It is distinguished from a collapse caused by an acute medical problem, such as an acute arrhythmia, transient ischaemic attack, or vertigo.

Falls are common in older people, especially those aged 65 years and over, and the prevalence increases with age.

The risk of falling is multifactorial, and prevention is usually based on assessing multiple risk factors.

A history of falls is one of the strongest risk factors for a fall, and all older people in regular contact with healthcare professionals should be asked routinely whether they have fallen in the past year.

Other risk factors for falls in older people include:
- Conditions that affects mobility or balance, such as arthritis, diabetes, incontinence, stroke, syncope, or Parkinson's disease.
- Other conditions, including muscle weakness, poor balance, visual impairment, cognitive impairment, depression, and alcohol misuse.
- Polypharmacy, or the use of psychoactive drugs (such as benzodiazepines) or drugs that can cause postural hypotension (such as anti-hypertensive drugs).
- Home hazards, such as loose rugs or mats, poor lighting, wet surfaces (especially in the bathroom), and loose fittings (such as handrails).

About 40–60% of falls result in major lacerations, traumatic brain injuries, or fractures. Other complications of falls include distress, pain, loss of self-confidence, reduced quality of life, loss of independence, and mortality.

Older people who present for medical attention because of a fall, report recurrent falls in the past year, or have other risk factors for falls should be assessed for gait and balance abnormalities (for example by using the Timed Up & Go test and/or the Turn 180° test).

A multifactorial risk assessment by an appropriately skilled and experienced clinician (usually in a specialist falls service) should be offered to older people who have had one or more falls in the past year or demonstrate abnormalities of gait and/or balance. This assessment should be part of an individualized, multifactorial intervention.

A multifactorial risk assessment may include assessing for home hazards, visual impairment, and drug treatments.

Interventions commonly offered by specialist falls services include strength and balance training, home hazard assessment and intervention, vision assessment and referral, and medication review (with modification or withdrawal).

People who do not have an indication to be referred for a multifactorial risk assessment should be reassessed at least annually.

The 2015 NICE Quality Standards defines a fall as an unexpected loss of balance resulting in a person unintentionally coming to rest on the ground or floor, or other lower-level surface regardless of whether an injury was sustained. This also includes falling on the stairs and onto a piece of furniture with or without loss of consciousness.

A fall is distinct from a collapse which is because of an acute medical condition such as arrhythmia, transient ischaemic attack (TIA) or vertigo. Anyone can have a fall, but older people are more vulnerable and likely to fall, especially if they have a long-term health condition. Most falls do not result in serious injury, however, once a person has experienced a fall, they are more likely to have recurring falls. Some falls may cause serious injury, even death.

In addition to any physical injury, a fall can impact on a person’s self-confidence, increase social isolation, and reduce independence. It is therefore important to provide relevant 4 support and advice where possible to prevent falls occurring by taking into consideration each person’s individual risk (for example, by undertaking a falls risk assessment including environmental risk assessment and where appropriate, to ensure falls risk reduction measures are in place (see section 4 for further information).

Fall prevention strategies and interventions need to consider the fact that falls can have several causes, such as frailty, infection, confusion, and the effect of certain prescribed drugs that require many different interventions. Fall prevention is the key to safeguard people from harm.