Are We Doing The Necessary Assessment for Elderly Patients Presenting With Falls?

Introduction
Falls are a leading cause of morbidity, mortality, and loss of independence in adults aged ≥65 years. World Health Organization (WHO) guidance recommends a comprehensive, multidisciplinary falls assessment within 48 hours of admission; however, adherence remains variable. Incomplete assessment risks missed reversible factors and recurrent falls. This quality improvement project (QIP) aimed to evaluate and improve the completeness of falls assessment across two acute Care of the Elderly units.

Method
A two-cycle Plan–Do–Study–Act (PDSA) QIP was conducted across Care of the Elderly wards at Pinderfields General Hospital and Dewsbury District Hospital. Cycle 1 (September 2024) retrospectively audited 30 patients aged ≥65 years admitted following a fall (15 per site). Falls assessment within 48 hours of admission was evaluated across 10 WHO-aligned domains: mobility, sensory function, cognitive function, autonomic function, past medical history, acute presentation/diagnosis, nutritional status, frailty, medication review, and investigations, using clerking, nursing, physiotherapy, and post-take consultant records.
Following identification of gaps, a standardised multidisciplinary Falls Assessment Checklist was introduced with targeted staff education. Cycle 2 (April–June 2025) re-audited a further 30 patients to assess post-intervention change.

Results
Baseline assessment demonstrated variable coverage of falls-risk domains, with consistent focus on investigations and medication review but incomplete assessment of contributory risk factors. Following checklist implementation, Cycle 2 demonstrated significant improvement across several key domains. Autonomic assessment increased from 68.3% to 85%, acute presentation/diagnosis from 66.6% to 72.5%, cognitive assessment from 56.6% to 80%, and mobility assessment from 43.8% to 74.4%. Nutritional assessment showed the greatest improvement, rising from 18.3% to 63.3%. Medication review and investigations remained consistently high, improving from 80% to 96.6% and 80% to 92.2%, respectively. Frailty assessment did not improve (73.3% to 70%). Sensory assessment, although improved (41.1% to 60%), and past medical history (46% to 54.6%) remained among the least frequently assessed domains.

Conclusion
A low-cost, standardised multidisciplinary Falls Assessment Checklist significantly improved the completeness and consistency of clinical falls assessment across two hospital sites, in line with WHO-aligned standards. More comprehensive assessment enabled improved recognition of modifiable risk factors, supporting more effective secondary prevention. Future QIP cycles will evaluate whether improved assessment translates into reductions in fall-related readmissions.