Comprehensive Geriatric Assessment (CGA): Falls history

Including a falls assessment as part of CGA helps identify preventable risks and allows timely interventions, which is particularly crucial in those living with frailty.¹

Frailty increases fall risk due to reduced strength, balance, slower reaction times, and polypharmacy. Evidence shows that people with frailty are not only more likely to fall but also to suffer serious consequences, such as fractures, head injuries, hospitalisation, and functional decline. Targeted falls prevention in this population reduces hospital admissions and improves quality of life.²

Key elements to assess in a falls history include:

• History of falls (how many, when, where, what circumstances, injuries, fear of falling)
• Stability (balance and gait assessment, orthostatic hypotension)
• Feet and footwear (pain, deformities, peripheral neuropathy, inappropriate or unsafe shoes)
• Medications (e.g. sedatives, antihypertensives, anticholinergics, psychotropics)
• Vision, cognition, continence, and environmental hazards
• Bone protection (assess fracture risk using FRAX or QFracture. FRAX score needs adjusting if 2 or more falls per year³).

It is important to identify which individual elements are increasing the risk of falls, and then develop a plan to minimise these risks where possible. Where a risk factor is non-modifiable, it is essential to consider how this risk might be mitigated e.g. providing advice on what to do in the event of a fall, and how to get up safely if possible.

Multifactorial interventions

Multifactorial interventions, combining strength and balance training, home hazard modification, medication review, and vision correction are the most effective strategies. A Cochrane Review on Falls Prevention⁴ confirms that these combined approaches significantly reduce falls in community and care settings.

Falls are often the first sign of declining health. Addressing them proactively is critical in frailty care.