Falls, frailty and fractures - Adherence of the Acute Medical Unit to Guidelines

Introduction

A significant proportion of hospital admissions among the elderly are attributed to falls, contributing to morbidity and mortality. NICE guidelines recommend a comprehensive assessment in elderly patients presenting with fall including lying standing blood pressure (LSBP) test, carrying out structured medications review and osteoporosis risk assessment. While a large proportion of patients are reviewed and assessed by frailty team after hospital admission, there are a considerable number of elderly patients with falls admitted to Acute Medical Unit especially during out-of-hours.

Objective

To assess the compliance of NICE guidelines on fall assessment in Acute Medical Unit. 

Methods

Retrospective random case note reviews of elderly patients over the age of 65 presented with falls in July 2025. 

Results

Total 18 patients

Demographics: mean age - 77.89 years (range 72-100), male preponderance of 61%

Clinical Frailty score: mean - 5.34 (range: 3-7)

Frailty index - Fit - 3, mild frailty - 6, moderate frailty 7, severe frailty - 2

Polypharmacy - 72% (13 out of 18)

Structured medications review done - 78% (14 out of 18)

LSBP - 72% (13 out of 18)

Bone health assessment: Vitamin D check - 44% (8 out of 18) and FRAX score - done on 5 (28%) not done on 39% (7 out of 18) while others are not applicable due to age above 90 years and already on antiresorptive therapy.

Conclusion

This audit revealed a suboptimal compliance on falls assessment according to NICE guidelines especially in bone health assessment. Further education sessions for the resident doctors along with a reminder poster and teachings in the department will be performed. Audit re-evaluation will be conducted in due course to reassess the compliance.