FALL to FRAIL: A Standardised Bundle for Reducing Falls Risk and Assessing Fracture Prevention in Older Adults With Frailty

Introduction

Falls in older adults are common and associated with significant morbidity, including fragility fractures and loss of independence. NICE and British Geriatrics Society guidance recommend comprehensive multifactorial falls assessment and intervention. This project aimed to introduce and evaluate a standardised ‘FRAIL’ falls assessment bundle for older patients admitted following a fall.

Methodology

A three-stage audit was conducted in patients aged ≥65 years with a Clinical Frailty Scale (CFS) score ≥6, admitted following a fall. Cycle 1 (n=15) retrospectively assessed documentation of falls history, medication review, postural blood pressure, 24-hour BP trends, FRAX fracture risk and long-term bone protection planning. A standardised FRAIL bundle (Falls history, Review medications, Assess postural BP and BP trends, Investigate fracture risk, Long-term bone plan) was introduced through structured teaching, ward posters and a documentation prompt. An interim snapshot audit (n=5) and subsequent final re-audit (n=40) assessed the same domains.

Results

Comparing baseline and final audit findings, falls history documentation increased from 87% to 90%, while medication review decreased from 87% to 83%. Postural BP assessment (BP/LSBP) improved from 87% to 100%, and lying-standing BP documentation increased from 87% to 95%. Assessment of 24-hour BP trends improved from 53% to 68%. FRAX fracture risk assessment demonstrated the greatest improvement, increasing from 27% to 58%. Long-term bone protection planning remained relatively unchanged (60% to 63%). Despite improvements in individual assessment domains, almost no evidence of explicit FRAIL bundle documentation was identified. Differences between baseline and final audit results were not statistically significant (Fisher’s exact test; FRAX p=0.07, all other measures p>0.05).

Conclusion

Introduction of the FRAIL bundle was associated with improvements in several aspects of falls assessment, particularly FRAX assessment and BP evaluation. However, limited evidence of explicit bundle documentation suggests that improvements cannot confidently be attributed to bundle adoption. Further interventions will focus on embedding FRAIL prompts into clerking and discharge documentation, targeted teaching and encouraging FRAX assessment and bone protection planning during ward rounds. Further re-audit will assess sustained improvement and bundle uptake.