Abstract
Background:
Falls are common among older people and are associated with serious sequelae, including hip fractures, physical injury, institutionalisation, and death. Data from the National Hip Fracture Database and the Trauma Audit and Research Network (TARN) reveal a significant financial liability for the NHS, driven largely by prolonged hospital stays. NICE guidelines recommend that all patients aged 65 and over should be routinely asked about any falls in the past 12 months during healthcare interactions. This practice is not consistently implemented during surgical admissions.
Methods:
A retrospective analysis of electronic health records was conducted. The audit included 166 patients aged ≥65 years admitted to surgical specialties, focusing on whether they were asked about falls and underwent appropriate assessments.
Findings:
Of the 166 patients audited, 65.7% (n=109) were screened for falls. Only 15.1% (n=25) presented with falls as their primary complaint. Screening was predominantly conducted by the Perioperative Medicine for Older People undergoing Surgery (POPS) team (57.8%, n=63), followed by physiotherapists (29.4%, n=32), and emergency department staff (12.8%, n=14). Key assessments included ECG in 88.0% (n=147), postural blood pressure in 49.7% (n=83), calcium levels in 86.2% (n=144), and vitamin D in 39.5% (n=66). Bone health management was initiated in 16.3% (n=27), and polypharmacy was reviewed in all patients by the POPS team.
Conclusion:
Routine enquiry about falls should be conducted in all surgical patients aged 65 and above, irrespective of their primary reason for admission. This audit underscores gaps in meeting NICE guidelines and highlights the need for a streamlined, consistent screening process across surgical specialties. Those with a history of falls should undergo timely assessment and be referred to the appropriate specialty for further evaluation and intervention. Early identification and management of modifiable risk factors can prevent future falls, reduce readmissions, and deliver long-term cost savings for the NHS.