Improving assessment and management of Concerns about Falling among older hospital inpatients

Introduction

Each year, around 30% of those aged 65 and over fall; around 20-30% of these falls result in moderate to severe injuries including bruising, fractures and head injuries.  Experiencing concern about falling is strongly associated with increased risk of future falls, with around half of those aged over sixty feeling some level of concern.  Evaluation of concerns about falling as part of a falls assessment is recommended by both the World Falls Guidelines and NICE.  

Method

Initial audit was conducted against the 2025 NICE Falls Guideline.  We then utilised plan–do–study–act quality improvement methodology as a framework for iterative testing of interventions and evaluation.  We implemented several interventions, including MDT teaching both face to face and as ‘topic of the week,’ raising awareness of CaF amongst medical staff, inclusion of CaF within allied health professional (AHP) initial assessments, use of a patient information / self-help guide produced by therapy staff and availability of referral to a dedicated clinic.  Audit was repeated following interventions.

Results

Preliminary audit identified that only 22% of inpatients aged 65 and over were assessed for concerns about falling.  Assessments were primarily conducted by AHPs (occupational therapy, physiotherapy, rehabilitation assistants).  Of the patients assessed, 64% expressed concern about falling.  Following implementation of interventions, 68% of patients were found to have been assessed, with 78% of these expressing concerns.  Whilst many of the assessments were still conducted by AHPs, the number of patients whose assessment for concerns about falling was conducted by medical staff was substantially increased on re-audit.

Conclusion

Simple interventions were found to be highly effective.  Low performance on initial audit was felt to be due to a knowledge gap within the MDT; this was addressed through dedicated training sessions.  Work is ongoing to roll out the project more widely within the Trust.