Prevalence of Acute Falls and Falls History Among Older Adults Attending the Emergency Department in the Home service.

Background
Falls are a common reason for Emergency Department (ED) attendance in older adults and are closely associated with frailty, functional decline, and recurrent healthcare utilisation. The Emergency Department in the Home (EDITH) service delivers acute medical and occupational therapy (OT) assessment in the person’s home, aiming to avoid unnecessary hospital attendance. Embedded OT assessment within EDITH provides a valuable opportunity to review underlying falls risks within the home environment, even when falls are not the primary reason for referral. This audit reviews OT identification of falls risk using the National Institute for Health and Care Excellence (NICE) 2025 guidelines as a reference.

Methods
A retrospective review was conducted over a three-month period, with 50 older adults randomly selected. Inclusion criteria were a primary presenting complaint other than a fall and receipt of OT assessment. Electronic patient records were reviewed to collate data on demographics, presenting complaint, OT assessment components, documented falls history within the preceding 12 months, discharge outcomes, and onward referrals.

Results
The mean age of the cohort was 82 years, with 52% female and 48% male. The most common presenting complaints were respiratory conditions (24%), infection (16%), and confusion (14%). Other presentations included pain, catheter-related issues, wounds, orthopaedic conditions, constipation, and functional decline.
All patients (100%) received an OT assessment incorporating a home environment assessment, and 96% underwent a functional assessment. Falls history was documented in 35 of 50 patients (70%). Of those, 14 patients (40%) had experienced at least one fall in the previous 12 months: seven had one fall, five had two falls, and two had three or more falls.
Following EDITH assessment and intervention, 82% of patients remained at home, and onward referrals were made for 48% of the cohort.

Conclusion
This OT-led review demonstrates a substantial prevalence of underlying falls history among older adults presenting to EDITH services for non-fall-related complaints. In line with NICE guidance, older adults in community settings who have experienced fewer than two falls in the previous year should still receive gait and balance assessment. Routine OT assessment within EDITH services plays a critical role in identifying falls risk, providing appropriate advice, and facilitating onward referrals.