Dr Sanskriti Shashank is an Indian medical graduate currently undertaking clinical attachments in the UK, with a growing interest in geriatric medicine and quality improvement. She is passionate about improving systems of care for older adults.
In June 2025, during a clinical observership in a geriatrics department, I noticed a striking pattern: a large proportion of admissions followed a fall. In older adults, falls are not only common, but they are also a major contributor to morbidity, prolonged hospital stays, increased staff workload, and escalating healthcare costs.
Despite clear, evidence-based guidelines on fall prevention, a persistent gap remains between what is recommended and what is practised.
Several factors feed into this disconnect. Time-pressured staff must often juggle multiple clinical demands, making it difficult to prioritise proactive fall prevention. Communication between doctors and therapy teams is sometimes fragmented, especially around mobility plans and assessing fall risk. I also observed uncertainty among staff about who is responsible for what, directly impacting the consistency and timeliness of interventions.
Improving outcomes requires more than clinical knowledge, it demands systems-level clarity and collaboration.
One example is the measurement of lying and standing blood pressure to assess postural hypotension. While clinically valuable, these checks are frequently delayed or deprioritised, particularly when requested inappropriately (for example, in patients who are immobile or require hoisting). When such assessments are reduced to routine requests without context, they risk becoming “tick-box” exercises, failing to inform decision-making and potentially delaying discharge.
Equally important is timely communication between medical and therapy teams. Therapists must be informed when a patient is medically optimised and ready to begin mobilisation. This step is crucial in rebuilding confidence after a fall. Delays, whether due to miscommunication or unclear role boundaries, can hinder recovery and prolong hospital stays, compounding the strain on already stretched NHS resources.
While the clinical frameworks for fall prevention are robust, the challenge lies in implementing them effectively. Addressing time constraints, streamlining communication, and clarifying team roles must be part of any strategy aiming to reduce inpatient falls.
We must move beyond protocol-driven care to system-aware practice. Preventing falls isn't just about checking boxes, it's about building a culture that supports collaborative, timely, and patient-centred action.
