Falls history.
The National Institute for Clinical Excellence (NICE) guidance on falls and fall prevention recommends that "Older people in contact with health care professionals should be asked routinely whether they have fallen in the past year and asked about the frequency, context and characteristics of the fall(s)." The guidance justifies this recommendation by pointing out that falls history is a significant risk factor and predictor of further falls. The guidance describes the purpose of this recommendation as establishing the frequency of falling, the context and circumstances of the fall and the severity or injuries sustained from the fall.
Balance and gait deficits.
The guidance goes on to recommend that "older people reporting a fall or considered at risk of falling should be observed for balance and gait deficits and considered for their ability to benefit from interventions to improve strength and balance". The guidance goes on to say that observation for balance and gait deficits could be done by an appropriately trained health care professional in any setting. A first level assessment is considered to be adequate if it consists of a simple observation of the person's ability to stand, turn and sit. The guidance specifies that older people with observed gait or balance problems should be referred for targeted interventions.
Falls risk assessment.
The guidance recommends that "Older people who present for medical attention because of a fall, or report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should be offered a multifactorial falls risk assessment. This assessment should be performed by a health care professional with appropriate skills and experience, normally in the setting of a specialist falls service. This assessment should be part of an individualised, multifactorial intervention".
A miutifactorial assessment is required because the risk of falling increases with the number of risk factors.
Health professionals are advised to take the following factors into account when assessing a person's risk of falling:
