This guideline gives advice about how to manage and prevent falls in the elderly. It is a remarkably practical guideline. I have tried to distil the important bits. I suspect that this is, in large, what most of us are doing already. It is interesting that NICE actually thinks that we should be doing relatively little of the assessment in General Practice.
Who should be assessed?
- All adults over 65 should be ‘routinely’ asked about falls (my advice – perhaps at medication reviews).
- All adults felt to be at risk should have an assessment of balance and gait. A good, easy to do test is the ‘Timed Up and Go Test’. If it takes patients more than 12 seconds to get up from sitting, walk 3m, turn around and sit down again, they are likely to be at risk.
What should be done for at risk patients?
- Refer for a formal falls assessment
- Consider their osteoporosis risk
- Give an information leaflet (eg about getting vision checked/hazards in the home).
- Medication Review – are there drugs that can be stopped – eg psychotropics?
In fact, this is all that NICE suggests we do in primary care, but it may be worth considering cardiac causes and organising an ECG if the falls could be cardiac. Lying and standing BP can also be done in practice. Continence problems are also worth considering (eg the person may be falling because they have urgency or frequency), as well as the patient’s cognition.