Clinical Review

Fall assessment in older people

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d5153 (Published 14 September 2011) Cite this as: BMJ 2011;343:d5153
  1. Jacqueline C T Close, consultant geriatrician123,
  2. Stephen R Lord, senior principal research fellow3
  1. 1Falls and Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, NSW 2031, Australia
  2. 2Prince of Wales Clinical School, University of New South Wales
  3. 3Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales
  1. Correspondence to: J C T Close j.close{at}neura.edu.au

Summary points

  • Fall risk screening identifies people at increased risk of falls who need detailed fall risk assessment and intervention, which can in turn prevent falls and fall related injury

  • Quick validated fall risk screening tools for older people are available for community, hospital, and nursing and residential care settings

  • Screen older people living in the community for fall risk every 12 months and assess for risk factors after a fall

  • Fall risk in hospital inpatients is changeable because physical and cognitive abilities may alter during a hospital stay

  • Although all older people in nursing and residential care are at high risk of falls, a screening tool that includes their ability to stand unaided and risk factors such as cognitive impairment, incontinence, and drug use can provide extra information about fall risk

Falls are common in older people and are the leading cause of injury related admissions to hospital in people of 65 years and over, accounting for about 14% of emergency admissions and 4% of all hospital admissions in this age group.1 A fall may result from acute disease (for example, chest infection), chronic underlying pathology (for example, Parkinson’s disease), or the interaction of a person with their surroundings (for example, tripping on a pavement). Evidence indicates that many falls could be prevented through appropriate assessment and intervention.2 3 4 The terms “fall risk screening” and “fall risk assessment” are sometimes used interchangeably. Screening is a process that primarily aims to identify people at increased risk of falls, whereas assessment aims to identify factors that increase the risk of a fall that can be dealt with by subsequent intervention. In the community setting, a fall risk screen can be used at a population level to identify older people who need a more detailed fall risk assessment and intervention or …

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