Falls Prevention

A fall is rarely "just a fall". It is usually several small things conspiring: blood pressure that dips on standing, plus new tablets, plus slippers worn smooth, plus a rushed trip to the toilet at night, plus thigh muscles that have quietly weakened. That's why falls work is detective work — and why the answer is almost never a single grab rail or, worse, telling someone to move less.

The costs run beyond fractures. After a fall, fear arrives: people stop walking to the shop, then around the garden, then around the room. Muscles weaken with disuse, which makes the next fall more likely — the dread spiral of falls work. Good prevention attacks the spiral at both ends: reduce the hazards and rebuild strength, balance and confidence.

When a fall happens anyway, the response matters enormously: check before moving (head, hips, wrists, pain), use safe lifting equipment rather than hauling, watch carefully afterwards — especially for head injuries in anyone on blood thinners — and treat the fall as free information about what to fix next.

• NICE NG249 (April 2025): falls — assessment and prevention in older people and people 50+ at higher risk. Multifactorial assessment and tailored interventions for those meeting risk criteria (falls with injury, loss of consciousness, unable to get up, two or more falls in a year, frailty).
• Regulation 12: falls risks must be assessed and mitigated; unsafe premises and equipment engage Regulation 15.
• MCA 2005 and Human Rights Act: a person with capacity may choose to take mobility risks; restrictions on those without capacity must be necessary, proportionate and least restrictive — no blanket "must not mobilise alone".
• RIDDOR / CQC notifications: serious injuries from falls are notifiable (CQC for people using registered services; RIDDOR where staff or work causes are involved).
• Care Act prevention duties support community strength-and-balance programmes.

Assessors track falls data and what happened next: assessments updated after each fall, causes actually chased (medication reviews requested, postural blood pressures done, referrals made), sensible use of technology (sensors as information, not surveillance), and no punitive restrictions. Post-fall protocols should be known by every worker — including checking for injury before moving and neuro observations after unwitnessed falls or head strikes. Repeated falls with identical "reassured, no injury noted" entries and no changed plan is the classic pattern CQC criticises.

• Assess multifactorially per NG249: falls history in detail (where, when, doing what), gait and balance, muscle strength, medicines (sedatives, antihypertensives, anticholinergics — the FRIDs), postural hypotension (lying and standing BP), vision, feet and footwear, continence urgency, cognition, environment, fear of falling.
• Turn each factor into an action: GP/pharmacist medication review; standing slowly with a pause taught for BP drops; opticians and cataract referrals; proper slippers with backs; a urinal bottle or commode at night; lighting on the route to the toilet; clutter and cables gone.
• Push strength and balance hard: seated exercises, standing practice at the rail, walking little and often — prescribed like medication ("three ten-minute walks daily"), because it works like medication.
• Night-plan the high-risk hours: last drink timing, toileting before bed, night lights, sensor mats where justified for the individual.
• Post-fall, every time: don't move the person until checked (pain, head, hip shortening/rotation, wrists); use flat-lift or hoist equipment if needed; observations after head strikes or unwitnessed falls per policy — urgently escalate anyone on anticoagulants who hits their head; record factually; review the plan within days, not months.
• Keep life in the plan: the aim is confident movement, not a person parked "for safety".

Example 1. A woman falls three times in a month, always mid-morning. The senior maps the pattern: each fall follows her new blood-pressure tablet with breakfast. Lying and standing BPs show a 30-point drop. The GP adjusts timing and dose, staff teach her to rise in stages and count to ten, and morning walks resume with a worker for a fortnight. No falls in the next quarter — found by charting, fixed by teamwork.

Example 2. A night worker finds a resident on the bathroom floor, unwitnessed. He wants to hop straight up; she keeps him still and warm while she checks — no pain, no shortening, but he's on apixaban and can't rule out a head bump. She uses the lifting cushion, starts neuro observations per protocol, and escalates for clinical advice. The scan is clear. The habit of assuming the worst first is what makes "he was fine" a fact rather than luck.