Frequent falls and the need for social and care support
Frequent falling is a sign that a patient may no longer be coping safely, so more social and care support is needed beyond treating any single cause.
Remember
Frequent falling over a short period signals that a patient may need more social and care support, so look beyond treating the cause of any single fall.
A single trip with a clear mechanical cause is usually dealt with by treating any injury and avoiding the hazard. Frequent falling shows a continuing problem and is a recognised sign of unmet care needs, so support is needed on top of treating any single cause.
Regular falling often points to frailty (reduced reserve against minor stresses), too little help at home, impaired balance or other illnesses. After a first fall, about two in three older people (66 per cent) fall again within a year.
Ask who the patient lives with, what help is available at home and whether anyone depends on them. Living arrangements influence the risk of falls and also recovery. An occupational therapist (a health professional who helps people manage daily activities safely) can assess the home and fit handrails or stair lifts. Patients are known to rearrange their furniture so that they can furniture walk (use it as support) around the home, and this signals decreasing function and a need for more support.
Ask how long the patient lay on the floor. If a patient is on the floor for more than 12 hours, this is associated with a higher incidence of complications such as rhabdomyolysis (muscle breakdown due to prolonged pressure). Patients who stay there a long time should have discussions about social issues and the increased need for care.
The Clinical Knowledge Summaries from NICE (the primary care guidance) advise a comprehensive falls assessment for older people who have fallen in the last year and are living with frailty, had an injury needing treatment, lost consciousness, could not get up unaided or have had two or more falls. Such an assessment appears to reduce falls only if it leads to an individual multifactorial plan, meaning one that tackles several risk factors together.
Key facts
- Frequent falling
- indicates that the patient needs more support, beyond treating the cause of a single fall.
- After one fall
- in older people, about two in three (66 per cent) fall again within a year.
- Time on the floor
- more than 12 hours is associated with a higher incidence of complications such as rhabdomyolysis, and patients who stay there a long time should have discussions about the increased need for care.
- Falls assessment
- the Clinical Knowledge Summaries from NICE advise a comprehensive falls assessment for older people who fell in the last year and are living with frailty, had an injury needing treatment, lost consciousness, could not get up unaided or have had two or more falls.
- Multifactorial plan
- a comprehensive falls assessment appears to reduce falls only if it leads to an individual plan that tackles several risk factors together.
- Furniture walking
- rearranging furniture so that it can be used as support while walking around the home is a sign of decreasing function, and more support is needed.
Exam traps
- A newly started sleeping tablet does not by itself show that the patient needs more social support, because it is a reason to review the patient's medicines (it can cause drowsiness and unsteadiness) and does not show that the patient is failing to cope at home.
- A drop in blood pressure on standing does not by itself show a need for more social and care support, because it can cause falls and should be measured and treated.
- An old wrist fracture does not show a need for more social support, because it bears on bone health and not on a pattern of frequent falls over a short period.
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