{"id":3927,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/falls\/"},"modified":"2026-07-09T11:07:10","modified_gmt":"2026-07-09T10:07:10","slug":"falls","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/medicineoftheelderlygeriatrics\/falls\/","title":{"rendered":"Falls"},"content":{"rendered":"\n<title>Falls<\/title>\n\n\n\n<p class=\"wp-block-paragraph\">Falls are increasingly common with age. There can be multiple causes for falls including acute illness, and falls can often co-exist with the onset of delirium. Falls can result in severe injury including fractures and head debilitating injuries, with associated consequent morbidity and mortality. Fear of falling can be for older people, and hard to treat. Realistic prescribing is important in older people; the risks of polypharmacy (including falls) increase with age.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It can be difficult to determine the reason for a fall, and one single reason may never be identified.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There are a number of risk factors; modifiable and non-modifiable. The purpose of comprehensive geriatric assessment is to identify all risk factors and address as many of the modifiable risk factors as possible. Risk factors for falls include (but are not limited to):<\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter\"><table class=\"has-fixed-layout\"><thead><tr><th>Age<\/th><th>Syncope of any cause<\/th><\/tr><\/thead><tbody><tr><td>Sarcopenia \/ low body weight<\/td><td>Medications (esp. high anticholinergic burden)<\/td><\/tr><tr><td>Sensory impairments particularly eyesight<\/td><td>Number of medications (polypharmacy)<\/td><\/tr><tr><td>Dizziness and vertigo (central or peripheral cause)<\/td><td>Incontinence&nbsp;<\/td><\/tr><tr><td>Dementia<\/td><td>Alcohol<\/td><\/tr><tr><td>Neurological conditions e.g. Parkinsonism, stroke disease, neuropathy<\/td><td>Metabolic disturbances (e.g. hypoglycaemia)<\/td><\/tr><tr><td>Delirium of any cause<\/td><td>Inappropriate walking aids<\/td><\/tr><tr><td>Pre-existing MSK injury or pain<\/td><td>Environmental factors (stairs, loose rugs etc) &nbsp;<\/td><\/tr><tr><td>Postural hypotension<\/td><td>&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>J.B &#8211; 9-7-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Patients who have recurrent falls despite attempts to address identifiable risk factors, or where further expert advice is needed<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Patients who solely require input from physiotherapy and\/or occupational therapy should be referred to the local services directly<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients who have clear red flags for cardiac syncope (definite loss of consciousness, abnormal ECG, facial injuries suggestive of LOC) \u2013 please consider referring directly to cardiology.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please consider involving a pharmacist before referring if medication\/polypharmacy review is the sole reason for referral.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please consider contacting the Parkinson\u2019s nurses instead of or alongside MOE referral if the patient has a diagnosis of PD.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer \u00a0<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">If acutely unwell and Hospital at Home admission is appropriate, please refer to locality <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/admissionsurgentcare\/hospital-at-home\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hospital at Home (H@H)<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Otherwise patients should be referred via SCI Gateway to their local geriatric medicine service<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/moeeastlothian\/\">MOE East Lothian<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/moe-edinburgh-north\/\">MOE Edinburgh North<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/moe-edinburgh-south\/\">MOE Edinburgh South<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/moe-midlothian\/\">MOE Midlothian<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/moewestlothian\/\">MOE West Lothian<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">In all older patients with falls, consider the possibility that this is the presenting symptom of an acute illness.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Appropriate history and examination therefore includes:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Consider osteoporosis risk using appropriate scoring system (Qfracture, FRAX).<\/li>\n\n\n\n<li>Number and frequency of falls including time of day, preceding activities (step by step history helpful)<\/li>\n\n\n\n<li>Other associated symptoms coinciding with onset of falls (i.e. suggesting intercurrent illness)<\/li>\n\n\n\n<li>Light headedness on standing, loss of consciousness at any point preceding \/ during fall (if LOC please give appropriate\u00a0 driving advice as per DVLA)<\/li>\n\n\n\n<li>Injuries sustained following falls (facial injuries\/failure to attempt rescue may indicate syncope more likely, injuries add to hazard risk of falls)<\/li>\n\n\n\n<li>Alcohol history<\/li>\n\n\n\n<li>Collateral history and witness account if possible (partner, family, carers)<\/li>\n\n\n\n<li>Cardiovascular, respiratory, abdominal, and neurological examinations as appropriate to identify intercurrent illness.<\/li>\n\n\n\n<li>Assessment of gait and mobility (e.g. Timed Up And Go test)<\/li>\n\n\n\n<li>Lying and standing blood pressures (after 5 min lying, immediately and again at 3 minutes)<\/li>\n\n\n\n<li>Full medication review (in particular considering anticholinergic burden and START\/STOPP criteria)<\/li>\n\n\n\n<li>ECG<\/li>\n\n\n\n<li>FBC, U&amp;E, LFT, Calcium, TFT, B12\/folate\/iron studies, random glucose, HbA1c in people with diabetes.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">How to measure lying and standing BP:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.rcplondon.ac.uk\/projects\/outputs\/measurement-lying-and-standing-blood-pressure-brief-guide-clinical-staff\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.rcplondon.ac.uk\/projects\/outputs\/measurement-lying-and-standing-blood-pressure-brief-guide-clinical-staff<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Polypharmacy guidance including information about anticholinergic burden:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/polypharmacy-guidance-appropriate-prescribing-making-medicines-safe-effective-and-sustainable-2026-2029\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.rightdecisions.scot.nhs.uk\/polypharmacy-guidance-appropriate-prescribing-making-medicines-safe-effective-and-sustainable-2026-2029<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Realistic prescribing:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.therapeutics.scot.nhs.uk\/wp-content\/uploads\/2018\/04\/Polypharmacy-Guidance-2018.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.therapeutics.scot.nhs.uk\/wp-content\/uploads\/2018\/04\/Polypharmacy-Guidance-2018.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Qfracture:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/qfracture.org\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/qfracture.org<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">FRAX:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.sheffield.ac.uk\/FRAX\/tool.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.sheffield.ac.uk\/FRAX\/tool.aspx<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Falls Falls are increasingly common with age. There can be multiple causes for falls including acute illness, and falls can often co-exist with the onset of delirium. Falls can result in severe injury including fractures and head debilitating injuries, with associated consequent morbidity and mortality. Fear of falling can be for older people, and hard<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4118,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[304],"class_list":["post-3927","page","type-page","status-publish","hentry","category-falls"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/medicineofelderlygeriatrics\/falls\/\" rel=\"tag\">Falls<\/a>","rttpg_excerpt":"Falls Falls are increasingly common with age. There can be multiple causes for falls including acute illness, and falls can often co-exist with the onset of delirium. Falls can result in severe injury including fractures and head debilitating injuries, with associated consequent morbidity and mortality. Fear of falling can be for older people, and hard","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3927","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3927"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3927\/revisions"}],"predecessor-version":[{"id":28854,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3927\/revisions\/28854"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4118"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3927"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3927"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}