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Falls assessment pathway

The National Institute for Health and Care Excellence (NICE) has updated falls guidance about who needs to be asked about falls, and who needs to be referred for further support.

Anyone over 65, and people aged 50–64 with risk increasing conditions should be asked about falls when receiving healthcare services. This guide helps you decide who needs support, what kind of support, and the right pathway to support them.

Use the steps below to make the right decision for the person in your care, and where to refer if a Comprehensive Falls Assessment (CFA) is needed.

Step 1: Who should we discuss falls with?

Clinical teams need to discuss falls proactively with:

• anyone aged 65 or over
• people aged 50 to 64 with one or more factors that could increase their risk of falls.

Factors that could increase the risk of falls include long-term health conditions that impact on a person’s daily life, such as arthritis, dementia, diabetes, Parkinson’s disease, having had a stroke and living with a learning disability.

Step 2: Ask five NICE screening questions

Ask if the person has fallen in the last year and…

  1. is living with Frailty (Clinical Frailty Scale 5+)
  2. was injured and needed medical treatment after a fall within the last year
  3. lost consciousness after a fall in the last year
  4. was unable to get up independently after falling in the last year
  5. has had two or more falls in the last year.

If yes to any question in step 2

Step 3

The person requires a Comprehensive Falls Assessment (CFA)

For Integrated Network Teams (INTs), the falls template within the Comprehensive Community Assessment (CCA) template has been updated. It reduces duplication from having to complete a separate CFA assessment.

For non-INT services, the Comprehensive Falls Assessment (CFA) should be completed.

Proceed to step 4 for referral information. 

If no to all questions in step 2

Step 3:

Assessment of gait and balance is recommended.

Following this assessment, and if indicated, there are community-based falls prevention exercise programmes delivered by providers across Bristol, North Somerset and South Gloucestershire.

Clinical teams can find information about these programmes in our Falls Awareness Bundle (FAB).

Skip to step 5 for more resources. 

If the person can safely wait for a clinic

Step 4

If the person can:

  • safely wait for a falls risk assessment and
  • safely get to a clinic.

If the person cannot get to a clinic or has an urgent need

Step 4:

If the person:

• Is unable to get to a clinic
• Is acutely unwell
• Cannot wait at least 6 weeks for a falls risk assessment
• Has an urgent need for assessment.

Refer via SPA to the Community Nursing, Community Therapy or Urgent Community Response. 

When a falls risk assessment has been completed on EMIS, Specialist Falls Service can be contacted for advice and guidance if needed.