Falls

  • Quality standard
  • QS86
  • Published: 
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Quality statement 1: Asking people about falls

Quality statement

People aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over are asked about the details of any falls when they attend appointments or assessments in community or hospital settings. [2017, updated 2025]

Rationale

A history of falls in the last year is the single most important risk factor for falls and is a predictor of further falls. Health and social care practitioners have regular contact with people across a wide range of settings, including in people's homes. By asking questions about falls and their context when someone presents after a fall, and opportunistically in appointments including, for example, assessments and reviews, health and social care practitioners can identify people who may be at risk of falling.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of people aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over attending appointments or assessments in community or hospital settings who were asked about falls.

Numerator – the number in the denominator who were asked about falls.

Denominator – the number of people aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over attending appointments or assessments in community or hospital settings.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (such as primary, community and secondary healthcare services and social care providers) ensure that appointments and assessments for people aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over include questions about falls and their context; hospitals ensure that attendance procedures include questions about falls for people aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over; and community health and social care providers ensure that protocols and training are in place for health and social care practitioners to ask people about falls and their context as part of assessments, appointments and health checks.

Health and social care practitioners (such as doctors, GPs, nurses, practice nurses, pharmacists, district nurses, physiotherapists, occupational therapists and social workers) ask people aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over attending for appointments and assessments whether they have fallen in the last year; about the frequency, context and characteristics of any falls, including whether they were injured or lost consciousness and whether they were able to get up independently.

Commissioners ensure that they commission services that make every contact count by addressing falls prevention as part of appointments and assessments.

People aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over who are seen by a health or social care practitioner are asked about falls when they have an appointment (for example, a routine check-up) or if they attend for urgent or emergency care. This should include being asked if they have fallen in the last year, how many times this has happened, what caused them to fall and what happened when they fell.

Definitions of terms used in this quality statement

Factors that could increase the 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 or Parkinson's disease; having had a stroke; and having a learning disability. [NICE's guideline on falls, terms used in this guideline; factors that could increase the risk of falls]

Fall

A fall is defined as an unexpected event which causes a person to rest on the ground, floor or lower level. [Adapted from NICE's guideline on falls; evidence review B, table 1]

Appointments or assessments

Scheduled appointments or assessments for urgent or emergency care where no accommodation or hospital admission is involved. This includes reviews for chronic conditions, medication reviews, annual flu vaccinations, NHS Health Checks, assessments of care and support needs, attendance at hospital outpatient clinics, emergency departments and minor injuries units. [Expert opinion]

Equality and diversity considerations

Some subgroups of the population (such as people who are not registered with a GP, people in traveller communities or people who are homeless) may not be in regular contact with health and social care services. Practitioners should take every opportunity to ask about falls history when people from these groups present, so that they can make every contact count.