Quality statement 2: Comprehensive falls assessment | Falls | Quality standards

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 have a comprehensive falls assessment if they meet the criteria for a comprehensive falls assessment. [2017, updated 2025]

Rationale

A comprehensive falls assessment allows a person's individual falls risk factors to be identified. This assessment is often carried out by a specialist falls service, but it can also be undertaken in other settings that have appropriate governance arrangements and professionals with skills and experience in falls prevention. Individual components of the assessment may be undertaken by different healthcare professionals in primary care services, community teams or specialist outpatient clinics (such as falls or geriatric outpatient services or assessment units). The person's individual risk factors identified in the comprehensive falls assessment should inform tailored interventions to reduce the risk of falls.

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 who have a comprehensive falls assessment if they meet the criteria for a comprehensive falls assessment.

Numerator – the number in the denominator who have had a comprehensive falls assessment.

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 who meet the criteria for a comprehensive falls assessment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The Healthcare Quality Improvement Partnership (HQIP) Falls and fragility fracture audit National Audit of Inpatient Falls reports data on whether people who have had an inpatient fall that resulted in a femoral fracture had a multifactorial assessment to optimise safe activity (previously known as multifactorial falls risk assessment) documented and how many days prior to the fall this had been undertaken or updated. The audit also reports data on whether an assessment of vision, measurement of lying and standing blood pressure, medication review, delirium assessment, mobility assessment and assessment of continence was documented during the admission when the fall occurred.

Outcome

Injuries due to falls in people aged 65 and over (age-sex standardised rate of emergency hospital admissions for injuries due to falls in people aged 65 and over per 100,000 population).

Data source: The UK government's Public health outcomes framework (available at integrated care board level) reports emergency hospital admissions due to falls in people aged 65 and over (indicator C29).

What the quality statement means for different audiences

Service providers (such as specialist services, primary care services, community teams) ensure that protocols are in place to receive referrals for comprehensive falls assessment; and that assessments are undertaken by staff with skills and experience in falls prevention, that they comprise multiple components to assess individual risk factors and form part of comprehensive falls assessment and management. Outside of specialist falls services, providers ensure that referral pathways are in place for specialist assessment when needed.

Healthcare professionals (such as consultants, GPs, nurses, physiotherapists and occupational therapists) work in a collaborative local context that enables assessments to be undertaken by staff with skills and experience in falls prevention in an appropriate care setting, with local referral pathways to support specialist assessment when needed. Professionals undertaking the assessment identify individual risk factors that can be addressed through comprehensive falls management.

Commissioners ensure that they commission services that perform comprehensive falls assessments in appropriate care settings with local referral pathways to support specialist assessment when needed, using professionals with skills and experience in falls prevention working in a collaborative local context.

People aged 50 to 64 with 1 or more factors that could increase their risk of falls and people aged 65 or over who meet the criteria for a comprehensive falls assessment have an assessment to identify if there is anything that might make them more likely to fall and whether there are things that can be done to reduce their risk of falling.

Source guidance

Falls: assessment and prevention in older people and in people 50 and over at higher risk. NICE guideline NG249 (2025), recommendations 1.1.3, 1.1.7, 1.2.1 and 1.2.2

Definitions of terms used in this quality statement

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]

People who meet the criteria for a comprehensive falls assessment

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:

In community settings, have fallen in the last year and meet any of the following criteria:
- Are living with frailty (also see the section on how to assess frailty in the NICE guideline on multimorbidity).
- Were injured in a fall and needed medical (including surgical) treatment.
- Have experienced a loss of consciousness related to a fall (also see the NICE guideline on transient loss of consciousness ['blackouts'] in over 16s).
- Have been unable to get up independently after a fall.
- Have had 2 or more falls in the last year.
In hospital inpatient settings or residential care settings.

For people aged 50 to 64, 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. [Adapted from NICE's guideline on falls, terms used in this guideline; factors that could increase the risk of falls and recommendations 1.1.3 and 1.1.7]

Comprehensive falls assessment

An assessment that aims to identify a person's risk factors for falling. This can be carried out by an appropriately trained single healthcare professional or a multidisciplinary team involving any of the following services, as appropriate: primary care services, community teams or specialist outpatient clinics (such as falls or geriatric medicine assessment clinics).

A comprehensive falls assessment may include the following assessments and examinations (where appropriate) to identify the person's individual fall risk factors:

Alcohol misuse (see the section on identification and assessment in the NICE guideline on alcohol-use disorders).
Cardiovascular examination (including a lying and standing blood pressure test).
Cognition and mood.
Delirium (hospital inpatient and residential care settings only; see the section on assessment and diagnosis in the NICE guideline on delirium).
Diet, fluid intake and weight loss.
Dizziness: ask about the presence and nature of any dizziness; if the person reports symptoms of rotational vertigo, consider performing a Dix-Hallpike manoeuvre (see the section on dizziness and vertigo in adults in the NICE guideline on suspected neurological conditions).
Footwear and foot condition.
Functional ability: assess the person's perceived functional ability and explore any concerns about falling.
Gait, balance and mobility, and muscle strength assessment.
Hearing impairments.
Long-term conditions that affect the person's daily life, for example, arthritis, dementia, diabetes or Parkinson's disease.
Medication review.
Neurological examination.
Osteoporosis risk assessment (see the NICE guideline on osteoporosis: assessing the risk of fragility fracture).
Urinary continence.
Visual impairments.

[NICE's guideline on falls, terms used in this guideline; comprehensive falls assessment and recommendation 1.2.2]