The Prevention and Management of Falls in the Community: A Framework for Action for Scotland 2014/15

Level 1
Conversation
A simple initial risk indeptification process which aims to identify people who have fallen/are at high risk of falling and may benefit from further support and/or intervention.

Level 2
Screen
A multifactorial falls risk screening process which aims to (a) identity risk factors for falling and for sustaining a fragility fracture, and (b) guide tailored management.

Level 3
Assessment
A specialist assessment which aims to assess further the risk factors identified, with a view to providing tailored intervention to reduce the risk of falls and/or fractures.

Characteristics:

• A simple process, facilitated by the use of a tool or an algorithm.
• Clear guidance on next steps has been agreed, including referral pathways and protocols.

A level 1 conversation will identify people who have experienced:

• Two or more falls in the previous 12 months.
• Loss of consciousness/blackouts/dizziness at the time of the fall/s.
• Difficulties with walking or balance.
• A change in ability or confidence to carry out usual daily activities following the fall/s.

Additional questions may be included which ask about:

• Previous fractures.
• Ability to get up from the floor.
• Fear of falling.

Next steps may include:

• Notifying a senior colleague/supervisor of the outcome.
• Referral or sign posting to appropriate services providing further assessment and intervention.
• Providing further assessment or intervention, if appropriately trained/qualified.

Characteristics:

• Standard questions and/or checklist relating to falls history and specific risk factors for falls and fractures.
• Responses trigger specific interventions and/or referrals for further intervention.
• May include the use of screening tools such as the Timed Up and Go.
• Provides clear guidance on next steps to be taken if/when a risk factor is identified.
• Includes red flags for urgent medical assessment (such as loss of consciousness, dizziness, unexplained falls).

Next steps may include:

• Creating a personalised Fall and Fracture Prevention Action Plan.
• Referral on to appropriate services/agencies.
• Providing further assessment or intervention, if appropriately trained/qualified.

Characteristics:

• A more detailed assessment of a specific risk factor identified, carried out by a qualified practitioner.
• May include the use of relevant assessment tools and outcome measures.
• Determines the specific interventions required to reduce risk.

Next steps may include:

• Providing tailored intervention including support for self management.
• Referral for further intervention or investigation.