The Prevention and Management of Falls in the Community: A Framework for Action for Scotland 2014/2015

Stage Two: Identifying individuals at high risk of falls and/or fragility fractures

Description (taken from Up and About)

At this stage:

• A person at high risk of falls and fragility fractures is identified and this triggers appropriate intervention, or referral for appropriate intervention.
• A person is identified either (a)when they report a fall, or present with a fall or an injury due to a fall, or (b)opportunistically when a health or social care practitioner asks about falls.
• Opportunistic case identification links with both anticipatory care and the 'shared assessment' process.
• A level 1 assessment aims to identify individuals at high risk of falling; it is not intended to determine all contributory factors or specific interventions required.

Actions to achieve the minimum standard for 2014/15

Action 2.1

Health and social care services offer Level 1 assessment^† to older people who report a fall or an injury or functional decline caused by a fall.

Principles

• A Level 1 assessment, or initial risk identification, aims to identify individuals who have fallen/are at high risk of falling and may benefit from intervention to prevent further falls and restore/retain function following a fall.
• Level 1 Assessment is a simple process, quick to administer and may take the form of a tool or an algorithm. To meet the minimum standard it includes questions about:
  • Frequency and circumstances of the fall/s.
  • Loss of consciousness/blackouts/dizziness at the time of the fall/s.
  • Difficulties with walking or balance.
  • Impact of the fall/s on day to day activities.

Action 2.2

Everyone identified at high risk of further falls by Level 1 assessment is offered intervention to identify and address possible contributory factors, i.e. Level 2 assessment^†.

Principles

• A Level 1 assessment tool or algorithm includes clear guidance for the assessor on what steps to take next, based on the findings of the screen.
• The assessor explains to the individual the reason why the intervention is indicated, what this will involve, such as a home visit or clinic attendance, and ensures consent has been given to refer for further assessment.
• There are local referral pathways to services providing Level 2 assessment, and agreed referral protocols.
• For people not referred for further intervention, and those who decline further intervention, up-to-date information is offered on the prevention of falls and the prevention of harm from falls (as described in Action 1.1).

^†Level 1 Assessment
A simple initial risk identification process which aims to identify individuals who have fallen/are at high risk of falling and may benefit from further assessment and intervention.
See Appendix 1 'The falls and fracture assessment continuum' for further information.

^†Level 2 Assessment
A multifactorial falls risk screening process which aims to (a) identify risk factors for falling and for sustaining a fragility fracture, and (b) guide tailored intervention.
See Appendix 1 'The falls and fracture assessment continuum' for further information.

Rationale

A fall is a symptom, not a diagnosis. It can be the first indication of a new or worsening health problem and/or can represent a tipping point, triggering a downward decline in independence. Older adults who fall once are two to three times more likely to fall again within a year¹ .

Structuring and standardising the screening process may improve service provider's adherence to guideline recommendations. The use of a small number of simple questions, requiring a yes/no answer, may also simplify documentation. Any positive answer to the screening questions puts the person screened in a high-risk group that warrants further evaluation² .

In care homes for older people, the recommended practice is for care home staff to carry out a Level 2 assessment routinely on all residents. If this is the case, a level 1 assessment is not required.

For evidence base for actions, see references 1 and 2.

Further information

Managing Falls and Fractures in Care Homes for Older People, produced by the Care Inspectorate & NHSScotland, 2011. Access at: http://www.scswis.com/index.php?option=com_content&view=article&id=7861:managingfalls-and-fractures-in-care-homes-for-older-people-&catid=246:Consultations&Itemid=570