Medicines, health changes, delirium and escalation

A fall can be a symptom as well as an event. New unsteadiness may follow a medicine change or reflect acute illness, infection, pain, dehydration or delirium. That is why preventing falls means looking beyond the environment and walking aids.

NICE recommends medication review, attention to delirium in residential settings, neurological and cardiovascular assessment, and consideration of long-term conditions in a comprehensive falls assessment. NICE also highlights that psychotropic medicines increase fall risk and should be reviewed when appropriate.

Changes that should make staff think harder

• Recent medicine changes: especially new sedating medicines, dose increases, or medicines started after hospital discharge.
• New confusion or reduced alertness: any sudden change from the person's usual presentation should be investigated.
• Drowsiness, staggering or slower reactions: these can be caused by illness, fatigue or medicines.
• Blackout, collapse or unexplained floor find: needs prompt escalation.
• Sudden pain, weakness or reluctance to walk: the existing mobility plan may no longer be safe.
• Repeated falls without a clear environmental cause: pursue a clinical review, not only housekeeping checks.

Frontline care staff must not adjust medicines unless their role and training explicitly allow it. Their role is to recognise change, follow the person's care plan and local procedure, and involve the appropriate senior or clinical staff promptly.

Manager focus: linking falls and clinical review

If a person's walking or alertness changes, do not assume the floor is the whole story. Noticing health change early is often key to preventing further falls.