What falls prevention means in care settings

Falls prevention is not a single rule, score or piece of equipment. It is the day-to-day work of spotting changes that raise a person's chance of falling, reducing risks that can be changed, and supporting safe, confident movement.

NICE NG249 recommends offering people in residential care a comprehensive falls assessment. Frontline care staff usually do not carry out the full clinical assessment, but they are central to prevention because they observe daily changes, follow and apply the person's care plan, and pass on information that helps the wider team act.

NICE also warns that risk prediction tools can distract from a full assessment. A checklist or score may be useful for local paperwork, but it must not replace attention to a person's current risks, recent changes and needs.

Falls are usually caused by several factors together

• Mobility and strength: reduced muscle strength, poor balance, slow reactions, pain, fatigue or difficulty rising from bed or a chair.
• Cognition and mood: dementia, delirium, confusion, fear of falling, impulsive walking or reduced hazard awareness.
• Cardiovascular and dizziness factors: low blood pressure on standing, blackouts, palpitations or feeling faint.
• Nutrition and continence factors: poor food or fluid intake, weight loss, urgency, rushing to the toilet or getting up several times at night.
• Medicine and health factors: psychotropic medicines, recent medicine changes, acute illness or long-term conditions that affect daily life.
• Sensory and foot factors: poor vision, poor hearing, foot pain, numbness, unsafe footwear or missing glasses.
• Environmental factors: poor lighting, clutter, wet floors, unsafe furniture layout, inaccessible walking aids or missing call bells.

The practical message for care staff is straightforward: look for multiple contributing factors. A fall, stumble or near miss usually reflects a combination of issues that need addressing.

Good falls prevention is person-centred, multi-factorial and practical. It reduces avoidable risk without taking away safe independence.