These recommendations are based on the National Collaborating Centre for Nursing and Supportive Care guideline, Clinical practice guideline for the assessment and prevention of falls in older people [National Collaborating Centre for Nursing and Supportive Care, 2004] commissioned by the National Institute for Health and Clinical Excellence (NICE).

Risk factors for falls

• The strongest risk factor for falls is a previous fall. NICE recommends that all older people in regular contact with healthcare professionals should be asked about this at least annually. Other risk factors listed by NICE and used in this guidance were reported as statistically significant [National Collaborating Centre for Nursing and Supportive Care, 2004].
• Evidence from a recent review was unable to conclusively show an association between any specific class of drug and falls. However, there was weak evidence of an association between falls and benzodiazepines, antidepressants, and antipsychotics.

Assessment of gait and balance

• There is a lack of evidence regarding which assessment tool is most predictive of falls and therefore most useful.
• NICE reviewed the evidence and assessed the utility, feasibility, and acceptability of a range of key assessment tools and concluded that the timed Up & Go test and the Turn 180° test are pragmatic, can be used in any setting, and require no special equipment [National Collaborating Centre for Nursing and Supportive Care, 2004].
• Evidence from studies of older people living in the community or attending a day hospital indicate that the timed Up & Go test and the Turn 180° test are useful for predicting falls.
• Guidelines from the American Geriatric Society suggest that people who do the timed Up & Go test with no difficulty or unsteadiness are likely to be at low risk of falling and generally need no further assessment [American Geriatrics Society, 2001].

Excluding the presence of postural hypotension

• Estimates of the prevalence of postural hypotension in the elderly range from 21% to 30%, and its prevalence increases with age [Graafmans et al, 1996; Carey and Potter, 2001].
• Postural hypotension is associated with an increase in morbidity and mortality, in part due to the increased incidence of falls. However, postural hypotension is not a diagnosis, and should lead to investigations for a possible underlying cause (such as hypovolaemia, prolonged bed rest, medication, or neurogenic failure) [Carey and Potter, 2001].