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GPs go forth

GPs should routinely ask older people about falls, says NICE

NICE chiefs are urging GPs to ask older people about falls during routine appointments, under a new set of standards aimed at cutting down on hundreds of thousands of hospital admissions due to falls injury.

Under the new diktat, NICE says GPs should 'ask older people whether they have fallen in the past year; about the frequency, context and characteristics of any falls; and if they ever lose their balance or feel unsteady on their feet'.

GPs are advised they should refer people at risk of falls for further assessment by specialists, who should carry out a 'multifactorial falls risk assessment'.

But the new standard adds GPs should 'communicate in a way that recognises that some older people are reluctant to admit to falling, and do not repeat questions about falls if a person has recently been asked'.

NICE said three in 10 people over 65 will fall at least once a year, and, while most falls do not result in seirous injury, around 255,000 older people are admitted to hospitals in England due to falls every year, costing the NHS some £2.3bn.

Dr Victoria Welsh, a GP who helped draw up the standards, said: 'Falls in later life are burdensome for individuals, their families and communities.

'Whilst falls may result in serious injury, such as hip fracture, they may also be the first indication of an underlying health issue. This quality standard prioritises the need to identify those at risk of falls, and assess and manage their associated factors so that we can prevent falls from happening in the first place.'

But the RCGP warned that under-pressure GPs are unlikely to have time to fit this into routine appointments.

RCGP chair Professor Helen Stokes-Lampard said that ’implementing this new guidance will undoubtedly be hampered by the standard 10-minute GP consultation, which is increasingly inadequate, particularly for older patients who are often living with multiple, long term conditions’.

Professor Stokes-Lampard added: 'GPs want to spend longer with our older patients so that we can discuss things with them like how to avoid falling - but in many cases this won’t be the reason a patient has come to visit the GP, and it’s incredibly hard to do everything that we should do whilst respecting the patient and their reason for visiting us.

’Nevertheless, it is essential that we do use all the opportunities we have with our older or more frail patients to establish whether they are susceptible to falling, and work with colleagues across health and social care to ensure they receive the most appropriate care and support. We also welcome initiatives that allow GPs to spend longer with patients with multiple health problems.'

NICE quality standard - falls prevention

The newly updated quality standard includes three new statements as follows:

  • Older people are asked about falls when they have routine assessments and reviews with health and social care practitioners, and if they present at hospital;
  • Older people at risk of falling are offered a multifactorial falls risk assessment;
  • Older people assessed as being at increased risk of falling have an individualised multifactorial intervention.

Source: NICE Quality Standard - Falls in older people


Readers' comments (15)

  • National Hopeless Service

    It is pointless asking these questions if the background services don't exist.

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  • Does anyone feel that there is now 12 minutes of extra stuff to ask in each 10 minute consultation and that's without addressing the patient's problems that they booked for to begin with?

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  • And do what the services are not there.

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  • Does NICE ever say Consultant endocrinologists, care of the elderly, cardiologists, gastroenterologists, rheumatologists.... are 'well placed' to do.....

    Why just GPs? We have the least amount of time to deal with multiple problems. On the other hand hospital doctors have far more time per patient for just for one problem.

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  • Cloud bloody cuckoo land.

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  • we should see one patient per day if we need to ask about every thing that every one says "GP SHOULD THIS"

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  • we had funding for 3 years for a nurse offering elderly healthcare assessments precisely for this kind of thing-it was appreciated and yes it did get problems found and dealt with earlier... but the funding stopped in yr 4 so that was the end of that.the nurse moved on, being mysteriously uninclined to do the job for nothing...

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  • AlanAlmond

    I hope with the help of this guidance we can work towards eradicating falls amongst the elderly and unsteady in the UK. Think how much money the NHS would save if all falls in older people could be prevented. We should be doing all we can to ensure elderly unsteady fall prone individuals don't fall so they can get to become even more elderly, even more unsteady and even more prone to fall over. If we try hard enough we will wil through! Let's all pull together and eradicate this surge once and for all.

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  • agree with above. GP is ideally placed not only to ask about, but also to prevent falls. In fact we should be able to predict these events and be there, ideally placed of cause, before fall actually occurs and offer our full support. Furthermore, we should advice patients not to age if we are concerned that aging could be detrimental to patients health and we should be always offering our support to those interested in stopping their aging. Simples.

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  • I'm an older person. I fall quite often but have absolutely no intention of stopping playing football.

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