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Researchers to test new falls risk tool in general practice after positive results

Researchers to test new falls risk tool in general practice after positive results

Researchers have developed a tool to help GPs predict falls risk in patients who could benefit from closer monitoring or early intervention.

Data from 1.7 million records over a 20-year period was used to develop the ‘STRATIFY-Falls’ tool which has been showed to identify which patients are most at risk of falling in the next one to ten years.

Within the cohort, they found more than 60,000 people aged 40 and above who had at least one high blood pressure measurement and had experienced at least one serious fall.

The resulting model takes account of age, sex, ethnicity, alcohol consumption, social deprivation, a history of falls, multiple sclerosis, and prescriptions of antihypertensives, antidepressants, hypnotics, and anxiolytics.

Tests of the tool on a database of almost 4 million healthcare records, the researchers found a tendency for the risk score to under-predict risk but it remained clinically useful around the risk of 10% of higher meaning it could help identify those who would most benefit, researchers reported in the BMJ.

In England each year there are around 235,000 hospital admissions for people over 65 due to falls, at a cost to the NHS of an estimated £2.3 billion.

Previous falls-risk scores have not been very accurate they said and once further testing has been done this tool could allow GPs to provide more personalised care and target falls prevention strategies for patients, such as exercise-based interventions or drug reviews, the researchers said.

Co-author Professor Richard McManus, GP and professor of primary care research at the University of Oxford, said: ‘GPs often have to balance the risks and benefits of medications for specific conditions, such as high blood pressure, against the potential risk of adverse events such as falls.

‘Having reliable tools to estimate people’s individualised risk of falling and change their medication to lower this risk would be very welcome.’

He added: ‘This kind of tool could in time be built into GP records systems to automatically flag such patients.’

The team is now planning a randomised controlled trial to evaluate and guide how the tool could be used in general practice with a focus on hypertension medicines.

Professor McManus explained: ‘In 2023, we will begin recruiting over 3,000 participants who are at high-risk of falls to the NIHR-funded OPTIMISE2 trial.

‘We will use the STRATIFY-Falls tool to identify these potential participants and then follow them up to see if they experience fewer falls after deprescribing their blood pressure lowering treatment.’

All integrated care systems will be required to have a community-based falls service that covers the whole region and operates 8am-8pm seven days a week by the end of this year. 

These should include ‘clear routes for onward referral’ into primary care, NHS England said last month.


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