What criteria should I use to determine whether to refer an older patient with falls for further assessment?

Refer an older patient (aged 65 years and over) for further assessment if they meet any of the following criteria:

• They have had two or more falls in the last 12 months.
• They present for medical attention following a fall.
• They cannot perform, or perform poorly on, gait and balance tests such as the Timed Up & Go test or the Turn 180° test.
• They have experienced a loss of consciousness related to a fall.
• They are living with frailty.
• They were injured in a fall and required medical or surgical treatment.
• They have recurrent falls or demonstrate abnormalities of gait and/or balance.

These patients should be offered a multifactorial falls risk assessment by an appropriately skilled clinician, usually in a specialist falls service, to identify and address individual risk factors.

The multifactorial assessment typically includes evaluation of falls history, gait, balance and mobility, muscle weakness, osteoporosis risk, cognitive and neurological status, visual impairment, urinary incontinence, cardiovascular examination, medication review (especially psychotropic and antihypertensive drugs), and home hazards.

For those not meeting referral criteria, reassess falls risk at least annually and provide verbal and written information on reducing falls risk.

This approach ensures targeted assessment and intervention for those most at risk, improving outcomes and preventing future falls.

References: ¹,²,³