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Falls in older people overview

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Falls in older people

About

What is covered

This pathway covers the assessment and prevention of falls in older people both in the community and during a hospital stay.
Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year.
The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall. Falls are estimated to cost the NHS more than £2.3 billion per year. Therefore falling has an impact on quality of life, health and healthcare costs.
People aged 65 and older have the highest risk of falling, and all parts of the pathway apply to this age group. The part of the pathway about preventing falls during a hospital stay also applies to people aged 50 to 64 who are admitted to hospital and are judged by a clinician to be at higher risk of falling because of an underlying condition.
NICE has also produced a pathway on hip fracture.

Updates

Updates to this pathway

3 November 2015 Link to NICE pathway on social care for older people with multiple long-term conditions added.
24 March 2015 Falls in older people: assessment after a fall and preventing further falls (NICE quality standard 86) added to this pathway.
4 March 2015 Link to NICE pathway on excess winter deaths and illnesses associated with cold homes added.
26 August 2014 Minor maintenance updates.
13 January 2014 Minor maintenance update.
12 December 2013 Mental wellbeing of older people in care homes quality standard added to the pathway.
11 November 2013 Minor maintenance update.
10 September 2013 Links to the 'Urinary incontinence in women pathway' have been added.
17 October 2013 Title of NICE public health guidance 16 updated from 'Mental wellbeing' to 'Occupational therapy and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care'.

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Falls: assessment and prevention of falls in older people

What is covered

This pathway covers the assessment and prevention of falls in older people both in the community and during a hospital stay.
Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year.
The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall. Falls are estimated to cost the NHS more than £2.3 billion per year. Therefore falling has an impact on quality of life, health and healthcare costs.
People aged 65 and older have the highest risk of falling, and all parts of the pathway apply to this age group. The part of the pathway about preventing falls during a hospital stay also applies to people aged 50 to 64 who are admitted to hospital and are judged by a clinician to be at higher risk of falling because of an underlying condition.
NICE has also produced a pathway on hip fracture.

Updates

Updates to this pathway

3 November 2015 Link to NICE pathway on social care for older people with multiple long-term conditions added.
24 March 2015 Falls in older people: assessment after a fall and preventing further falls (NICE quality standard 86) added to this pathway.
4 March 2015 Link to NICE pathway on excess winter deaths and illnesses associated with cold homes added.
26 August 2014 Minor maintenance updates.
13 January 2014 Minor maintenance update.
12 December 2013 Mental wellbeing of older people in care homes quality standard added to the pathway.
11 November 2013 Minor maintenance update.
10 September 2013 Links to the 'Urinary incontinence in women pathway' have been added.
17 October 2013 Title of NICE public health guidance 16 updated from 'Mental wellbeing' to 'Occupational therapy and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care'.

Sources

NICE guidance and other sources used to create this pathway.

Quality standards

Falls in older people: assessment after a fall and preventing further falls

These quality statements are taken from the falls in older people: assessment after a fall and preventing further falls quality standard. The quality standard defines clinical best practice for falls in older people: assessment after a fall and preventing further falls and should be read in full.

Mental wellbeing of older people in care homes

These quality statements are taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice for mental wellbeing of older people in care homes and should be read in full.

Quality statements

Checks for injury after an inpatient fall

This quality statement is taken from the falls in older people: assessment after a fall and preventing further falls quality standard. The quality standard defines clinical best practice in falls in older people: assessment after a fall and preventing further falls and should be read in full.

Quality statement

Older people who fall during a hospital stay are checked for signs or symptoms of fracture and potential for spinal injury before they are moved.

Rationale

When a person falls, it is important that they are assessed and examined promptly to see if they are injured. This will help to inform decisions about safe handling and ensure that any injuries are treated in a timely manner. Checks for injury should be included in a post fall protocol that is followed for all older people who fall during a hospital stay.

Quality measures

Structure
Evidence of local arrangements to ensure that hospitals have a post fall protocol that includes checks for signs or symptoms of fracture and potential for spinal injury before the older person is moved.
Data source: Local data collection. Results for 2011 were collected by the pilot audit by the Royal College of Physicians (2012) Report of the 2011 inpatient falls pilot audit, section 2: Policy, protocol and paperwork, table 2.5.1 (a).
Process
Proportion of falls by older people during a hospital stay where the person is checked for signs or symptoms of fracture and potential for spinal injury before they are moved.
Numerator – the number in the denominator where the person is checked for signs or symptoms of fracture and potential for spinal injury before they are moved.
Denominator – the number of falls in older people during a hospital stay.
Data source: Local data collection.
Outcomes
(a) Level of harm caused by falls in hospital in people aged 65 and over.
Data source: Local data collection.
(b) Injuries resulting from falls in hospital in people aged 65 and over.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (NHS organisations with inpatient beds, such as district hospitals, mental health trusts and specialist hospitals) ensure that staff have access to and follow a post fall protocol that includes undertaking checks for signs or symptoms of fracture and potential for spinal injury before moving an older person who has fallen.
Healthcare professionals check older people who fall in hospital for signs or symptoms of fracture and potential for spinal injury before moving them.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services from providers that have a post fall protocol that includes undertaking checks for signs or symptoms of fracture and potential for spinal injury before moving an older person who has fallen.

What the quality statement means for patients, service users and carers

Older people who fall in hospital are checked for fractures and possible injury to their spine before they are moved.

Source guidance

Definitions of terms used in this quality statement

Fall
A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground or an object below knee level. A fall is distinguished from a collapse that occurs as a result of an acute medical problem such as an acute arrhythmia, a transient ischaemic attack or vertigo.
[Adapted from Falls – risk assessment (NICE clinical knowledge summary)]
Post-fall protocol
A post fall protocol should include:
  • checks by healthcare professionals for signs or symptoms of fracture and potential for spinal injury before the patient is moved
  • safe manual handling methods for patients with signs or symptoms of fracture or potential for spinal injury (community hospitals and mental health units without the necessary equipment or staff expertise may be able to achieve this in collaboration with emergency services)
  • frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (for example, unwitnessed falls) based on the NICE guideline on head injury
  • timescales for medical examination after a fall (including fast track assessment for patients who shows signs of serious injury, are highly vulnerable to injury or have been immobilised); medical examination should be completed within a maximum of 12 hours, or 30 minutes if fast tracked.
The post fall protocol should be easily accessible (for example, laminated versions at nursing stations).
[Adapted from NPSA Essential care after an inpatient fall, recommendations 1 and 2, and expert consensus]

Safe manual handling after an inpatient fall

This quality statement is taken from the falls in older people: assessment after a fall and preventing further falls quality standard. The quality standard defines clinical best practice in falls in older people: assessment after a fall and preventing further falls and should be read in full.

Quality statement

Older people who fall during a hospital stay and have signs or symptoms of fracture or potential for spinal injury are moved using safe manual handling methods.

Rationale

When a person falls, it is important that safe methods are used to move them, to avoid causing pain and/or further injury. This is critical to their chances of making a full recovery. Safe manual handling methods should be included in a post fall protocol that is followed for all older people who fall during a hospital stay.

Quality measures

Structure
Evidence of local arrangements to ensure that hospitals have a post fall protocol that includes using safe manual handling methods for moving older people with signs or symptoms of fracture or potential for spinal injury.
Data source: Local data collection. Results for 2011 were collected by the pilot audit by the Royal College of Physicians (2012) Report of the 2011 inpatient falls pilot audit, section 2: Policy, protocol and paperwork, table 2.5.1 (b).
Process
Proportion of falls by older people during a hospital stay where the person has signs or symptoms of fracture or potential for spinal injury and is moved using safe manual handling methods.
Numerator – the number in the denominator where the person is moved using safe manual handling methods.
Denominator – the number of falls by older people during a hospital stay where the person has signs or symptoms of fracture or potential for spinal injury.
Data source: Local data collection.
Outcome
Level of harm caused by falls in hospital in people aged 65 and over.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (NHS organisations with inpatient beds, such as district hospitals, mental health trusts and specialist hospitals) ensure that staff have access to and follow a post fall protocol that includes using safe manual handling methods to move older people who have fallen in hospital and have signs or symptoms of fracture or potential for spinal injury.
Healthcare professionals use safe manual handling methods to move older people who fall in hospital and have signs or symptoms of fracture or potential for spinal injury.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services from providers that have a post fall protocol that includes using safe manual handling methods to move older people who have fallen in hospital and have signs or symptoms of fracture or potential for spinal injury.

What the quality statement means for patients, service users and carers

Older people who fall in hospital and who may have a fracture or possible injury to their spine are moved in a safe manner, using suitable equipment if needed.

Source guidance

Definitions of terms used in this quality statement

Fall
A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground or an object below knee level. A fall is distinguished from a collapse that occurs as a result of an acute medical problem such as an acute arrhythmia, a transient ischaemic attack or vertigo.
[Adapted from Falls – risk assessment (NICE clinical knowledge summary)]
Post-fall protocol
A post fall protocol should include:
  • checks by nursing staff for signs or symptoms of fracture or potential for spinal injury before the patient is moved
  • safe manual handling methods for patients with signs or symptoms of fracture or potential for spinal injury (community hospitals and mental health units without the equipment or expertise may be able to achieve this in collaboration with emergency services)
  • frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (for example, unwitnessed falls) based on the NICE guideline on head injury
  • timescales for medical examination following a fall (including fast track assessment for patients with signs of serious injury, or high vulnerability to injury, or who have been immobilised); medical examination should be completed within a maximum time period of 12 hours, or 30 minutes if fast tracked.
The post fall protocol should be easily accessible (for example, laminated versions at nursing stations).
There should be access to specialist equipment such as hard collars, flat lifting equipment and scoops, and staff available who have the expertise to use the equipment, for handling patients with suspected fracture or potential for spinal injury.
[Adapted from NPSA Essential care after an inpatient fall, recommendations 1 and 2, and expert consensus]

Medical examination after an inpatient fall

This quality statement is taken from the falls in older people: assessment after a fall and preventing further falls quality standard. The quality standard defines clinical best practice in falls in older people: assessment after a fall and preventing further falls and should be read in full.

Quality statement

Older people who fall during a hospital stay have a medical examination.

Rationale

When an older person falls, it is important that they have a prompt medical examination to see if they are injured. This is critical to their chances of making a full recovery. Timescales for medical examination should be included in a post fall protocol that is followed for all older people who fall in hospital.

Quality measures

Structure
Evidence of local arrangements to ensure that NHS organisations with inpatient beds have a post fall protocol that includes timescales for medical examination.
Data source: Local data collection. Results for 2011 were collected as part of the pilot audit by the Royal College of Physicians (2012) Report of the 2011 inpatient falls pilot audit, section 2: Policy, protocol and paperwork, table 2.5.1 (f).
Process
a) Proportion of falls in older people during a hospital stay where the person has a medical examination completed within 12 hours.
Numerator – the number in the denominator where the person has a medical examination completed within 12 hours.
Denominator – the number of falls in older people during a hospital stay.
Data source: Local data collection.
b) Proportion of falls in older people during a hospital stay where the person shows signs of serious injury, is highly vulnerable to injury or has been immobilised, where a fast track medical examination is completed within 30 minutes.
Numerator – the number in the denominator where the person has a fast track medical examination completed within 30 minutes.
Denominator – the number of falls in older people during a hospital stay where the person shows signs of serious injury, is highly vulnerable to injury or has been immobilised.
Outcome
Level of harm caused by falls during a hospital stay in people aged 65 and over.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (NHS organisations with inpatient beds, such as district hospitals, mental health trusts and specialist hospitals) ensure that their staff have access to and follow a post fall protocol that includes timescales for medical examination for older people who fall during a hospital stay.
Healthcare professionals (medically qualified) complete medical examinations within the timescales specified in their organisation’s post fall protocol for older people who fall in hospital.
Commissioners (clinical commissioning groups and NHS England) ensure that they commission services from providers that have a post fall protocol that includes timescales for medical examination for older people who fall in hospital.

What the quality statement means for patients, service users and carers

Older people who fall in hospital have a medical examination to see if they are injured, which is carried out soon after the fall.

Source guidance

Definitions of terms used in this quality statement

Fall
A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground or an object below knee level. A fall is distinguished from a collapse that occurs as a result of an acute medical problem such as an acute arrhythmia, a transient ischaemic attack or vertigo.
[Adapted from Falls – risk assessment (NICE clinical knowledge summary)]
Post-fall protocol
A post fall protocol should include:
  • checks by nursing staff for signs or symptoms of fracture or potential for spinal injury before the patient is moved
  • safe manual handling methods for patients with signs or symptoms of fracture or potential for spinal injury (community hospitals and mental health units without the equipment or expertise may be able to achieve this in collaboration with emergency services)
  • frequency and duration of neurological observations for all patients where head injury has occurred or cannot be excluded (for example, unwitnessed falls) based on the NICE guideline on head injury
  • timescales for medical examination following a fall (including fast track assessment for patients with signs of serious injury, or high vulnerability to injury, or who have been immobilised); medical examination should be completed within a maximum time period of 12 hours, or 30 minutes if fast tracked.
The post fall protocol should be easily accessible (for example, laminated versions at nursing stations).
[Adapted from NPSA Essential care after an inpatient fall, recommendations 1 and 2 and expert consensus]

Multifactorial falls risk assessment

This quality statement is taken from the falls in older people: assessment after a fall and preventing further falls quality standard. The quality standard defines clinical best practice in falls in older people: assessment after a fall and preventing further falls and should be read in full.

Quality statement

Older people who present for medical attention because of a fall have a multifactorial falls risk assessment.

Rationale

When older people present for medical attention because of a fall it provides their healthcare practitioner with a good opportunity to begin the process of undertaking a multifactorial falls risk assessment. A multifactorial falls risk assessment aims to identify a person’s individual risk factors for falling. This will enable practitioners to refer the person for effective interventions targeted at their specific risk factors, with the aim of reducing subsequent falls.

Quality measures

Structure
Evidence of local arrangements to ensure that older people who present for medical attention because of a fall have a multifactorial falls risk assessment.
Data source: Local data collection.
Process
a) Proportion of older people who present for medical attention to their general practice because of a fall who have a multifactorial falls risk assessment.
Numerator – the number in the denominator who have a multifactorial falls risk assessment.
Denominator – the number of older people who present for medical attention to their general practice because of a fall.
Data source: Local data collection.
b) Proportion of older people who present for medical attention at hospital because of a fall who have a multifactorial falls risk assessment.
Numerator – the number in the denominator who have a multifactorial falls risk assessment.
Denominator – the number of older people who present for medical attention at hospital because of a fall.
Data source: Local data collection. Royal College of Physicians (2011) Falling standards, broken promises, Organisation audit results, section 5.1: Multifactorial falls risk assessment.
c) Proportion of older people who present for medical attention at walk in health centres because of a fall who have a multifactorial falls risk assessment.
Numerator – the number in the denominator who have a multifactorial falls risk assessment.
Denominator – the number of older people who present for medical attention at walk in health centres because of a fall.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners and commissioners

Service providers (such as general practice, specialist falls services, community and secondary care services) ensure that staff are trained to undertake multifactorial falls risk assessments for older people who present for medical attention because of a fall.
Health and social care practitioners undertake a multifactorial falls risk assessment for older people who present for medical attention because of a fall, or refer them to a service with staff who are trained to undertake this type of assessment.
Commissioners (clinical commissioning groups) ensure that they commission services that have the capacity and staff who are trained to undertake multifactorial falls risk assessments for older people who present for medical attention because of a fall.

What the quality statement means for patients, service users and carers

Older people who are seen by a healthcare professional (such as their GP or a nurse) because of a fall have an assessment that aims to identify anything that might make them more likely to fall, and to see whether there are things that can be done to help them avoid falling in future. This assessment will be done by a specialist healthcare professional.

Source guidance

  • Falls (NICE guideline CG161), recommendations 1.1.2.1 (key priority for implementation) and 1.1.2.2

Definitions of terms used in this quality statement

Fall
A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground or an object below knee level. A fall is distinguished from a collapse that occurs as a result of an acute medical problem such as an acute arrhythmia, a transient ischaemic attack or vertigo.
[Adapted from Falls – risk assessment (NICE clinical knowledge summary)]
Multifactorial falls risk assessment
An assessment with multiple components that aims to identify a person’s risk factors for falling. This assessment should be performed by a healthcare professional with appropriate skills and experience. It should be part of an individualised, multifactorial intervention. A multifactorial falls risk assessment may include the following:
  • identification of falls history
  • assessment of gait, strength, balance and mobility
  • assessment of fracture risk
  • assessment of perceived functional ability and fear relating to falling
  • assessment of visual impairment
  • assessment of cognitive impairment and neurological examination
  • assessment of urinary incontinence
  • assessment of home hazards
  • cardiovascular examination and medication review.
[Adapted from Falls (NICE guideline CG161), recommendations 1.1.2.1 and 1.1.2.2, and expert consensus]
Present for medical attention
Older people who fall may present for medical attention in a variety of settings and to different healthcare practitioners. Examples of settings include general practice, emergency departments, inpatient wards, walk in health centres and community services. [Expert consensus]

Strength and balance training

This quality statement is taken from the falls in older people: assessment after a fall and preventing further falls quality standard. The quality standard defines clinical best practice in falls in older people: assessment after a fall and preventing further falls and should be read in full.

Quality statement

Older people living in the community who have a known history of recurrent falls are referred for strength and balance training.

Rationale

Balance impairment and muscle weakness caused by ageing and lack of use are the most prevalent modifiable risk factors for falls. Strength and balance training has been identified as an effective single intervention and as a component in successful multifactorial intervention programmes to reduce subsequent falls. It is important that strength and balance training is undertaken after a multifactorial falls risk assessment has been completed.

Quality measures

Structure
Evidence of local arrangements to ensure that older people living in the community who have a known history of recurrent falls are referred for strength and balance training.
Data source: Local data collection.
Process
a) Proportion of older people living in the community with a known history of recurrent falls reporting to their GP who are referred for strength and balance training.
Numerator – the number in the denominator referred for strength and balance training.
Denominator – the number of older people living in the community with a known history of recurrent falls reporting to their GP.
Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises, includes questions on strength and balance training within the section on Organisation audit results, section 5.3: interventions for falls prevention.
b) Proportion of older people living in the community who report recurrent falls to a healthcare practitioner in hospital who are referred for strength and balance training.
Numerator – the number in the denominator referred for strength and balance training.
Denominator – the number of older people living in the community who report recurrent falls to a healthcare practitioner in hospital.
Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises, includes questions on strength and balance training within the section on Organisation audit results, section 5.3: interventions for falls prevention.
Outcome
Rates of recurrent falls in older people.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners and commissioners

Service providers (such as specialist falls services, district general hospitals, community health providers, independent sector providers and charities) ensure that staff are trained to deliver and monitor strength and balance training programmes for older people living in the community who have a known history of recurrent falls.
Health and social care practitioners are aware of local referral pathways for falls and ensure that older people living in the community who have a known history of recurrent falls are referred to a service that has staff who are trained to deliver and monitor a strength and balance training programme.
Commissioners (clinical commissioning groups and local authorities) ensure that they commission services that have the capacity and staff who are trained to deliver and monitor strength and balance training programmes for older people living in the community who have a known history of recurrent falls.

What the quality statement means for patients, service users and carers

Older people living in the community (for example, in their own home or in sheltered or supported accommodation) who have fallen more than once in the last year have the opportunity to see an expert who will help them start a programme of exercises (sometimes called ‘strength and balance training’) to build up their muscle strength and improve balance. These exercises will be designed specifically for them, and the expert will check how they are getting on.

Source guidance

Definitions of terms used in this quality statement

Fall
A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground or an object below knee level. A fall is distinguished from a collapse that occurs as a result of an acute medical problem such as an acute arrhythmia, a transient ischaemic attack or vertigo.
[Adapted from Falls – risk assessment (NICE clinical knowledge summary)]
Older people living in the community
Community settings include:
  • people’s own homes and other housing, including temporary accommodation
  • extra care housing (such as warden supported, sheltered or specialist accommodation)
  • Shared Lives Scheme (formerly Adult Placement Scheme) living arrangements
  • supported living.
[Expert opinion]
Recurrent falls
Falling twice or more within a time period of 1 year.
[Expert consensus]
Strength and balance training
A strength and balance training programme should be individually prescribed and monitored by an appropriately trained professional.
[Falls (NICE guideline CG161), recommendation 1.1.4.1, and expert consensus]

Home hazard assessment and interventions

This quality statement is taken from the falls in older people: assessment after a fall and preventing further falls quality standard. The quality standard defines clinical best practice in falls in older people: assessment after a fall and preventing further falls and should be read in full.

Quality statement

Older people who are admitted to hospital after having a fall are offered a home hazard assessment and safety interventions.

Rationale

Adapting or modifying the home environment is an effective way of reducing the risk of falls for older people living in the community. Home hazard assessment undertaken in the person’s home, and intervention if needed, has been identified as a component in successful multifactorial intervention programmes. It is important that a home hazard assessment is undertaken after a multifactorial falls risk assessment has been completed.

Quality measures

Structure
a) Evidence of local arrangements to ensure that older people who are admitted to hospital after having a fall are offered a home hazard assessment.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that older people who are admitted to hospital after having a fall are offered safety interventions if these are identified by a home hazard assessment.
Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises, Clinical audit results, section 3: Multi factorial risk assessment and intervention contains the following question: Were appropriate home hazard interventions offered?
Process
a) Proportion of older people admitted to hospital after a fall who are offered a home hazard assessment.
Numerator – the number in the denominator offered a home hazard assessment.
Denominator – the number of older people admitted to hospital after having a fall.
Data source: Local data collection.
b) Proportion of older people admitted to hospital after having a fall who have a home hazard assessment that is performed in their home.
Numerator – the number in the denominator who have a home hazard assessment performed in their home.
Denominator – the number of older people admitted to hospital after having a fall.
Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises, Clinical audit results, section 3: Multi factorial risk assessment and intervention contains the following question: Was an access or home visit/assessment performed in the patient’s own environment?
c) Proportion of older people whose home hazard assessment identified a need for safety interventions who are offered those interventions.
Numerator – the number in the denominator who are offered safety interventions.
Denominator – the number of older people whose home hazard assessment identified a need for safety interventions.
Data source: Local data collection. The Royal College of Physicians (2011) Falling standards, broken promises, Clinical audit results, section 3: Multi factorial risk assessment and intervention contains the following question: Were appropriate home hazard interventions offered?
d) Proportion of older people who accepted the offer of safety interventions who received those interventions.
Numerator – the number in the denominator who received safety interventions.
Denominator – the number of older people who accepted the offer of safety interventions.
Data source: Local data collection.
Outcome
Falls rates in the home for older people.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as community health trusts, independent sector providers and district general hospital trusts) ensure that they employ staff with the expertise to perform home hazard assessments for older people who are admitted to hospital after having a fall and, if appropriate, the assessment is followed up with the offer of safety interventions and/or modifications.
Healthcare professionals (in particular occupational therapists) ensure that they perform home hazard assessments for older people who are admitted to hospital after having a fall, and offer safety interventions and modifications as appropriate. This should happen in the person’s home and within a timescale that is agreed with the person or their carer.
Commissioners (clinical commissioning groups and local authorities) ensure that they commission services that have the capacity and employ staff with the expertise to perform home hazard assessments for older people who are admitted to hospital after having a fall, and in which the assessment is followed up with the offer of safety interventions and/or modifications as appropriate.

What the quality statement means for patients, service users and carers

Older people who are admitted to hospital after having a fall are visited in their home after they are discharged by a trained healthcare professional (usually an occupational therapist) who will check for anything that might put them at risk of falling again. If the healthcare professional thinks that making changes in the person’s home (for example, changing the layout of furniture) or having special equipment might lower the chances of another fall, they will offer help with this.

Source guidance

Definitions of terms used in this quality statement

Fall
A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground or an object below knee level. A fall is distinguished from a collapse that occurs as a result of an acute medical problem such as an acute arrhythmia, a transient ischaemic attack or vertigo.
[Adapted from Falls – risk assessment (NICE clinical knowledge summary)]
Home hazard assessment
Home hazard assessment should be undertaken in the person’s home and should be more than a ‘checklist’ of hazards. It is essential that the assessment explores how the actual use of the environment affects the person’s risk of falling.
[Adapted from the College of Occupational Therapists' practice guideline Occupational therapy in the prevention and management of falls in adults (2015)]

Equality and diversity considerations

Healthcare professionals undertaking home hazard assessments and offering safety interventions should be aware that age, socioeconomic status, family origin and culture may influence the willingness of people to accept help with home hazards.

Participation in meaningful activity

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing.

Rationale

It is important that older people in care homes have the opportunity to take part in activity, including activities of daily living, that helps to maintain or improve their health and mental wellbeing. They should be encouraged to take an active role in choosing and defining activities that are meaningful to them. Whenever possible, and if the person wishes, family, friends and carers should be involved in these activities. This will help to ensure that activity is meaningful and that relationships are developed and maintained.

Quality measures

Structure
Evidence of local arrangements to ensure that older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing.
Data source: Local data collection.
Outcome
a) Feedback from older people in care homes that they are offered opportunities to take part in activity during their day.
Data source: Local data collection. Adult Social Care Outcomes Toolkit. The following documents from the toolkit include questions about choice and control, social participation and involvement, occupation and dignity: CHINT3 care home interview schedule and CHOBS3 care home observation schedule.
The Personal Social Services Adult Social Care Survey (England). This survey collects data on service users’ views and opinions over a range of outcome areas, including satisfaction with social care and support and quality of life. Appendix F of this report provides a link to model questionnaires.
b) Feedback from older people in care homes that they have taken part in activity during their day that is meaningful to them.
Data source: Local data collection. Adult Social Care Outcomes Toolkit. The following documents from the toolkit include questions about choice and control, social participation and involvement, occupation and dignity: CHINT3 care home interview schedule and CHOBS3 care home observation schedule.
The Personal Social Services Adult Social Care Survey (England). This survey collects data on service users’ views and opinions over a range of outcome areas, including satisfaction with social care and support and quality of life. Appendix F of this report provides a link to model questionnaires.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that opportunities for activity are available and that staff are trained to offer spontaneous and planned opportunities for older people in care homes to participate in activity that is meaningful to them and that promotes their health and mental wellbeing.
Social care, health and public health practitioners ensure that they offer older people in care homes opportunities during their day to participate in spontaneous and planned activity that is meaningful to them and that promotes their health and mental wellbeing.
Local authorities and other commissioning services ensure that they commission services from providers that can produce evidence of activities that are undertaken within the care home and can demonstrate that staff are trained to offer spontaneous and planned opportunities for older people in care homes to participate in activity that is meaningful to them.

What the quality statement means for service users, family, friends and carers

Older people in care homes have opportunities during their day to take part in activities of their choice that help them stay well and feel satisfied with life. Their family, friends and carers have opportunities to be involved in activities with them when the older person wishes.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Meaningful activity
Meaningful activity includes physical, social and leisure activities that are tailored to the person’s needs and preferences. Activity can range from activities of daily living such as dressing, eating and washing, to leisure activities such as reading, gardening, arts and crafts, conversation, and singing. It can be structured or spontaneous, for groups or for individuals, and may involve family, friends and carers, or the wider community. Activity may provide emotional, creative, intellectual and spiritual stimulation. It should take place in an environment that is appropriate to the person’s needs and preferences, which may include using outdoor spaces or making adaptations to the person’s environment. [Adapted from SCIE guide 15, Choice and Control, Living well through activity in care homes: the toolkit (College of Occupational Therapists) and expert consensus]
Mental wellbeing
Mental wellbeing includes areas that are key to optimum functioning and independence, such as life satisfaction, optimism, self-esteem, feeling in control, having a purpose in life, and a sense of belonging and support. [Adapted from the Mental health improvement programme, background and policy context (NHS Health Scotland)]

Equality and diversity considerations

Staff working with older people in care homes should identify and address the specific needs of older people arising from diversity, including gender and gender identity, sexuality, ethnicity, age and religion.
When tailoring activities to the needs and preferences of older people, staff should be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, and cultural differences. Staff should have the necessary skills to include people with cognitive or communication difficulties in decision-making (from Dignity in care [SCIE guide 15]: Choice and control). Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
When collecting feedback from older people about whether they have been offered opportunities for meaningful activity, staff should consider using alternative methods for older people who find it difficult to provide feedback. For example, tools such as Dementia Care Mapping can be used, and/or feedback from people who are considered suitable to represent the views of the older person, such as family members, carers, or an advocate.

Personal identity

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes are enabled to maintain and develop their personal identity.

Rationale

It is important that staff working with older people in care homes are aware of the personal history of the people they care for and respect their interests, beliefs and the importance of their personal possessions. Older people should be involved in decision-making and supported and enabled to express who they are as an individual and what they want. They should be able to make their own choices whenever possible. Enabling older people to maintain and develop their personal identity during and after their move to a care home promotes dignity and has a positive impact on their sense of identity and mental wellbeing.

Quality measures

Structure
Evidence of local arrangements to ensure that older people in care homes are enabled to maintain and develop their personal identity.
Data source: Local data collection.
Outcome
Feedback from older people in care homes that their personal identity is respected.
Data source: Local data collection. Adult Social Care Outcomes Toolkit. The following documents from the toolkit include questions about choice and control, personal cleanliness and comfort, social participation and involvement, occupation and dignity: CHINT3 care home interview schedule and CHOBS3 care home observation schedule.
The Personal Social Services Adult Social Care Survey (England). This survey collects data on service users’ views and opinions over a range of outcome areas, including satisfaction with social care and support and quality of life. Appendix F of this report provides a link to model questionnaires.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care work to embed a culture built on dignity and choice in care homes and ensure that staff are trained to work in partnership with older people in care homes in order to enable them to maintain and develop their personal identity.
Social care, health and public health practitioners work with older people in care homes to tailor support and opportunities to their needs and preferences, with the aim of maintaining and developing their personal identity.
Local authorities and other commissioning services ensure that they commission services from providers that can produce evidence of the actions they have taken to embed a culture of dignity and choice, and that staff are trained to work in partnership with older people in care homes in order to enable them to maintain and develop their personal identity.

What the quality statement means for service users

Older people in care homes are given support and opportunities to express themselves as individuals and maintain and develop their sense of who they are.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]

Enabled

‘Enabled’ refers to actions taken by staff working with older people in care homes to ensure that older people can maintain and develop their personal identity. This may include using life history to tailor support and opportunities to the needs and preferences of the individual. Staff should ensure that older people are able to choose their own clothes, have their most valued possessions with them and choose where to sit while they are eating. It may be necessary to adapt the older person’s environment and provide access to outdoor spaces. Staff should facilitate social inclusion by promoting and supporting social interactions and access to social networks, involvement with the community, and existing and new relationships. [Adapted from Dignity in care (SCIE guide 15), Choice and control and Social inclusion, and expert consensus]
Personal identity
This refers to a person’s individuality, including their needs and preferences, and involvement in decision-making in all aspects of their life. Maintaining a sense of personal identity can involve using life history to maintain and build a meaningful and satisfying life, as defined by the person themselves. Central to personal identity is the feeling of having a purpose in life, feeling valued, having a sense of belonging and a feeling of worth. Relationships, including those with family, carers and friends, are an important aspect of a person’s identity and can have a significant impact on mental wellbeing. An individual’s personal identity may change as their circumstances alter. [Adapted from Personalisation: a rough guide (SCIE guide 47), My Home Life: Promoting quality of life in care homes, ‘Voice, choice and control’ in care homes (Joseph Rowntree Foundation); and expert consensus]

Equality and diversity considerations

Staff working with older people in care homes should identify the specific needs arising from diversity, including gender and gender identity, sexuality, ethnicity, spirituality, culture, age and religion.
When ensuring that older people are enabled to maintain and develop their personal identity be aware of any learning disabilities, acquired cognitive impairments, communication or language barriers or cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
When collecting feedback from older people about whether they have been enabled to maintain and develop their personal identity staff should consider using alternative methods for older people who find it difficult to provide feedback. For example, tools such as Dementia Care Mapping can be used, and/or feedback from people who are considered suitable to represent the views of the older person such as family members, carers, or an advocate.

Recognition of mental health conditions

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes have the symptoms and signs of mental health conditions recognised and recorded as part of their care plan.

Rationale

Mental health conditions are highly prevalent among older people in care homes, but are often not recognised, diagnosed or treated. Ageing with good mental health can make a key difference in ensuring that life is enjoyable and fulfilling. The recognition and recording of symptoms and signs of mental health conditions by staff who are aware of the role of the GP in the route to referral can help to ensure early assessment and access to appropriate healthcare services.

Quality measures

Structure
Evidence of protocols to ensure that staff are trained to recognise the symptoms and signs of mental health conditions in older people, and record them in their care plan.
Data source: Local data collection.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that staff are trained to be alert to the symptoms and signs of mental health conditions in older people in care homes and to record them in a care plan.
Social care, health and public health practitioners look for symptoms and signs of mental health conditions and record them in the older person’s care plan.
Local authorities and other commissioning services commission services from providers that can produce evidence of protocols for training staff to be alert to the symptoms and signs of mental health conditions in older people in care homes and to record them in a care plan.

What the quality statement means for service users

Older people in care homes are cared for by staff who recognise the symptoms and signs of mental health conditions (such as depression and anxiety) and record them in their care plan.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Mental health conditions
These include common mental health conditions such as depression, generalised anxiety disorder and social anxiety disorder, and may also include dementia and delirium. People may have more than one mental health condition at a given time. (See the NICE guidelines on dementia (NICE clinical guideline 42), depression in adults (NICE clinical guideline 90), depression in adults with a chronic physical health problem (NICE clinical guideline 91), delirium (NICE clinical guideline 103), common mental health disorders (NICE clinical guideline 123) and social anxiety disorder (NICE clinical guideline 159) for more information.)
Recognised
Recognised in this context relates to staff observing and recognising the symptoms and signs of mental health conditions, and sharing information and concerns with healthcare professionals, including GPs. Staff should be continually alert to new or worsening symptoms and signs. Observation of behaviour should happen on an ongoing basis and in response to the presentation of relevant symptoms. [Expert consensus]
Trained staff
This refers to staff who have been trained to recognise and record the symptoms and signs of mental health conditions when caring for older people. Staff should be alert to the presentation of new symptoms and signs and aware of existing conditions. Staff should also be competent in recognising when older people need a referral for assessment and management of the mental health condition. [Expert consensus]

Equality and diversity considerations

When looking for symptoms and signs of mental health conditions, be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, sensory impairment and cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
It is important that staff are aware that older people in care homes have the same right to access healthcare as people living independently in the community. This is stated in the NHS Constitution.

Recognition of sensory impairment

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes who have specific needs arising from sensory impairment have these recognised and recorded as part of their care plan.

Rationale

Mild but progressive sight and hearing losses are a common feature of ageing and may go unnoticed for some time, but can have a serious effect on a person’s communication, confidence and independence. The recognition and recording of needs arising from sensory impairment by staff who are alert to the symptoms and signs and aware of the role of the GP in the route to referral can help to ensure early assessment and access to appropriate healthcare services. For older people in care homes this is essential to improve their quality of life and avoid isolation, which can have a detrimental effect on mental wellbeing.

Quality measures

Structure
Evidence of protocols to ensure that staff are trained to recognise specific needs arising from sensory impairment in older people, and record these needs as part of their care plan.
Data source: Local data collection.
Process
Proportion of older people in care homes who have regular sight tests.
Numerator – the number of people in the denominator who have had a sight test within the past 2 years.
Denominator – the number of older people in care homes.
Data source: Local data collection.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that staff are trained to be alert to specific needs arising from sensory impairment in older people in care homes and to record them in a care plan.
Social care, health and public health practitioners are alert to and recognise specific needs arising from sensory impairment in older people in care homes and record them in their care plan.
Local authorities and other commissioning services commission services from providers that can produce evidence of protocols for training staff to be alert to specific needs arising from sensory impairment in older people in care homes and to record them in a care plan.

What the quality statement means for service users

Older people in care homes are cared for by staff who recognise needs that occur because of sight or hearing problems and record these as part of their care plan.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Recognised
Recognised in this context relates to the recognition by staff working with older people in care homes of the needs arising from sensory impairment and the sharing of information with healthcare professionals, including GPs. Staff should be continually alert to new and existing needs. This should involve monitoring of existing impairments and recognition of new sensory impairments. This is likely to include ensuring regular sight and hearing checks are arranged, cleaning glasses, and changing hearing aid batteries, or referral to an appropriately trained professional. [SCIE research briefing 21 and expert consensus]
Regular sight test
Adults are normally advised to have a sight test every 2 years. However, in some circumstances, the ophthalmic practitioner may recommend more frequent sight tests, for example in people who:
  • have diabetes
  • are aged 40 or over and have a family history of glaucoma
  • are aged 70 or over. [NHS Choices]
Sensory impairment
Sensory impairment most commonly refers to sight or hearing loss. It includes combined sight and hearing loss, which is frequently referred to as dual sensory impairment or deafblindness. [Adapted from Basic Sensory Impairment Awareness (NHS Education for Scotland) and Social care for deafblind children and adults (Department of Health)]
Trained staff
This refers to staff who have been trained to recognise and record the symptoms and signs of sensory impairment when caring for older people. Staff should be aware that there are many different types of sight and hearing loss, with a large variation in the degree of impairment. Staff should also be competent in recognising when older people need a referral for assessment and management of the sensory impairment. [Expert consensus]

Equality and diversity considerations

Sensory impairment is common in older people. It is frequently perceived as an expected feature of ageing rather than as potentially disabling. It is important that sensory impairment is not considered as acceptable for older people in care homes. This may need to be emphasised during training to increase awareness and recognition of sensory impairments.
When looking for signs or symptoms of sensory impairment, be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, and cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life
It is important that staff are aware that older people in care homes have the same right to access healthcare as people living independently in the community. This is stated in the NHS Constitution.

Recognition of physical problems

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes have the symptoms and signs of physical problems recognised and recorded as part of their care plan.

Rationale

Physical problems can cause discomfort and affect activities of daily living, participation in social activities and independence, and therefore mental wellbeing. The recognition and recording of the symptoms and signs of physical problems by trained staff who are aware of the role of the GP in the route to referral can help to ensure early assessment and access to appropriate healthcare services. This is essential to improve the quality of life and mental wellbeing of older people in care homes.

Quality measures

Structure
Evidence of protocols to ensure that staff are trained to recognise the symptoms and signs of physical problems in older people in care homes, and record them as part of their care plan.
Data source: Local data collection.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that staff are trained to be alert to symptoms and signs of physical problems in older people in care homes and to record them in a care plan.
Social care, health and public health practitioners look for symptoms and signs of physical problems in older people in care homes and record them in their care plan.
Local authorities and other commissioning services commission services from providers that can produce evidence of protocols for training staff to be alert to the symptoms and signs of physical problems in older people in care homes and to record them in care plans.

What the quality statement means for service users

Older people in care homes are cared for by staff who recognise the symptoms and signs of physical problems (such as pain, dizziness, problems with walking, constipation and continence problems) and record them in their care plan.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Physical problems
Examples of physical problems that could potentially affect a person’s wellbeing include, but are not limited to:
  • joint and muscular pain
  • undiagnosed pain
  • incontinence
  • dizziness
  • constipation
  • urinary tract infection
  • reduced ability to move without support
  • unsteady gait. [Expert consensus]
Recognised
Recognised in this context relates to the recognition by staff working with older people in care homes of physical problems and the sharing of information with healthcare professionals, including GPs. Staff should be continually alert to new physical problems and should monitor existing physical problems. [Expert consensus]
Trained staff
Trained staff refers to staff who have been trained to recognise and record the symptoms and signs of physical problems when caring for older people. Staff should be alert to the presentation of new symptoms and competent in recognising when older people need a referral for assessment and management of physical problems. [Expert consensus]

Equality and diversity considerations

When identifying an older person’s needs arising from physical problems, be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, and cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
It is important that staff are aware that older people in care homes have the same right to access healthcare as people living independently in the community. This is stated in the NHS Constitution.

Access to healthcare services

This quality statement is taken from the mental wellbeing of older people in care homes quality standard. The quality standard defines clinical best practice in mental wellbeing of older people in care homes and should be read in full.

Quality statement

Older people in care homes have access to the full range of healthcare services when they need them.

Rationale

Older people in care homes typically have greater and more complex health needs than those living in the community, and these needs can affect their wellbeing if they are not addressed. Many care home residents experience problems accessing NHS primary and secondary healthcare services, including GPs. It is important that care homes have good links with GPs and referral arrangements, so that services can be accessed easily and without delay when they are needed. This is essential to prevent unmet healthcare needs from having a negative impact on mental wellbeing.

Quality measures

Structure
Evidence of referral arrangements to ensure that older people in care homes are given access to the full range of healthcare services when they need them.
Data source: Local data collection.
Outcome
Feedback from older people in care homes and from their family, friends and/or carers that they are satisfied with the care they have received.

What the quality statement means for organisations providing care, social care, health and public health practitioners, local authorities and other commissioning services

Organisations providing care ensure that they work in partnership with healthcare organisations to implement effective arrangements for access to primary, secondary, specialist and mental health services for older people in care homes.
Social care, health and public health practitioners facilitate access to primary, secondary, specialist and mental health services for older people in care homes by referring the person to the required service when they need it.
Local authorities and other commissioning services commission services from providers that can produce evidence of arrangements with local healthcare organisations which facilitate access to primary, secondary, specialist and mental health services for older people in care homes.

What the quality statement means for service users

Older people in care homes can see their GP and use hospital services when they need them.

Source guidance

Definitions of terms used in this quality statement

Care homes
This refers to all care home settings, including residential and nursing accommodation, and includes people accessing day care and respite care. [Expert consensus]
Healthcare services
These include primary care, and acute and specialist physical and mental health services. [GP services for older people living in residential care: a guide for care home managers. (SCIE guide 52)]

Equality and diversity considerations

When deciding if access to healthcare services is needed, staff working with older people in care homes should be aware of any learning disabilities, acquired cognitive impairments, communication and language barriers, sensory impairment, and cultural differences. Staff should ensure that they are aware of the needs and preferences of older people who are approaching the end of their life.
It is important that staff are aware that older people in care homes have the same right to access healthcare as people living independently in the community. This is stated in the NHS Constitution.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Glossary

A care setting such as a nursing home or supported accommodation.
An assessment with multiple components that aims to identify risk factors that can be treated, managed or improved.
An assessment with multiple components that aims to identify risk factors that can be treated, managed or improved.
An intervention with multiple components that is linked to a person's multifactorial assessment.
An intervention with multiple components that is linked to a person's multifactorial assessment.
For preventing falls during a hospital stay, older people are people aged 50 years and older. For preventing falls in other situations, older people are people aged 65 years and older.
Older people living in their own homes or in extended care.
A tool that aims to calculate a person's risk of falling, either in terms of 'at risk/not at risk', or in terms of 'low/medium/high risk', etc.

Paths in this pathway

Pathway created: June 2013 Last updated: January 2016

© NICE 2016

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