Falls are the commonest single reason for older people to present to urgent care.  People presenting acutely following a fall commonly have the following presenting histories:

  • ‘Found on the floor’.
  • ‘Legs gave way’.
  • ‘Collapsed’.

Accurate history taking, with independent verification of what happened if at all possible, is essential in order to establish an underlying cause (e.g., whether it is a simple trip or mechanical fall, or has a cardiac cause).

Medications are another common cause of falls.  They can cause dizziness, drowsiness and sudden changes in blood pressure, all of which may precipitate the fall.  Medications may also cause complications such as patients on anticoagulation (e.g., warfarin).

It is also vital to look for multiple injury sites on a person who has fallen and not just focus on obvious visible signs such as skin bruises.  The possibility that the person may not have been found for a prolonged time after they fell should also be considered since this will have implications for their management and recovery.

The NICE pathway and associated documents can be accessed here.

These include:

NICE Quality Standard 86 covers Falls in older people and can be accessed here.

NICE Clinical Guideline 161 covers Falls in older people: assessing risk and prevention and can be accessed here.

NICE Information for the public on Falls in older People is here.

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NICE Information for the public on Preventing Falls in older People is here.

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