Falls Risk Assessment
Understanding the risk factors for falls is the foundation of effective prevention. All residents should be assessed on admission, after any fall, after a change in condition, and at regular intervals. NICE CG161 recommends using a multifactorial falls risk assessment.
Understanding Falls Risk Factors
Falls risk factors are traditionally categorised into three groups: intrinsic (personal), extrinsic (environmental), and medication-related. Most falls result from a combination of risk factors rather than a single cause. The more risk factors a person has, the greater their risk of falling.
The strongest single predictor of a fall is a history of previous falls. This is why every resident who falls should be reassessed promptly, and why recording and analysing falls data is essential.
Intrinsic (Personal) Risk Factors
- History of previous falls (strongest single predictor)
- Age over 65 (risk increases significantly with age)
- Mobility problems — gait instability, muscle weakness, balance disorders
- Visual impairment — cataracts, macular degeneration, poor lighting needs
- Cognitive impairment — dementia, confusion, delirium
- Urinary incontinence or urgency (rushing to the toilet)
- Orthostatic hypotension — dizziness on standing
- Acute illness — infection, dehydration, anaemia
- Depression or anxiety
- Fear of falling (leads to reduced activity and deconditioning)
- Sensory deficits — neuropathy, poor proprioception
- Chronic conditions — Parkinson's, stroke, arthritis
Extrinsic (Environmental) Risk Factors
- Slippery or wet floors
- Uneven flooring, loose rugs, or trailing cables
- Poor lighting (especially at night)
- Lack of handrails or grab rails
- Inappropriate footwear (slippery soles, loose-fitting shoes)
- Cluttered walkways and corridors
- Furniture at unsafe heights (bed too high or too low)
- Missing or ill-fitting mobility aids
- Inappropriate use of walking aids
- Lack of call bell access or response delay
Medication-Related Risk Factors
- Sedatives and hypnotics (e.g., benzodiazepines, z-drugs)
- Antipsychotic medication
- Antidepressants (especially SSRIs and TCAs)
- Antihypertensives (causing postural hypotension)
- Diuretics (causing urgency and dehydration)
- Hypoglycaemic agents (risk of low blood sugar)
- Opioid analgesics (sedation, dizziness)
- Polypharmacy (4+ medications increases fall risk significantly)
- Recent medication changes
Falls Risk Assessment Template
Complete this assessment on admission, after any fall, after a change in condition or medication, and at regular intervals (at least monthly or as per your organisation's policy).
Resident Details
Previous Falls History
Medical History
Mobility & Balance
Environmental Assessment
Overall Risk Rating
NICE CG161 Recommendations
- •All older people in contact with healthcare professionals should be asked routinely about falls in the past year.
- •Older people who present with a fall should be offered a multifactorial falls risk assessment.
- •Older people with identified risk factors should be offered a multifactorial intervention plan.
- •Regular medication review should be part of the multifactorial assessment.
Further Reading
Important Notice
Care Handbook is a guidance resource only. It does not replace your organisation's policies, formal training, or current CQC standards. Always follow your employer's specific procedures and consult your line manager, GP, or falls team if you are unsure.