Clinical Learning
Clinical 4: Falls assessment and prevention
Applying NICE NG249 to falls assessment and prevention in older people and adults aged 50 to 64 at higher risk.
Clinical safety: Use current guidance, local policy and patient-specific judgement.
Learning objectives
• Identify who should receive comprehensive falls assessment • Avoid inappropriate reliance on falls risk prediction scores • Carry out a structured multifactorial assessment • Match interventions to modifiable individual risk factors • Support activity, exercise and shared decision making
Clinical safety note
A fall can represent acute illness, syncope or significant injury. Immediate post-fall assessment and local emergency pathways take priority. NG249 replaced the older CG161 guideline in 2025, so use current NG249 rather than legacy risk-score approaches.
A major change in falls guidance
NICE NG249 replaced CG161 in 2025. A key message is not to use falls risk prediction tools to predict an individual's risk of falling. Instead, identify who needs further assessment and address the person's actual risk factors. In hospital inpatient and residential care settings, NICE recommends comprehensive falls assessment and management.
Comprehensive assessment
A comprehensive falls assessment may include cardiovascular examination with lying and standing blood pressure, cognition and mood, gait and balance, muscle strength, dizziness, vision, hearing, footwear, continence, medication review, osteoporosis risk, long-term conditions, diet/fluid status and neurological examination. The point is not to complete a checklist for its own sake: identify modifiable factors and act on them.
Interventions
Tailor interventions to the person's risk factors and setting. These may include structured medication review, strength and balance exercise, home hazard assessment, vision or footwear interventions, management of postural hypotension, and treatment of contributory conditions. Avoid unnecessary restriction. NICE encourages people to remain active during hospital and residential-care stays unless there is a specific clinical reason not to.
After a fall
A fall may be the presentation of an acute illness, arrhythmia, syncope, postural hypotension, medication effect, delirium, neurological disease or injury. Assess the event rather than simply labelling the person a “faller”. Involve the person in goals and prevention plans and communicate interventions across settings at discharge or transfer.
