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GPs should routinely ask elderly about falls, says NICE

RCGP warns 10-minute consultation may hinder this

Jo Carlowe

Tuesday, 31 January 2017

GPs should ask older patients about falls during routine appointments.

This is the recommendation from the National Institute for Health and Care Excellence (NICE), which today published an update to its quality standard to help prevent falls in older people.

The updated quality standard calls for health care professionals working across health and social care to ask older people (65 and over) about falls during routine GP appointments, when they attend hospital and during home visits by social care workers.

While the update has been welcomed, the Royal College of General Practitioners notes that its implementation may be hampered by the standard 10-minute GP consultation, which it describes as “increasingly inadequate”, particularly for older patients living with multiple, long-term conditions. 

Research suggests that approximately 30% of people aged 65 and up will fall at least once a year. 

The update to the quality standard says they should be asked whether they have had falls in the last year, or consider themselves to be at risk of falling. For example, if they ever lose their balance or feel unsteady on their feet.

If an older person is then deemed to be at risk, health care professionals should refer the older person to the appropriate service.

Professor Gillian Leng, deputy chief executive at NICE, said: “We know that prevention is better than cure when it comes to falls, particularly in older people.

“Asking older people about falls on a regular basis will identify those who are most at risk. Through this simple intervention, those people can then be referred to the right health care professional or service to stop them falling in the future.”

Commenting, RCGP Chair Professor Helen Stokes-Lampard, said: “Caring for elderly patients is a very substantial part of a GP’s workload, and we see the terrible effects of falls on a daily basis – not just in terms of physical harm, but knock on effects, such as anxiety and decreased confidence.

“The NICE standards released today highlight the importance of preventing falls in elderly patients, where possible, which is welcome…But implementing this new guidance will undoubtedly be hampered by the standard 10-minute GP consultation, which is increasingly inadequate, particularly for older patients who are often living with multiple, long-term conditions.

“GPs want to spend longer with our older patients so that we can discuss things with them like how to avoid falling - but in many cases this won’t be the reason a patient has come to visit the GP, and it’s incredibly hard to do everything that we should do whilst respecting the patient and their reason for visiting us.

“Nevertheless, it is essential that we do use all the opportunities we have with our older or more frail patients to establish whether they are susceptible to falling, and work with colleagues across health and social care to ensure they receive the most appropriate care and support. We also welcome initiatives that allow GPs to spend longer with patients with multiple health problems.”

The updated quality standard outlines that older people who are deemed to be at risk of falling are offered a multifactorial falls risk assessment. And people flagged as being at an increased risk should be given a managed intervention individual to their needs.

This quality standard, which contains three new quality statements, updates the original publication from 2015.

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