Because falls are the leading cause of injuries to older people, the Reducing Harm from Falls programme developed the Ask, assess, act initiative as part of the national patient safety campaign Open for better care.
Clinical guidelines recommend routine screening for falls risk for all older people, based on evidence in cohort studies that an older person who has had a fall is at risk of a subsequent fall, and that mobility impairment, gait disorders and balance deficits are significant risk factors[1, 2, 3].
Screening means that falls risk assessment and appropriate interventions can be targeted to those most likely to benefit ie, those most at risk. This case study shows how occupational therapists used the patient data system to screen older people presenting to ED after a fall, and helped them target home safety assessments and modifications to those most at risk of falling again
Since older people can have several risk factors needing intervention, and each older person will have a different risk profile, it is not surprising that systematic reviews have found that multifactorial assessment and interventions reduce the rate of falls in community-dwellers and hospital inpatients, and may reduce falls in older people in residential care[5, 6].
In practice, multifactorial risk assessment and intervention involves ‘… systematically checking for and acting on falls-related risks factors that could be treated, modified or better managed in individual patients’, and includes the management of underlying conditions.
ASK the older person three simple screening questions.
ASSESS the older person to identify their particular falls risk factors.
ACT by putting in place individualised interventions and supports to address their risks.
The Ask, assess, act resources are outlined in the helpsheet and are available from the Commission’s website for you to download and print. Free printed copies of the promotional posters and pocket cards can be requested by emailing email@example.com.
The Ask, assess, act resources are based on a synthesis of these guidelines:
- the 2013 NICE clinical guideline 161  which has this online falls pathway for assessment and prevention of falls in older people
- the 2011 AGS/BGS clinical practice guideline  which has this annotated algorithm for screening and assessment.
A number of district health boards and other providers trialled the Ask, assess, act initiative in 2013 - here’s a story from an outpatient department at Waikato DHB.
The resources have been updated for use in April Falls 2014 activities, with an overview of care after a fall being added to the pocket card. The resources promote the Ask, assess, act process and can be used to support existing assessment and care planning tools, or to highlight what might be included or changed.
The Ask, assess, act process is ideally used in hospital, primary health care, and community (home care) settings, but the principles also apply in age-related residential care.
We welcome feedback on the format, content and usefulness of these resources – please get in touch with us at firstname.lastname@example.org.
- National Institute for Health and Care Excellence. 2013. NICE Clinical guideline 161 Falls: assessment and prevention of falls in older people. URL: http://publications.nice.org.uk/falls-assessment-and-prevention-of-falls-in-older-people-cg161 (accessed 10 July 2013).
- Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. 2011. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society 59(1): 148–157.
- National Collaborating Centre for Nursing and Supportive Care and the Guideline Development Group (2004). Clinical practice guideline for the assessment and prevention of falls in older people. Royal London: College of Nursing.
- Healey F, Darowski A. 2012. Older patients and falls in hospital. Clinical Risk 18(5): 170–6.
- Gillespie LD, Robertson MC, Gillespie WJ et al. 2012. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (9):CD007146.
- Cameron ID, Gillespie LD, Robertson MC et al. 2012. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews (12): CD005465.