A multifactorial approach to falls assessment and prevention,
which includes physiotherapy, reduces falls in older people.
Physiotherapy includes the delivery of evidence-based
exercise programmes to optimise an individual’s strength and balance.
Physiotherapists work in partnership with community exercise groups
to ensure continuity of care and provide the recommended dosage
of exercise, enabling sustainable long term benefits.
Evidence-based multifactorial falls assessment and
personalised
care reduces falls
Multifactorial falls risk assessment reduces falls by 24% and should be offered to all older
people who have fallen or are at risk of falls(1-3). Physiotherapists are able to detect early
difficulties with movement, strength and balance. This enables them to identify the most
appropriate risk factors for individuals, as well as determining an individual’s overall risk of falls.
Physiotherapists also assess for other causes of falls, such as behavioural and environmental,
to pinpoint contributing factors(3).
Based on assessment findings, a person centred care plan is developed. The care plan may
include options which assist individuals to achieve their agreed goals, for example positive
risk-taking based on the individual’s strengths (i.e. what they can do). This proactive approach
enables people to remain active and live well
Multifactorial interventions may reduce rate
of falls
Multifactorial interven tions may reduce the rate of falls compared
with usual care or attention control(5). These interventions should
be considered for people who have fallen, or are at a risk of falls,
including older people in settings such as care homes(3).
Physiotherapists advise on managing modifiable risks,
such as footwear, and co-ordinate referrals to health and
community services(3).
The cost of falls to the NHS in England due to hazards in the
home environment is £435 million(6). Home hazard modification
is a cost-effective intervention, which includes support,
equipment and advice to complete daily living activities,
often delivered in partnership with occupational therapists(7).
A long lie on the floor is associated with serious injury,
increased mortality and increased risk of secondary complications
. Physiotherapists teach people how to get
up from the floor safely and/or how to minimise time spent
on the floor. Specific strength training may enable individuals
to get up from the floor independently.
Fear of falling affects approximately 50% of people who have
fallen and up to 50% who have never fallen, which can reduce confidence
and independence, and lead to social isolation. Exercise programmes
may reduce fear of falling in the short term, without increasing the risk or
frequency of falls. Cognitive behavioural therapy
can be delivered by trained support workers and can
reduce both fear of falling and depression.
The NHS Long Term Plan has recommended a
significant increase in the number of first contact
practitioner roles in general practice. First
contact physiotherapists, alongside community
physiotherapists, are ideally placed to provide advice
on lifestyle, falls prevention, bone health and reduction
of fracture risk using NICE recommended screening
tools, such as FRAX and QFracture
Physiotherapists also work as fracture liaison service
(FLS) coordinators to systematically identify and assess
people at risk of fragility fractures and recommend
interventions for bone health and falls prevention
Per 300,000 population, an effective FLS will prevent
250 fragility fractures, including 140 hip fractures, over
five years The total expected local savings to the
NHS and social care is £2.1 million for a service cost
of around £640,000 (a net benefit of £1.46 million);
however, FLS is not consistently available