Last Updated: May 1, 2025

Personalised assessments factoring in hazards in the home and medical history will help reduce falls in older and at-risk people, according to new NICE guideline.

Updated guidelines from the National Institute for Health and Care Excellence (NICE), published this week, covers fall hazards in a person’s home, but also in residential care homes, hospital and other healthcare settings in the community for the first time.

The new guidance recommends checks are carried out by an occupational therapist or other appropriately trained healthcare professional, therapy assistant or technician with supervision. The assessment should check for things in the home and in the garden that might cause a fall, such as uneven flooring or poor lighting, and make recommendations on equipment and adaptations like handles and grab rails that can help reduce the risk of a fall. The assessment would also consider the person’s physical and cognitive capacity to get around safely and their previous medical history.

Falls can occur at any age but become more common as people get older. Around a third of people aged 65 and over, and around half of people aged 80 and over fall at least once a year.

In 2022/23 there were roughly 210,000 emergency hospital admissions in England that were the result of a fall for people over the age of 65. Around 146,700 of these admissions were people aged over 80. Falls are the most common cause of fragility fractures and the consequences of a fracture can be significant. Between 18% and 33% die within a year after a hip fracture.

The annual cost of fragility fractures to the UK has been estimated at £4.4billion, including £1.1billion for social care; hip fractures specifically account for around £2billion of this sum.

For individuals who have fallen in the past year, and are living with fragility, were injured in a fall, experienced loss of consciousness after a fall, haven’t been able to get up independently post-fall or have had two-or more falls in a short period of time, the updated guidelines recommend offering a comprehensive falls assessment and management plan.

The assessment can include physical examinations, checking balance and gait, and asking about dizziness. It considers each person’s individual risk factors and how they can be resolved, improved or managed to reduce the risk of a fall.

A range of interventions will be recommended after the falls assessment, including a falls prevention exercise programme.

Professor Jonathan Benger, Chief medical officer and interim director of the centre for Guidelines at NICE, said, ‘Falls prevent a major growing public health problem that can have devastating effects on older people and those at-risk due to medical conditions, often resulting in a loss of independence, chronic pain and reduced quality of life.

‘This useful and useable guideline has been updated to ensure people identified as being at greatest risk get help and support tailored to their individual needs so they can live full and active lives.

‘Fewer people suffering falls will result in a drop in the number of hospital visits and the need for ongoing treatments which will reduce pressure on the NHS.’

Dr Tom Downes, NHS national clinical director for older people, said, ‘Falls are the elading cause of hospital admissions in older people and can have serious consequences, including being a primary reason in a person losing their independence later on in life.

‘Identifying those at greatest risk of falls and providing them with the preventative help and support they need will not only improve people’s lives, but it will also free up clinical time and resource too.’

The updated guidelines recommend healthcare professionals consider carrying out a review to help identify any medicines that may increase risk of falls and consider adjusting such medicines to reduce that risk.

The guidelines continue to recommend evidence-based falls prevention exercise in community settings. However, a new addition to the guidelines recommends improving access to exercise for older and at-risk groups who do not require assessment.

It is also recommended that people, including those in hospital and residential care, are encouraged to remain active unless advised against doing so.

To view the updated NICE guidelines, click here.