National falls and fracture prevention strategy 2019-2024 draft: consultation

Appendix 2. A multifactorial approach to falls prevention^[40]

The multifactorial screen will include a comprehensive falls history, general health questions and screening for risk factors related to:

The multifactorial screen will include a comprehensive falls history, general health questions and screening for risk factors related to:

• alcohol intake related to the fall/s*
• cardiovascular and neurological symptoms (including postural hypotension)
• cognition*
• environment
• fear of falling, anxiety and depression
• feet and footwear
• fracture risk
• function/activities of daily living
• gait and balance, mobility and muscle strength
• incontinence including urgency and frequency*
• medications
• nutritional status*
• vision and hearing.

The Falls and Fracture Prevention Action Plan includes interventions to manage the known risk factors identified by the multifactorial screen.

Interventions may include:

• Assessment of fracture risk +/- management of osteoporosis.
• Detailed assessment of gait, balance and mobility levels and lower extremity joint function.
• Strength and balance training, which is individualised, progressive, challenges balance and is of at least 50 hours duration (not all of which need be supervised directly).
• Assessment of the home environment for falls hazards with safety intervention.
• Assessment of activities of daily living (ADL) skills including use of adaptive equipment and mobility aids, as appropriate.
• Therapeutic interventions to improve the person's functional ability and minimise fear of falling.
• Management of risk associated with feet and footwear.
• Medication review with modification or withdrawal.
• Vitamin D supplementation.
• Medical assessment where cardiovascular and neurological problems or unexplained falls are identified.
• Management of postural hypotension.
• Management of heart rate and rhythm abnormalities.
• Assessment and management of visual impairment.
• Assessment and management of hearing impairment.*
• Education and information provision as part of a tailored multifactorial intervention.
• Continence assessment and management.*
• Nutritional assessment and advice.*
• Alcohol advice and support if required
• Assessment and management of fear of falling, anxiety or depression.*
• Where cognitive impairment is recognised, referral for ongoing support as required
• Assessment of telehealthcare needs.*
• Alcohol intervention.*

*Indicates a recommendation not included in published guidelines but agreed by the development group as good practice.