The Prevention and Management of Falls in the Community: A Framework for Action for Scotland 2014/15

The aim of the Framework for Action is to support a more consistent approach to falls prevention and management and in doing so improve experiences and outcomes for older people, their families and carers; and to accelerate the pace of implementing integrated falls and fragility fracture pathways.

Appendix 2: The Falls and Fracture Risk Assessment Continuum

Level 1

A simple initial risk indeptification process which aims to identify people who have fallen/are at high risk of falling and may benefit from further support and/or intervention.

Level 2

A multifactorial falls risk screening process which aims to (a) identity risk factors for falling and for sustaining a fragility fracture, and (b) guide tailored management.

Level 3

A specialist assessment which aims to assess further the risk factors identified, with a view to providing tailored intervention to reduce the risk of falls and/or fractures.


  • A simple process, facilitated by the use of a tool or an algorithm.
  • Clear guidance on next steps has been agreed, including referral pathways and protocols.

A level 1 conversation will identify people who have experienced:

  • Two or more falls in the previous 12 months.
  • Loss of consciousness/blackouts/dizziness at the time of the fall/s.
  • Difficulties with walking or balance.
  • A change in ability or confidence to carry out usual daily activities following the fall/s.

Additional questions may be included which ask about:

  • Previous fractures.
  • Ability to get up from the floor.
  • Fear of falling.

Next steps may include:

  • Notifying a senior colleague/supervisor of the outcome.
  • Referral or sign posting to appropriate services providing further assessment and intervention.
  • Providing further assessment or intervention, if appropriately trained/qualified.


  • Standard questions and/or checklist relating to falls history and specific risk factors for falls and fractures.
  • Responses trigger specific interventions and/or referrals for further intervention.
  • May include the use of screening tools such as the Timed Up and Go.
  • Provides clear guidance on next steps to be taken if/when a risk factor is identified.
  • Includes red flags for urgent medical assessment (such as loss of consciousness, dizziness, unexplained falls).

Next steps may include:

  • Creating a personalised Fall and Fracture Prevention Action Plan.
  • Referral on to appropriate services/agencies.
  • Providing further assessment or intervention, if appropriately trained/qualified.


  • A more detailed assessment of a specific risk factor identified, carried out by a qualified practitioner.
  • May include the use of relevant assessment tools and outcome measures.
  • Determines the specific interventions required to reduce risk.

Next steps may include:

  • Providing tailored intervention including support for self management.
  • Referral for further intervention or investigation.


Email: Susan Malcolm

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