The Prevention and Management of Falls in the Community: A Framework for Action for Scotland 2014/2015

The Framework builds on the model presented in the Up and About resource, and focuses on falls prevention and management and fracture prevention for older people living in the community. The Framework is underpinned by evidence from research and draws on knowledge and experience gained by the falls prevention community in Scotland over the last four years.

Stage Two: Identifying individuals at high risk of falls and/or fragility fractures

Description (taken from Up and About)

At this stage:

  • A person at high risk of falls and fragility fractures is identified and this triggers appropriate intervention, or referral for appropriate intervention.
  • A person is identified either (a)when they report a fall, or present with a fall or an injury due to a fall, or (b)opportunistically when a health or social care practitioner asks about falls.
  • Opportunistic case identification links with both anticipatory care and the 'shared assessment' process.
  • A level 1 assessment aims to identify individuals at high risk of falling; it is not intended to determine all contributory factors or specific interventions required.

Actions to achieve the minimum standard for 2014/15

Action 2.1

Health and social care services offer Level 1 assessment to older people who report a fall or an injury or functional decline caused by a fall.


  • A Level 1 assessment, or initial risk identification, aims to identify individuals who have fallen/are at high risk of falling and may benefit from intervention to prevent further falls and restore/retain function following a fall.
  • Level 1 Assessment is a simple process, quick to administer and may take the form of a tool or an algorithm. To meet the minimum standard it includes questions about:
    • Frequency and circumstances of the fall/s.
    • Loss of consciousness/blackouts/dizziness at the time of the fall/s.
    • Difficulties with walking or balance.
    • Impact of the fall/s on day to day activities.

Action 2.2

Everyone identified at high risk of further falls by Level 1 assessment is offered intervention to identify and address possible contributory factors, i.e. Level 2 assessment.


  • A Level 1 assessment tool or algorithm includes clear guidance for the assessor on what steps to take next, based on the findings of the screen.
  • The assessor explains to the individual the reason why the intervention is indicated, what this will involve, such as a home visit or clinic attendance, and ensures consent has been given to refer for further assessment.
  • There are local referral pathways to services providing Level 2 assessment, and agreed referral protocols.
  • For people not referred for further intervention, and those who decline further intervention, up-to-date information is offered on the prevention of falls and the prevention of harm from falls (as described in Action 1.1).

Level 1 Assessment
A simple initial risk identification process which aims to identify individuals who have fallen/are at high risk of falling and may benefit from further assessment and intervention.
See Appendix 1 'The falls and fracture assessment continuum' for further information.

Level 2 Assessment
A multifactorial falls risk screening process which aims to (a) identify risk factors for falling and for sustaining a fragility fracture, and (b) guide tailored intervention.
See Appendix 1 'The falls and fracture assessment continuum' for further information.


A fall is a symptom, not a diagnosis. It can be the first indication of a new or worsening health problem and/or can represent a tipping point, triggering a downward decline in independence. Older adults who fall once are two to three times more likely to fall again within a year1 .

Structuring and standardising the screening process may improve service provider's adherence to guideline recommendations. The use of a small number of simple questions, requiring a yes/no answer, may also simplify documentation. Any positive answer to the screening questions puts the person screened in a high-risk group that warrants further evaluation2 .

In care homes for older people, the recommended practice is for care home staff to carry out a Level 2 assessment routinely on all residents. If this is the case, a level 1 assessment is not required.

For evidence base for actions, see references 1 and 2.

Further information

Managing Falls and Fractures in Care Homes for Older People, produced by the Care Inspectorate & NHSScotland, 2011. Access at:


Email: Julie Townsend

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