NICE issues guidance on falls prevention in elderly
Guidelines on the prevention
of falls in older people have been issued by the National Institute for Clinical Excellence and the National Collaborating Centre for Nursing and Supportive Care this week.
The key priorities for implementing the clinical guideline in the NHS
in England and Wales are risk identification, risk assessment and intervention.
To identify those at risk, older people, defined as those aged 65 years
or older, who are in contact with health professionals, should be asked
routinely whether they have fallen in the past year and to describe the
frequency, context and characteristics of any falls. Gait, balance, mobility
and muscle strength should also be assessed, along with osteoporosis
risk, cardiovascular health and functional ability.
Excessive, or suboptimal, medicine use is one of the major risk factors
for falling and the guidance recommends that the assessment should include
a medication review, although it does not provide specific advice about
changes to medicines. David Green, specialist pharmacist at Colchester
Hospital and member of the guideline development group, explained: “The
research base around medication is poor and has made making specific
recommendations around medication difficult despite the commonly held
opinion that medication, especially psychotropic and cardiovascular,
is a significant contributing risk factor for falls.”
However, Mr Green said that the new pharmacy contract provided a real
opportunity for community pharmacists to offer specific medicines review
services to older people as part of a falls prevention programme. This
will allow pharmacists to discuss compliance, and risk and side effect
profiles with patients and, where appropriate, to take patients off certain
medicines in order to help reduce their risk of falls.
Other suggested interventions to help reduce the risk of falls include
strength and balance training and home hazard reduction and education.
NICE judged that there was insufficient evidence to support recommending
a number of interventions, such as vitamin D supplementation.
Head and neck cancer Guidance on how health care services should
be provided for adults with head and neck cancers has also been
issued by NICE this week. The guidance highlights the importance
of multi-disciplinary teams and recommends that services be commissioned
at the Cancer Network level.
The guidance can be accessed here |
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