Falls Risk Assessment Questions

Falls are among the most common and most serious harms in hospital, especially for older people, where a fall can be the start of a long decline. The CBT tests whether you can identify who is at risk, prevent falls sensibly, and respond well when one happens.

Risk is multifactorial

There is no single cause of falling, and no single question that captures the risk. A proper falls assessment looks across several factors together: a history of previous falls, medicines that cause drowsiness or dizziness, poor mobility and balance, confusion or dementia, poor vision, urgent toileting needs, and hazards in the environment. Questions that reduce this to age alone, or to one tick-box, are missing the point. So is the opposite error of assuming every older patient will inevitably fall.

Medicines deserve a mention because they come up often. Sedatives cause unsteadiness, and blood pressure drugs can cause dizziness on standing. Reviewing them is part of prevention.

Prevention that respects the person

Good prevention starts with why someone is at risk. A confused patient repeatedly trying to get up is usually trying to meet a need, often the toilet. Meeting that need, increasing supervision, and making the environment safe prevents falls while keeping the person’s dignity. Simply telling them to stay put, or restraining them, is neither effective nor acceptable.

Bed rails are a specific trap. They are not a routine answer. They can cause entrapment, a person who climbs over them can fall further and be hurt worse, and they can amount to restraint. They are used only after individual assessment, never as a default.

After a fall

When a patient is found on the floor, the instinct to lift them straight back into bed is the wrong one. You check for injury and level of consciousness first, because moving someone with a possible head or spinal injury can cause harm. Assess ABCDE if they are unwell, get help, and move them only once it is safe. Then monitor, document what happened, and report it as an incident. Next: pressure ulcer risk assessment. Five falls scenarios first.