Scope - Falls: assessment and prevention of falls in older people
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
SCOPE
1 Guideline titleFalls: assessment and prevention of falls in older people
1.1 Short title
Falls
2 Background
a) The National Institute for Clinical Excellence ('NICE' or 'the Institute') has commissioned the National Collaborating Centre for Nursing and Supportive Care to develop a clinical guideline on the assessment and prevention of falls in older people for use in the NHS in England and Wales. This follows referral of the topic by the Department of Health and Welsh Assembly Government (see Appendix). The guideline will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness.
b) The Institute's clinical guidelines will support the implementation of National Service Frameworks (NSFs) in those aspects of care where a Framework has been published. The statements in each NSF reflect the evidence that was used at the time the Framework was prepared. The clinical guidelines and technology appraisals published by the Institute after an NSF has been issued will have the effect of updating the Framework.
3 Clinical need for the guideline
a) Falls are a major cause of disability and the leading cause of mortality resulting from injury in people aged over 75 in the UK. One-third to one-half of people aged over 65 fall each year. Furthermore, over 400,000 older people in England attend accident and emergency departments following an accident and up to 14,000 people die annually in the UK as a result of an osteoporotic hip fracture (National Service Framework for Older People 2001). Falling, therefore, has an impact on quality of life, health and healthcare costs.
4 The guideline
a) The guideline development process is described in detail in three booklets that are available from the NICE website (see 'Further information'). The Guideline Development Process - Information for Stakeholders describes how organisations can become involved in the development of a guideline.
b) This document is the scope. It defines exactly what this guideline will (and will not) examine, and what the guideline developers will consider. The scope is based on the referral from the Department of Health and Welsh Assembly Government (see Appendix).
c) The areas that will be addressed by the guideline are described in the following sections.
4.1 Population
4.1.1 Groups that will be covered
The recommendations made in the guideline will cover the care of the following groups.
a) Older people who are at risk of falling or who have fallen.
b) Older people who attend primary or secondary care settings following a fall.
4.1.2 Groups that will not be covered
The following groups will not be covered by this guideline.
a) Hospitalised patients who sustain a fall while in hospital or who may be at risk of falling during hospitalisation. Currently no interventions have been proven to be effective in the prevention of falls in the acute setting.
b) People who are confined to bed for the long term.
4.2 Healthcare setting
a) This guideline will make recommendations on the care given by healthcare professionals who have direct contact with and make decisions concerning the care of older people who have fallen or are at risk of falling.
b) It will also make recommendations on the care given by healthcare professionals, or carers where applicable, involved in the care of older people who have been taken to hospital following a fall.
c) This is an NHS guideline, but it may also address the interface with other services, such as those provided by social services, secure settings, care homes and the voluntary sector; it will not include services exclusive to these sectors.
4.3 Clinical management
a) This guideline will make cost-effective recommendations on clinical management based on the best evidence available to the Guideline Development Group.
b) The recommendations will address both the identification and assessment of older people at risk of falling and those who have fallen.
c) The recommendations will also cover interventions for the primary prevention of falls and the management and rehabilitation after falls, such as:
d) Recommendations will also take account of the psychosocial aspects of falling, including fear of falling and loss of confidence resulting from a fall.
e) When referring to pharmacological interventions, the guideline will normally recommend use of the intervention within its licensed indications. Exceptionally, and only where the evidence supports it, the guideline may recommend use outside the licensed indications. The guideline expects that prescribers will use the Summary of Product Characteristics to inform their prescribing decisions for individual patients.
f) The guideline will not cover:
4.4 Audit support within guideline
The guideline will provide level 2 audit review criteria and advice.
4.5 Status
4.5.1 Scope
This is the final version of the scope.
4.5.2 Guideline
The development of the guideline recommendations will begin in July 2002.
5 Further information
Information on the guideline development process is provided in:
These booklets are available as PDF files from the NICE website (www.nice.org.uk). Information on the progress of the guideline will also be available from the website.
6 Reference
National Service Framework for Older People (2001). Department of Health.
Appendix - Referral from the Department of Health and Welsh Assembly Government
The Department of Health and Welsh Assembly Government asked the Institute: "To prepare clinical guidelines for the NHS in England and Wales for the assessment and prevention of falls, including recurrent falls in older people; with an associated clinical audit system."
This page was last updated: 30 March 2010
