The National Institute for Clinical Excellence (NICE) commissioned the National Collaborating Centre for Nursing and Supportive Care (NCC-NSC) to develop guidelines on the assessment and prevention of falls in older people. This follows referral of the topic by the Department of Health and Welsh Assembly Government. This document describes the methods for developing the guidelines and presents the resulting recommendations. It is the source document for the NICE (abbreviated version for health professionals) and Information for the public (patient) versions of the guidelines that are published by NICE. A multidisciplinary Guideline Development Group produced the guidelines and the development process was undertaken by the NCC-NSC.

The main areas examined by the guideline were: the evidence for factors that increase the risk of falling; the most effective methods of assessment and identification of older people at risk of falling; the most clinically and cost effective interventions and preventative strategies for the prevention of falls; the clinical effectiveness of hip protectors for the prevention of hip fracture; the most clinically and cost effective interventions and rehabilitation programmes for the prevention of further falls; older peoples' views and experiences of falls prevention strategies and programmes.

Contents

• Disclaimer
• Guideline Development Group membership and acknowledgements
• Terminology
• Abbreviations
• General glossary
• 1. Executive summary
• 2. Principles of practice and summary of guideline recommendations
  • 2.1 Principles of practice
  • 2.2 Summary of guideline recommendations
• 3. Background to the current guideline
  • Clinical need
• 4. Aims of the guideline
  • 4.1 Who the guideline is for
  • 4.2 Groups covered by the guideline
  • 4.3 Groups not covered
  • 4.4 Health care setting
  • 4.5 Interventions covered
  • 4.6 Interventions not covered
  • 4.7 Audit support within guideline
  • 4.8 Guideline Development Group
• 5. Methods used to develop the guideline
  • 5.1 Summary of development process
  • 5.2 Risk factors for falling: review methods and results
  • 5.3 Assessment of those at high risk of falling: review methods and results
  • 5.4 Fear of falling as a risk factor and tools to measure fear of falling: methods and results
  • 5.5 Interventions for the prevention of falls: review methods and results
  • 5.6 Analysis of compliance with interventions for the prevention of falls
  • 5.7 Interventions to reduce the psychosocial consequences of falling: review methods and results
  • 5.8 Patient views and experiences: review methods and results
  • 5.9 Rehabilitation: review methods and results
  • 5.10 The effectiveness of hip protectors: review methods and results
  • 5.11 Cost effectiveness review and modelling: methods and results
  • 5.12 Submission of evidence process
  • 5.13 Evidence synthesis and grading
  • 5.14 Formulating and grading recommendations
• 6. Guideline recommendations with supporting evidence reviews
  • 1.1 Case/risk identification
  • 1.2 Multifactorial falls risk assessment
  • 1.3 Multifactorial interventions
  • 1.4 Strength and balance training
  • 1.5 Exercise in extended care settings
  • 1.6 Home hazard and safety intervention
  • 1.7 Psychotropic medications
  • 1.8 Cardiac pacing
  • 1.9 Encouraging the participation of older people in falls prevention
  • 1.10 Education and information giving
  • 1.11 Interventions that cannot be recommended
  • 1.12 Interventions that cannot be recommended because of insufficient evidence
• 7. Recommendations for research
• 8. Audit criteria
  • Possible objectives for an audit
  • People that could be included in an audit
  • Data sources and documentation of audit
  • Measures that could be used as a basis for an audit
• 9. Dissemination of guideline
• 10. Validation
• 11. Scheduled review of guideline
• 12. References
• Appendix A Guideline Development Group membership and acknowledgements
• Appendix B Search strategies and databases searched
• Appendix C Quality checklists/data extraction forms
• Appendix D Registered stakeholders
• Appendix E Clinical effectiveness evidence table
• Appendix F Quality assessment of trials
• Appendix G Table of excluded studies
• Appendix H Meta-analysis figures
• Appendix I The scope

NICE guideline on the management of osteoporosis – under development: The NCC-NSC is currently developing a guideline for NICE on osteoporosis. It is suggested that when this guideline is published in 2006, it is used in conjunction with these guidelines on falls prevention.

This work was undertaken by the National Collaborating Centre for Nursing and Supportive Care (NCC-NSC) and the Guideline Development Group (GDG) formed to develop this guideline. Funding was received from the National Institute for Clinical Excellence (NICE). The NCC-NSC consists of a partnership between: Centre for Evidence-Based Nursing; Centre for Statistics in Medicine; Clinical Effectiveness Forum for Allied Health Professionals, College of Health; Health Care Libraries (University of Oxford); Health Economics Research Centre, Royal College of Nursing and UK Cochrane Centre.