Fall Risk Assessment

A Fall Risk Assessment is a structured evaluation that helps doctors and nurses identify how likely a person is to fall, so that steps can be taken to keep them safe. It is most often used in older adults, but can be done for anyone whose health, mobility, or medication might increase their chance of falling.

During the assessment, a trained health professional observes how the person stands, walks, and balances. They also review the person's medical history, current medications, vision, and home environment. The findings are scored on a standardised tool — such as the Morse Fall Scale or the Timed Up and Go test — to place the person into a low, medium, or high risk category. This guides the care team in choosing the right safety measures.

A Fall Risk Assessment is recommended whenever a patient's circumstances suggest they may be at greater-than-usual risk of falling. It is a routine part of care for older adults admitted to hospital, entering a nursing facility, or attending a geriatrics (specialist care for older people) outpatient clinic. It may also be triggered by a recent fall or a noticeable change in how a person moves or functions.

• Adults aged 65 and older, especially those living alone
• Anyone who has already fallen once in the past year
• People with dizziness or low blood pressure when standing (orthostatic hypotension)
• People with conditions affecting balance or the nervous system, such as Parkinson's disease or stroke
• People with muscle weakness or joint problems that affect walking
• Patients taking multiple medications, particularly blood pressure drugs, sleeping pills, or sedatives
• People with poor vision or cataracts (clouding of the eye lens)
• People with osteoporosis (thinning and weakening of the bones), where a fall is especially dangerous
• Anyone recovering from surgery or a serious illness who has reduced strength or coordination

There are very few situations in which a Fall Risk Assessment would not be appropriate. It is a non-invasive (no needles or cuts involved) observation-based process, so it is suitable for almost all patients. In rare cases, a patient who is fully bedridden and has no prospect of walking may not benefit from the standard walking tests, and the assessment would be adapted accordingly by the care team.

A Fall Risk Assessment is a purely observational and functional test; it involves no injections, no radiation, and no invasive procedures, so it carries no meaningful medical risk to the patient.

• Minor muscle fatigue or discomfort in patients with very limited mobility who are asked to stand or walk during the test — the assessor will always stay close to support the patient
• A very small chance of losing balance momentarily during walking tests, which is why a trained health professional supervises every step
• Anxiety or distress in some patients who feel self-conscious about being observed — staff are trained to conduct the assessment in a calm and respectful way

Because a Fall Risk Assessment does not involve anaesthesia (medicine that makes you unconscious or numb) or any invasive procedure, there is usually no need to fast or to stop eating and drinking beforehand. No special dietary changes are required.

Patients are generally advised to bring a list of all current medications to the appointment, as some drugs — especially those that cause dizziness or drowsiness — are important factors in the assessment. There is no need to pause or stop any medication before the assessment; the doctor or nurse will review medications as part of the process.

Wear comfortable, well-fitting footwear and loose clothing that allows the assessor to observe how you move. If you normally use a walking aid such as a cane or walker, bring it with you. In some hospitals, basic tests such as blood pressure measurement and a vision check may be carried out before or alongside the assessment.

The assessment itself typically follows a sequence similar to this, though the exact steps and tools used may vary between hospitals and clinics:

• A health professional introduces themselves and explains what will happen
• Your medical history, current medications, and any previous falls are reviewed through questions
• Blood pressure is measured while you are sitting and then again while standing, to check for orthostatic hypotension (a drop in blood pressure that can cause dizziness when rising)
• Vision and hearing may be briefly checked
• You are observed standing up from a chair, walking a short distance, turning around, and sitting back down — this is part of the Timed Up and Go test
• Balance tests may be performed, such as standing still with feet together or in a heel-to-toe position
• Your home environment and daily routine may be discussed to identify hazards such as loose rugs, poor lighting, or bathroom risks
• The assessor scores the results using a standardised scale and discusses findings with the wider care team

Because the assessment itself is non-invasive, there is no physical recovery period needed. Most patients can return to their normal activities immediately after. The value of the assessment lies entirely in what happens next: the care team uses the results to put a personalised fall-prevention plan in place. Depending on the findings, this plan may involve several different types of support.

• If you are in hospital, nursing staff may place a fall-risk alert on your bed and ensure call buttons are within easy reach
• A physiotherapist (a specialist in movement and physical rehabilitation) may be asked to design a strength and balance exercise programme tailored to your abilities
• An occupational therapist (a specialist who helps people manage daily tasks safely) may assess your home and recommend changes such as grab rails in the bathroom, better lighting, or removal of trip hazards
• Your doctor may review your medications to reduce or replace any that increase dizziness or unsteadiness
• If poor vision was identified, a referral to an eye specialist may be recommended
• Appropriate footwear advice is often provided, as poorly fitting shoes are a common but easily corrected risk factor
• A follow-up assessment is usually scheduled after any significant change in health, mobility, or medication, or on a regular basis if you remain in a higher-risk category
• Family members or carers are often included in the education session so they can support safety at home