APPENDIX 1.3: Community Falls & Osteoporosis Assessment: Part 2

Community Falls & Osteoporosis Assessment: Part 2

(for Community Mental Health & Learning Disability teams)

Guidance for targeting interventions and appropriate referral for any person reporting a fall

Name: ………………………………………….…..………… DOB: ….……..……………… NHS No: ….…..…….……………..

Address: ……………………………………………………………………….…………………………………………………………

…………………………………………………..Tel No: ………………………….… GP: ……………………………………………

Risk Factor / Assessor advice and
Interventions / Referral options
1. History of falling & fear of falling
From the falls history assessment, is the fall unexplained or with history of blackout?
History of one fall in past year
Recurrent falls (more than 2 in 1 year)
Ask about fear of falling/loss of confidence / □Yes→
□ No
□ Yes→
□ No
□Yes→
□ No
□Yes→
□No / Refer to GP to do cardiac/neuro exam/medication review
Check gait & balance & refer to
Physio/ OT if required
Review cause of fall(s) with
patient
Refer OT/PT / Falls clinic via GP
letter
Physio/OT
GP/Nurse/OT/PT
as appropriate
OT/PT for fear of
falling
2. Medication
Is the person on four or more medications?
Does the person take anti-depressants, anti-psychotics, sedatives or drugs
that lower blood pressure
Is alcohol consumption a factor in patient’s
falls? / □ Yes→
□No
□ Yes→
□No
□ Yes→
□ No / Has medication been reviewed in
last 6 months? Check
compliance with medication
Check lying & standing BP
Highlight risks of alcohol and medication interactions. Offer
written advice. Refer GP if appropriate / GP
Community Pharmacist
GP
GP
3. Walking / Balance / Transfers
Is person unsteady on feet / shuffling gait /
poor balance. Any difficulty getting from
sitting to standing? / □Yes→
□ No / Refer for balance or gait
assessment. Check walking aids.
Offer advice dependent on own
professional skills / knowledge / Community
Physio/OT
4. Vision
Has the patient had an eye test in the last
year?
Do they wear bifocals or varifocals? / □Yes→
□ No
□ Yes→ / Recommend appointment with
optician
Consider single lens glasses
Give advice on risk of falls on step/stairs when wearing bifocals / Optometrist
Consider Sensory
Impairment Team if
appropriate
5. Hearing
Any difficulty in hearing conversational
speech? / □Yes→
□ No / Check for wax and clear wax if necessary.
If problem with hearing persists
refer to GP for audiology referral / Practice Nurse
Audiology via GP
Sensory Impairment
Team
6. Nutrition / hydration
Any recent weight loss? / □ Yes→
□ No / Ask if clothes have become
loose. Discuss diet, mouth/
denture problems.Advise about adequate fluid intake. Consider
meals services locally. Provide information / Discuss with GP
Dentist
Social Services
Dietitian

Patient Name: ……………………………………. Date of birth: …………………………… NHS no: …….……………

Risk Factor / Assessor advice and
Interventions / Referraloptions
7.Dizziness
Is the patient dizzy?
Orthostatic (postural) hypotension
Lying:
Standing:
Pulse: / □ Yes→
□ No / What starts it, how long
does it last? Is it prompted by
head/neck movements/change
in position?
Take lying & standing BP (if drop
In systolic is 20mm Hg or more
or diastolic 10mm Hg refer to GP).
Advise slow changes in position
and encourage fluids / GP
GP
8. Environmental hazards
Cluttered home, slip, trip hazards or poor
lighting? / □ Yes→
□ No / Identify hazards and discuss
Waysof reducing risks of a fall. ConsiderHomecheck or Intouch
for small repairs/safety checks / Community OT
or OT Direct
Homecheck/Handyman
Service
  1. Footwear / foot care
Is person able to care for own feet and
nails?
Is current footwear suitable? / □ Yes
□No→
□Yes
□ No→ / Refer to podiatry or nail
cutting service
Advise about suitable low-heeled supportive shoes and provide
footwear brochure / Podiatry
Age Concern nail cutting
clinics
  1. Medical Conditions
New or acute confusion, incontinence,
Infection, constipation / □ Yes→
□ No / Check for systemic infection or
change in risk factors / GP/ CPN/ DN
  1. Osteoporosis
Is there a diagnosis of osteoporosis?
Other risk factors:
History of fragility fracture (fall from standing
height) after age 50
Menopause before age 45
Current history of taking oral steroids
Parental history of hip fracture
Secondary causes (eg use of steroids,
Coeliac, Rheumatoid Arthritis & others) / □Yes→
□ No
□Yes→
□Yes →
□Yes →
□Yes→
□Yes→ / Check compliance with
medicationand ensure aware of National Osteoporosis Society
information
Refer GP
Provide bone health literature,
including advice on smoking
cessation and alcohol intake.
Check BMI and medical
conditions / GP
Action Plan:

If referral to GP or other services, please include the following with referral:

Current medication, past medical history and any other relevant information including recent investigations.

Clinician name:………………………………….. Signature:…………..………………………. Date: ………………………

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