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The NICE impact on falls and fragility fractures

Falls should not be an inevitable part of ageing – and their snowball effect means the consequence of falls are far from limited to just hospital admissions, says Professor Gillian Leng, deputy chief executive and director of health and social care at NICE

Almost a third of over-65s in the UK have a fall at least once a year, with around 500,000 people presenting at hospital with fragility fractures. This is estimated to cost the NHS £4.4bn a year. As our population of older people continues to rise, it’s clear from these figures that reducing falls and effectively assessing fracture risk have never been more important.

The consequences of falls don’t stop at hospital admissions. Particularly for older people, one fall can generate further problems, such as a loss of independence and confidence, leading to physical and mental deterioration and frailty. People who fall are also more likely to suffer further falls and fractures. This snowball effect not only adds mounting pressure to our health and social care system, it threatens to deplete quality of life and fuel vulnerability. 

Over the years, NICE has produced a range of evidence-based guidance and resources to support healthcare professionals in this challenge. We have now published a new impact report, which highlights how our guidance has been implemented by the healthcare system and the progress made so far.

The report explores how NICE has helped to improve falls prevention, detecting and managing osteoporosis and fracture risk, support after fragility fracture, and the management of people who have experienced hip fracture – which alone is estimated to cost the NHS £2bn a year.

In 2013, NICE published guidance on falls in older people, and in 2015 we went on to issue a quality standard on this topic. Since their publication, monthly survey data revealed a reduction in the proportion of people experiencing a fall while in care and an increase in the recognition of the importance of frailty. The data also found that the proportion of trusts using fall risk prediction tools has reduced since NICE issued a recommendation that they should not be used in hospitals. These tools have not been shown to accurately predict the risk of falling. Instead, all patients over 65, and those aged 50 to 64 who may have a relevant underlying condition, should be considered as being at risk. They should be offered a multifactorial risk assessment taking account of things like any history of falls, medication they are on and visual impairment.

This is positive news and shows that we are moving in the right direction. Health and care professionals are basing their practice on evidence of what really works, and importantly, outcomes for people at risk of falling are improving as a result.

But there is still more work to be done.

For example, strength and balance training programmes have been shown to reduce the rate of falls. Our report found that although people are being referred to these programmes, uptake needs to improve. Also, while there is evidence that multifactorial risk assessments are being carried out in hospitals, the quality of content varies, which signals another area for improvement.

Falling should not become an inevitable part of ageing. At NICE we will continue to support professionals to make a positive impact on the prevention and management of fractures, falls and frailty. But, as a health and social care system, we must keep up the momentum and ensure those most at risk of falling remain at the very heart of evidence-based improvements.


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