The falls history everyone takes is 'have you fallen in the past year?' It catches the event and misses the capacity. A more useful question is whether they could get up off the floor on their own, and when they last did.
It matters because the time spent on the floor after a fall — not the fall — is what produces pressure injury, rhabdomyolysis, hypothermia, pneumonia and the admission. An older person who falls and can get up is in a different clinical situation from one who cannot, even if they have fallen the same number of times.
Then act on the answer: teach backward chaining, check they have a means of summoning help that is on their body rather than on a wall, and ask whether anyone would notice within a few hours if they did not answer the phone.
- Ask directly: can you get up from the floor by yourself, and when did you last do it?
- Teach the backward-chaining technique, or refer for it.
- Check the alarm is worn, not mounted — a pendant on the bedside table helps nobody.
- Ask who would notice, and after how long.
- Record the answer where the out-of-hours team will see it.
Why it matters
Two people with the same falls history face completely different risks depending on whether they can get back up.
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