A conceptual paper argues that the widely used WHO risk factor model for falls in older age, which groups risks into biological, behavioural, environmental and socioeconomic domains, misses what happens during a hospital admission. The authors propose a fifth domain: hospitalisation and subsequent care.
That domain would include in-hospital factors such as length of stay, adverse events such as delirium and in-hospital falls, and whether transitional care services are used after discharge. The aim is a falls assessment at discharge that reflects the risk the admission itself has added.
The weeks after discharge are a known period of high falls risk, and the discharge assessment often repeats the community checklist without asking what changed during the stay. This framework gives a structure for those questions.
It is a proposal, not a validated tool, and the paper does not report outcome data. Its value is as a prompt for discharge planning while evidence is gathered.
- At discharge, ask whether the patient had delirium or a fall during the admission.
- Note length of stay; longer admissions bring more deconditioning.
- Arrange transitional support, such as physiotherapy or a home visit, for higher-risk patients.
- Review new or changed medicines that raise falls risk before the patient leaves.
- Share in-hospital events with the GP in the discharge summary.
Why it matters
The admission itself can create the risk that leads to a fall at home.
Don't overread it
This is a proposed framework without outcome data; it has not been shown to prevent falls.
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