Commentary on NICE guidance 249-falls: assessment and prevention in older people and in people 50 and over at higher...

The new National Institute for Health and Care Excellence (NICE) Falls Guideline (NG249) updates CG161 (2013). NG249 aims to reduce the risk and incidence of falls, associated clinical consequences and loss of confidence or independence. The scope has expanded to include people aged 50-64 at higher risk of falls, identified by their medical condition and people in hospital or residential care. The intended audience includes health, social care and local authority commissioners and practitioners, care home providers and people at risk of falls. The Quality Standards (QS86) have been updated and simplified. The 39 recommendations on identifying people at risk, comprehensive falls risks assessment, interventions, maximising participation, information and education, are intended to be feasible and cost-effective in the UK national health and care system. Risk assessment tools are not recommended in any setting; however, a welcome change is tiered intervention responses dependent on initial risk assessment, which roughly aligns to the World Falls Guidelines. Will NG249 generate new actions to reduce population falls rates? Two aspects suggest perhaps not. The general description of recommended exercise is not strengthened with details on dose and lacks a clear statement discouraging low intensity/untargeted exercise; such programmes are likely more prevalent than those based on level one evidence. Linked to this, the guidance statement that most recommendations, including exercise, have no cost implications as they reflect current practice is highly contestable. With no reliable audit data and much anecdotal evidence to refute it, the danger is that commissioners and funders will see no case for review or reinvestment. An opportunity lost?