Balancing Falls Prevention and Independence in Older People’s Services
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Falls prevention is one of the most scrutinised areas of older people’s services, often driving highly cautious practice. While preventing harm is critical, an excessive focus on eliminating falls risk can lead to unnecessary restrictions, reduced mobility and accelerated physical decline. High-quality services recognise that effective falls prevention must sit alongside positive risk-taking, enabling people to remain active, confident and independent.
This article connects falls prevention with positive risk-taking and quality and governance, demonstrating how safety and autonomy can coexist in regulated services.
Why risk-averse falls management causes harm
Blanket restrictions such as discouraging walking, limiting transfers or increasing supervision without clinical justification can weaken muscles, reduce balance and increase long-term falls risk. Emotional impacts are equally significant, with many older people reporting frustration, loss of confidence and withdrawal from daily activities.
Positive risk-taking reframes falls prevention as a shared problem-solving process rather than a set of prohibitions.
Operational example 1: Maintaining independent transfers
Context: A resident experienced two low-level falls when transferring from bed to chair.
Support approach: Rather than introducing constant supervision, the service completed a multifactorial falls assessment with physiotherapy input.
Day-to-day delivery: Bed height was adjusted, transfer techniques practiced daily, and grab rails installed.
Evidence of effectiveness: Incident records showed no further falls over six months and increased confidence during transfers.
Operational example 2: Encouraging outdoor mobility
Context: An older person wanted to continue walking in the garden despite uneven surfaces.
Support approach: Risks were assessed and an enablement plan developed rather than restricting access.
Day-to-day delivery: Appropriate footwear was agreed, walking times planned for daylight hours, and staff completed visual checks.
Evidence of effectiveness: Wellbeing reviews recorded improved mood and physical stamina with no recorded falls.
Operational example 3: Supporting self-directed exercise
Context: A resident wished to continue light exercise independently.
Support approach: The service worked with physiotherapy to agree safe movements.
Day-to-day delivery: Exercises were documented in the care plan and reviewed weekly.
Evidence of effectiveness: Mobility scores improved and reliance on staff support reduced.
Commissioner expectation
Commissioners expect falls prevention approaches to evidence both harm reduction and promotion of independence, demonstrating value for money and avoidance of unnecessary dependency.
Regulator expectation (CQC)
CQC expects providers to show that falls risks are managed proportionately and that people are not subject to restrictive practices without clear, recorded justification.
Embedding balanced falls prevention
Effective services integrate falls data analysis, supervision discussions and multidisciplinary input to ensure learning informs practice. Positive risk-taking is embedded as a governance priority, not left to individual discretion.
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