Falls assessment (Multifactorial falls risk assessment)

A thorough assessment of why an older person is falling or unsteady, looking at many possible causes together so the treatable ones can be found and acted on.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

Falls in older people usually have several causes at once, so a good assessment looks at many things together rather than blaming one.
Its main purpose is to find treatable or reversible causes — such as medicines that increase falls risk, low blood pressure on standing, poor sight, or weakness — and act on them.
Strength and balance exercises are one of the most effective parts of most plans, but the plan must be tailored to you.
The assessment plans rather than treats; it only helps if the plan is followed, and you should be fully involved in shaping it.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeWhole-person assessment to find and reduce the causes of falls

AnaestheticNot needed

How long it takesOften a long appointment; may involve more than one professional or visit

Hospital stayUsually outpatient, in a falls clinic, or in your own home

Time off workUsually none

When you'll see resultsA personal plan to reduce your falls risk, explained to you and your GP

On the NHS?Available on the NHS when clinically indicated; also offered privately

A general guide. Your specialist will give you advice for your situation.

Best fit

Looks for many possible causes of falling at once, rather than blaming a single factor

Pause if

Someone acutely unwell or injured after a fall, who needs emergency assessment first.

Main recovery point

You answer detailed questions, are examined, and do simple walking and balance tasks with support. It can be tiring, so breaks and bringing someone with...

Good aftercare

A clear written plan covering the treatable causes found, shared with the person and their GP.

During the assessment

You answer detailed questions, are examined, and do simple walking and balance tasks with support. It can be...

Tests, if needed

Blood tests, a heart tracing or other checks may be arranged to look for causes such as anaemia, heart rhythm...

Your plan

The causes found are explained and brought together into a personal plan — often including exercises, medicine...

Acting on it

Exercises, referrals (such as physiotherapy or an occupational therapy home visit), equipment and medicine...

Medical line illustration of frailty, falls and mobility assessment for Falls assessment. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is a falls assessment?

A falls assessment is a careful look at why an older person is falling, nearly falling, or feeling unsteady. It is usually led by a clinician with the right skills — often in a specialist falls service — and may involve a geriatrician, physiotherapist, occupational therapist and others. Because falls in later life rarely have a single cause, the assessment deliberately looks at many things at once: this is sometimes called a multifactorial assessment.

It typically checks your walking, balance and leg strength; your blood pressure lying down and standing; your medicines; your eyesight, hearing and feet; your memory and mood; your bone health; continence; and hazards at home. The aim is to find the causes that can be treated or changed — and many of them can — and to build a plan that lowers your risk of falling again.

A falls assessment gathers information and plans; it does not by itself stop falls. Its value comes from finding reversible causes and from the plan being acted on — for example a strength and balance exercise programme, adjusting medicines that increase the risk of falling, treating low blood pressure on standing, sorting out vision or footwear, and making the home safer. You should be fully involved, because the plan only works if it fits your life.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Walking, balance and strength check

Watching how you stand, walk and turn, and assessing leg strength and balance, sometimes with simple timed tasks, to see where the risk lies.

Blood pressure and heart checks

Measuring blood pressure lying and standing to look for a drop on standing, and checking the heart rhythm, as both can cause falls and blackouts.

Medicines review

A structured look at all your medicines for any that increase falls risk — such as some for blood pressure, sleep, mood or anxiety — and whether they can be safely reduced, never stopped without advice.

Senses, feet and bones

Checking eyesight and hearing, foot problems and footwear, and your bone health, since these affect both the risk of falling and the risk of breaking a bone.

Memory, mood and continence

Brief checks of thinking and mood, and a look at bladder problems, all of which can contribute to falls in older people.

Home and daily living

Often with an occupational therapist, looking at hazards at home — lighting, rugs, stairs, the bathroom — and at aids or changes that would make moving about safer.

A multifactorial falls assessment compared with a single check

Feature	Multifactorial falls assessment	Single check
What it looks at	Many possible causes together	Usually one thing
Who is involved	A clinician, often with a wider team	Often one person
Medicines	All reviewed for falls risk	Often not reviewed
Output	A tailored, multi-part plan	Advice on one factor
Best for	Recurrent falls or unsteadiness	A single obvious cause

Because falls usually have several causes, a single check often misses the bigger picture. NICE advises against relying on simple falls 'risk scores' in place of a proper assessment.

Preparing for your test

Bring all your medicines, or an up-to-date list, including anything bought without a prescription, as well as sleep, pain and water tablets.
Wear or bring the shoes you usually walk in, and bring your glasses and hearing aids.
Make a note of your falls: how many, where, what you were doing, and whether you felt dizzy, blacked out or had warning.
Note any dizziness on standing, blackouts, palpitations, or problems with your bladder.
Think about hazards or worries at home, and whether you avoid activities because you are afraid of falling.
If possible, bring someone who has seen you fall or who helps you, as their account is useful.
Bring details of your GP and any recent test results or letters.

What happens

The clinician usually starts by asking in detail about your falls — when, where, how, and whether you had any warning, dizziness or blackout — and about your health, medicines and daily life. They then examine you, including watching you stand up, walk and turn, and checking your balance and leg strength, sometimes with simple timed tasks.

Your blood pressure is usually measured lying down and again after standing to look for a drop that can cause dizziness or falls, and your heart rhythm may be checked. Your eyesight, hearing, feet and footwear are looked at, brief memory and mood questions may be asked, and your bone health and continence considered. Tests such as blood tests, a heart tracing or, sometimes, a bone scan may be arranged.

More than one professional may be involved — for example a physiotherapist for strength and balance, or an occupational therapist who may visit your home to check for hazards. The findings are brought together into a personal plan to reduce your risk, which should be explained to you and shared with your GP. A good assessment treats you with dignity, takes your fear of falling seriously, and shapes the plan around what you can and want to do.

Is this test right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Someone acutely unwell or injured after a fall, who needs emergency assessment first.
A blackout strongly suggesting a heart cause, which may need urgent cardiac assessment rather than a routine falls clinic.
Relying on a simple falls 'risk score' instead of a proper assessment — NICE advises against this.
As a substitute for treating an obvious acute cause such as infection, dehydration or delirium.

Delay or rearrange if…

The person is acutely unwell, has an untreated infection, or is delirious — treat that first.
There has been a recent injury or fracture that needs to settle or be managed first.
Key information — medicines, recent results, an account of the falls — is missing.
The person is too unwell or exhausted on the day to take part in walking and balance tasks safely.

Alternatives to discuss

Strength and balance exercise programmes through community or physiotherapy services.
A structured medication review alone if medicines are the main concern.
Cardiac assessment if blackouts suggest a heart rhythm or fainting cause.
Bone health (osteoporosis) assessment to reduce fracture risk.
Home safety assessment and aids through occupational therapy or social care.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Benefits

Looks for many possible causes of falling at once, rather than blaming a single factor
Can find treatable or reversible causes, such as medicine side effects, low blood pressure on standing, poor sight or weakness
Leads to a tailored plan, often including strength and balance exercises that genuinely reduce falls
Reviews medicines that increase falls risk and considers safely reducing them
Considers bone health, so a plan can also lower the risk of breaking a bone if you do fall
Can restore confidence and help you stay active and independent

Risks & complications

More common

The assessment takes time and several questions, walking tasks and visits can be tiring
Talking about falls, fear of falling, memory or coping can feel sensitive
Being asked to do walking and balance tasks that feel challenging or expose unsteadiness
Suggested changes — exercises, equipment, medicine adjustments — take time and effort to put in place

Less common

Feeling momentarily dizzy or unsteady during standing blood pressure or balance tests (you are supported throughout)
Tests picking up minor findings that lead to further investigation
A plan that is made but not followed through if no one owns the next steps

Rare but serious

False reassurance if a normal assessment is taken to mean falls will not happen again, when no plan removes all risk

The assessment itself is low-risk — mainly questions, an examination and some walking and balance tasks, done with support. The bigger issues are that it can be tiring and emotionally sensitive, and that a good plan only helps if it is acted on. No assessment removes all risk of falling. Ask which causes were found, which can be treated, and how the plan — especially exercise and any medicine changes — will be supported and reviewed.

Published figures to discuss

A falls assessment is an assessment, not a treatment, so it carries little physical risk and complication rates do not really apply. The meaningful question is whether acting on it reduces falls — which it can, particularly through tailored strength and balance exercise and by addressing causes such as medicines and low blood pressure on standing. How much any individual benefits varies widely with their causes, how frail they are, and whether the plan is followed, so a single percentage would be misleading and is not given here.

Figure	Reported range	How to interpret it	Source / confidence
At least one fall each year in people aged 65 and over	Around 1 in 3, rising with age and frailty	A fall is a clinical event, not just bad luck; it should trigger a multifactorial assessment.	NICE NG249 — Falls: assessment and prevention in older peoplenice.org.ukPublished figure
Fall-related injury	Common; around 1 in 10 older adults report fall-related injury in population surveys	Head injury, hip pain, inability to weight-bear or anticoagulant use should prompt urgent assessment.	NICE NG249 — Falls: assessment and prevention in older peoplenice.org.ukPublished figure
Hip fracture one-year mortality	Often quoted around 20 to 30% in older adults	Preventing falls and treating osteoporosis are linked priorities.	NICE NG249 — Falls: assessment and prevention in older peoplenice.org.ukPublished figure
Falls risk prediction tools used alone	Not recommended by updated NICE falls guidance	Tools should not replace clinical judgement and a multi-domain assessment of gait, balance, medicines, vision, feet, cognition and home hazards.	NICE NG249 — Falls: assessment and prevention in older peoplenice.org.ukSource-linked context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no physical recovery from a falls assessment. What matters afterwards is that the treatable causes are acted on, that you have a clear plan you can follow, and that it is reviewed as things change — with you fully involved.

During the assessment

You answer detailed questions, are examined, and do simple walking and balance tasks with support. It can be tiring, so breaks and bringing someone with you are fine.

Tests, if needed

Blood tests, a heart tracing or other checks may be arranged to look for causes such as anaemia, heart rhythm problems or low blood pressure on standing.

Your plan

The causes found are explained and brought together into a personal plan — often including exercises, medicine changes, vision or footwear advice and home safety — shared with you and your GP.

Acting on it

Exercises, referrals (such as physiotherapy or an occupational therapy home visit), equipment and medicine adjustments are set in motion. Some happen quickly; others take time.

Review

Your risk and your plan should be reviewed, especially after any further fall or change in health, with a clear contact if things change.

What's normal — and not a worry

Feeling tired after a long appointment and some walking and balance tasks
Being given exercises to do regularly, which take weeks to build strength and confidence
Waiting while referrals, equipment or a home visit are arranged
Having medicines reviewed and, where advised, gradually adjusted
Gradual rather than instant improvement in steadiness and confidence

Aftercare

Do the strength and balance exercises you are given regularly, as these are one of the most effective ways to reduce falls.
Do not stop or change any medicine on your own; if a change is advised, it should be explained and, where needed, made gradually.
Get your eyes tested and wear the right glasses, and wear well-fitting, supportive shoes indoors and out.
Make the changes suggested at home, such as removing trip hazards, improving lighting and using any aids provided.
Stay as active as you safely can — avoiding activity through fear of falling tends to make falls more likely.
Keep follow-up appointments and make sure your GP has the plan.
Seek urgent help after a fall with a head injury, severe pain or inability to weight-bear, or for blackouts, chest pain or sudden weakness.

Before your test

All medicines or an up-to-date list gathered
Your usual walking shoes, glasses and hearing aids
A note of your falls — how, where and any warning signs
A note of dizziness on standing, blackouts or bladder problems
Someone who has seen you fall, if possible
A list of worries or hazards at home
Knowing who to contact after another fall or if things change

⚠ Get urgent help if…

A fall with a head injury, especially if on blood-thinning medicines — seek urgent help
A fall causing severe pain, deformity, or being unable to stand or bear weight (possible fracture)
Blacking out, fainting or collapsing without warning
Chest pain, palpitations, or sudden severe breathlessness
Sudden weakness, numbness, slurred speech or face drooping — call 999 (possible stroke)
Sudden confusion or a marked change in alertness
Repeated falls in a short time, or a sudden worsening of balance

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A useful falls assessment identifies the specific things making you fall — for instance a medicine, a drop in blood pressure on standing, weak legs, poor sight or a hazard at home — and sets out what can be done about each. Many of these causes can be treated or improved, and a tailored exercise programme can meaningfully reduce future falls.

No assessment can promise you will never fall again, and a plan only helps if it is followed. The benefit depends on acting on the treatable causes and keeping up the exercises. Your clinician should be clear about which causes were found, which can be changed, and what is realistic for you.

How long it lasts

Your falls risk changes over time — with new illnesses, new medicines, changes in eyesight or strength, or after a hospital stay. So a falls plan is not a one-off fix; it should be reviewed, especially after any further fall or change in health. Keeping up strength and balance exercises is important, because the benefit fades if they stop.

Related tests, treatments or support

A falls assessment overlaps with a mobility and balance assessment, a frailty assessment and a structured medication review, and is often part of a wider comprehensive geriatric assessment. It may lead to bone health assessment and treatment to reduce fracture risk, physiotherapy, an occupational therapy home visit, or eye and foot care. Your clinician will explain which of these you need.

Follow-up & long-term care

After the assessment you should be given a clear plan and have a copy sent to your GP, with referrals — such as physiotherapy or a home visit — and any medicine changes set in motion. You should know who is responsible for each part and when you will be reviewed. Any further fall, blackout or change in health should prompt a fresh look rather than waiting.

Keep up your strength and balance exercises, as the benefit fades if they stop
Have your eyes checked regularly and keep glasses up to date
Keep an up-to-date medicines list and have medicines reviewed periodically
Keep your home free of trip hazards and well lit
Wear supportive, well-fitting footwear
Ask for review after any further fall or change in health

Repeat, follow-on and what comes next

Falls risk changes over time, so the plan needs reviewing — especially after any further fall.
Strength and balance gains fade if exercises stop, so the plan is ongoing rather than one-off.
Some causes are only found after initial tests, prompting further assessment.
Medicine changes made to reduce falls risk may need monitoring and further adjustment.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

A clear written plan covering the treatable causes found, shared with the person and their GP.
A tailored strength and balance exercise programme, with support to keep it up.
Any medicine changes explained, made gradually where needed, and monitored.
Referrals and home changes actually set in motion, with a way to chase delays.
A planned review and a named contact for after another fall or a change in health.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

The length of the appointment and whether more than one professional is involved
Whether a physiotherapy and balance assessment or an occupational therapy home visit is included
Any tests arranged, such as blood tests, a heart tracing or a bone scan, charged separately
Whether it is a stand-alone assessment or part of a wider geriatric assessment
Follow-up reviews and any tailored exercise programme
Letters and onward referrals

Make sure your written quote includes

Who carries out the assessment and which professionals are included
Whether a written plan and a letter to your GP are included
Whether tests and a home visit are included or charged separately
Whether a tailored exercise programme is included or referred on
How follow-up and review are arranged and charged
What happens if further tests or referrals are needed
The cancellation policy

On the NHS? Falls assessment is available on the NHS when clinically indicated, often through a specialist falls service; private assessment may be used for speed or choice.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Choosing a specialist safely

Check the specialist is on the GMC Specialist Register for this area.
Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good specialist will welcome every one of these.

Which causes of my falls have you found, and which can be treated or improved?
Are any of my medicines increasing my risk, and can they be safely reduced?
Did my blood pressure drop when I stood up, and does that need treating?
What exercises should I do, and can I be referred for a tailored programme?
Should my bone health be checked to lower my risk of a fracture?
When will my falls risk be reviewed, and who do I contact after another fall?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the specialist who carries out my test, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this test not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Is a falls assessment available on the NHS?

Yes. Falls assessment is available on the NHS when clinically indicated, often through a falls service or as part of older people's care. It is also offered privately, which may be quicker.

Why are they looking at so many different things?

Because falls in older people usually have more than one cause. Looking at walking, blood pressure, medicines, eyesight, feet, memory, bones and the home together gives the best chance of finding the things that can actually be changed.

Will my medicines be changed?

Possibly. Some medicines increase the risk of falling. If any can be safely reduced, this will be discussed with you and, where needed, done gradually. You should never stop or change a medicine on your own.

Do the exercises really make a difference?

Yes — well-chosen strength and balance exercises are one of the most effective ways to reduce falls, but they need to be tailored to you and kept up over time to keep working.

I'm afraid of falling and have stopped going out. Can this help?

Yes. Fear of falling is taken seriously in a good assessment. Avoiding activity tends to weaken muscles and increase falls, so part of the plan is helping you regain confidence and stay active safely.

Will they check whether I might break a bone?

Bone health is usually considered, because falling and weak bones together raise the risk of a fracture. If needed, you may be offered a bone scan and treatment to strengthen your bones.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NICE NG249 — Falls: assessment and prevention in older people NICE QS86 — Falls in older people quality standard NHS — Falls Age UK — Falls prevention British Geriatrics Society — Falls and bone health

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.