Falls are often a turning point in an older person’s life. As nurses, we know the damage a fall can do — not just physically, but emotionally and psychologically. Falls are also one of the leading reasons that older people seek unscheduled health care. We all know how traumatic and fraught with risk an acute admission or Emergency Department attendance can be for an older person, particularly those living with frailty, however falls also have a profound economic impact, with a cost to the government of close to one billion pounds every year. Therefore, there is an urgent need to reduce falls.
But in the rush to reduce falls, are we unintentionally increasing the very risk we’re trying to prevent?
That was the central question I explored in a recent presentation in the 快猫视频 OPF Frailty Matters webinar titled Fall proofing Frailty: A Balancing Act in Prevention. My background in care home nursing, and care of older people generally, has taught me that falls and frailty are not just linked — they’re entangled in a vicious cycle. Frailty increases the risk of falls, and falls can accelerate frailty. This bidirectional relationship means we cannot effectively address one without addressing the other.
Frailty is often misunderstood. It’s not just about getting older and It’s not a normal part of ageing. It’s a life-limiting syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Crucially, frailty is both preventable and, in some cases, reversible.
Too often, traditional falls prevention strategies focus on risk aversion: no unsupervised walking, restricted mobility, bed and chair alarms. Strategies that I have learned throughout my career and have used time and time again throughout my career also. While well-intended, these measures can reduce an older person’s confidence, limit physical activity, and lead to deconditioning — all of which worsen frailty and, paradoxically, increase the long-term risk of falls.
To truly reduce falls, we must fall proof frailty.
In my presentation, I used mnemonics I have developed to illustrate how we can better understand and intervene — BINGO and LOSE. The first, BINGO, helps identify the signs and symptoms of frailty:
- B – Balance problems: For example falls, unsteadiness, impaired mobility, postural instability
- I – Incontinence: Loss of bladder or bowel control is frequently associated with frailty
- N – Nutrition: Malnutrition, unintentional weight loss, decreased appetite
- G – Gait speed reduced: A slowed walking speed isn’t just a mobility issue; it’s an established marker of frailty and a predictor of adverse outcomes
- O – Overall decline: Generalised weakness, slowing, fatigue, sarcopenia, decreased exercise tolerance.
In practice, if we encounter an older person who wins this game of BINGO, chances are they are living with frailty. But frailty doesn’t appear overnight. It develops gradually, through the accumulation of deficits over time. I used a second BINGO — this time to illustrate how frailty develops:
- B – Burden of disease: Chronic, long-term conditions that are common in older people e.g. diabetes, COPD, heart failure and arthritis contribute to cumulative physiological stress
- I – Inflammation: Chronic low-grade inflammation (sometimes called ‘inflamm-ageing’) accelerates muscle loss, immune dysfunction (immunosenescence) and vulnerability to stressors
- N – Nutrition deficits: Whether due to poor appetite, dental issues, isolation, or poverty, inadequate calorie and protein intake is a key driver of sarcopenia and unintentional weight loss
- G – Gradual inactivity: Reduced physical activity contributes to losing strength, impaired balance and decreased confidence, creating a downward spiral of deconditioning, muscle loss and impaired endurance
- O – Organ decline: The age-related decline in multiple organ systems, for example cardiovascular, renal or neurological systems, reduces resilience and homeostatic reserve.
So how do we respond?
We need to shift from solely reactive, risk-averse approaches to proactive, strength-based strategies. We need to help people at risk of or living with frailty LOSE BINGO:
- L – Lifestyle interventions: A focus on healthy eating, strength and balance exercises, good sleep, hydration and alcohol/smoking cessation
- O – Occupational engagement: Purpose matters. Hobbies, roles and routines support mental wellbeing, cognitive function and motivation to stay active
- S – Strength and stamina: Structured exercise programmes — even simple resistance bands or sit-to-stand practice — can significantly improve physical function and reduce fall risk by improving strength, balance and stamina
- E – Early identification: Screening for frailty allows us to intervene early, before people reach the tipping point into significant decline.
In practice, this means changing how we think and talk about falls and frailty. It means reviewing whether the falls prevention measures we use are enabling or disabling independence and physiological resilience. It means advocating for frailty screening in all older adult services. And it means empowering care home and community staff with the tools and confidence to support all older people to LOSE BINGO.
Fall proofing frailty is not about ignoring fall risk — it’s about reframing it. It’s about seeing frailty not as an inevitable slide, but as a condition we can understand, detect and often influence. It’s about not viewing falls and frailty as separate silos, but as two interlinked conditions. It’s about recognising that by focusing on frailty we could more meaningfully reduce falls, alongside the myriad of other benefits associated with stopping frailty in its tracks. As nurses, regardless of the setting we practice in, we are in a prime position to do just that.
Let’s stop asking how we can just stop older people falling. Let’s start asking how we can make them stronger, more confident, and more resilient, which will in turn, reduce their risk of falling. Let’s help them LOSE BINGO.
