Around a third of people aged 65 and over, and half of those aged 80 and over, fall at least once a year. A serious fall can look sudden, but often it's a culmination of vulnerabilities that have compounded over several months, or even longer. Strength declines, balance changes, pain alters how someone moves, and everyday activities become harder. Alongside those musculoskeletal (MSK) changes, some people also experience symptoms like dizziness, medication changes, cognitive decline or fear of falling. Together, they can describe growing vulnerability.

Falls affect the whole health system, with around 210,000 emergency admissions in those aged 65 and over in England related to falls in 2022/23. Fragility fractures cost the UK an estimated £4.4bn a year, with hip fractures accounting for an estimated 1.8m hospital bed days and £1.1bn in hospital costs each year.

Once someone arrives in accident and emergency after a fall, more often than not, the telling signs of frailty have been there for months. Struggling with stairs, a near fall, a request for a grab rail or a relative saying someone has stopped walking to the shops matter more when viewed together.

With an ageing population that continues to grow, no health system has successfully found a solution. The NHS 10-Year Health Plan committed to a shift from sickness to prevention. Falls, especially in the frail and elderly, are a prime example of where that could be put into action, with earlier visibility and detection indicating when sooner intervention could reduce the likelihood of a fall or prevent it altogether.

Finding the pattern before the fall

A single interaction is unlikely to be enough to identify where a fall intervention is required. Similarly, a GP, physiotherapist, community team and social care professional will all be responding appropriately to the issue that presents to them, but this is usually only one part of a much wider picture, purely because the health system isn't optimised to connect those different interactions, observations and perspectives. Consequently, patterns become obvious only when those siloed elements are viewed together as a holistic, complete picture.

There are some systems in place trying to address the issue; routine health data already helps services identify frailty and, since 2017, GPs have used tools such as the electronic Frailty Index (eFI) to identify older people who may be living with moderate or severe frailty. International guidance also recommends proactively asking older people about previous falls. The opportunity is to use these signals effectively without adding another manual task for stretched teams.

A serious fall, especially one resulting in a hip fracture, can lead to surgery, rehabilitation and readmission. Sadly, between 18% and 33% of people die within a year of a hip fracture, and around one in five move into long-term care; inpatient care in the year after a hip fracture costs an average of £14,642 per patient. On an individual level, the loss of confidence and independence comes at a real personal cost.

By the time those costs appear on a hospital ledger, the opportunity for prevention may have been months earlier and somewhere else in the pathway.

How AI can help close the prevention gap

Medicine often uses combinations of biomarkers to understand what is happening before the clinical picture is obvious. Falls have no dedicated biomarker test, but signs and symptoms of declining resilience can provide early evidence of frailty.

NICE advises against using falls risk prediction tools to predict an individual's likelihood of falling. However, AI can help services organise information, identify combinations of established risk factors and prioritise people who may need earlier assessment, which increases the window of opportunity to notice the signs and act upon them.

We use structured digital assessment in MSK care to gather clinical history, symptoms and functional information before a clinician sees the patient, helping services prioritise urgency and route people towards the right care. This means we can view worsening pain, reduced mobility, difficulty rising from a chair and fear of movement in context and as part of a bigger picture, rather than as a series of isolated complaints.

Giving clinicians a clearer picture of a person's physical health sooner can support clinical judgement and direct people towards the support they need while they are still living independently at home. Evidence for exercise programmes has shown a 23% reduction in fall rates among older people living in the community. Together, this means clinical capacity can be used more effectively and appropriately, so anyone who needs professional assessment is prioritised while others can be supported through self-management.

A serious fall should not be the moment the health system acts. Better use of digital triage and existing data can draw attention to where support and attention is needed, giving professionals more opportunity to intervene before declining strength, confidence and independence become an emergency admission.

For healthcare leaders, prevention starts with seeing the pattern while there's still time to change it.