Falls are a serious concern, especially for older adults, as they can result in significant injury, pain, loss of confidence, and a rapid decline in health and independence. Even minor injuries can have a considerable impact, leading to distress, reduced mobility, and a fear of falling, which can increase the risk of future falls.
In care homes, falls often result in ambulance callouts and hospital conveyance “as a precaution,” adding to pressure on emergency services and causing further disruption for residents. Preventing falls and identifying pain early is therefore critical, not only to protect residents’ wellbeing, but also to reduce avoidable pressure on the ambulance service and NHS.
By improving the assessment, monitoring and subsequent management of pain, care homes have a powerful opportunity to reduce and prevent falls, minimise avoidable ambulance callouts, and improve residents’ quality of life. This is where PainChek®, an evidence-based medical device for pain assessment, plays a critical role.
The hidden connection between pain and falls
Pain in older adults, particularly those living with dementia, is frequently under-detected and misdiagnosed. Residents may be unable to verbally communicate discomfort, and their pain-related behaviours could be mistaken for agitation, confusion or distress.
Research has found that persistent pain doubles the likelihood of a fall and so those with undetected pain are particularly prone to falls and accidents. Persistent pain is also a risk factor for the development of frailty and reduced mobility; two symptoms associated with increased risk of falls. Moreover, falls are particularly dangerous for frail individuals as the likelihood of serious injury is heightened.
Unmanaged pain can directly increase fall risk by:
- Causing changes in gait and balance
- Increasing frailty
- Reducing strength and mobility
- Triggering unsafe and sudden movements due to discomfort
- Leading to over- or under-sedation due to inappropriate medication use
- Increasing restlessness and agitation
When pain goes unnoticed, care staff often respond to the corresponding behaviour rather than the cause, missing the opportunity to prevent falls and other incidents.
The growing pressure of falls and ambulance callouts
Falls are one of the most common reasons for emergency ambulance callouts from care homes. Even when injuries seem minor, uncertainty around pain, safeguarding, or clinical risk often leads to residents being taken to hospital “just in case.” Ambulance callouts have a significant operational, clinical, and emotional impact on care homes, affecting not only the resident involved but also staff, other residents, and the wider service. Below, we outline why this is the case.
1. Disruption to care and staffing
When an ambulance is called, a member of staff must provide one-to-one supervision to the resident while they are waiting – this can often be for hours and will pull staff away from other residents in need. Indeed, data shows that many older people in England have previously waited more than four hours for an ambulance to arrive after having a fall. The one-to-one supervision required whilst waiting can cause rotas to be disrupted and increase workload pressure, particularly in smaller homes or on night shifts where overall safety and care delivery can be compromised.
2. Distress for patients
Ambulance attendance can be confusing and frightening, particularly for those living with dementia. It can lead to heightened anxiety and agitation as well as disruption to necessary routines. The resident who has experienced the fall is often uncomfortable and keeping them still while help arrives can be challenging. This is especially true when a potential fracture or serious injury is suspected, as carers must balance maintaining the resident’s comfort with ensuring they remain safely in one position until paramedics can assess them. Residents witnessing the emergency may also become confused and distressed by the scene.
3. Hospital-related harm
If the resident is conveyed to hospital, they may face delirium and cognitive decline – causing them to return with reduced independence and increased long-term care needs. Residents could also face infection risks from illnesses within the hospital and may suffer from deconditioning and loss of mobility while confined to a hospital bed.
Due to underfunding and fragmentation across the health and social care sectors, the right assessments and care plans often aren’t in place to ensure these increased care needs are met and that resourcing is adequately funded.
4. Operational and financial impact
Frequent ambulance callouts can increase scrutiny on homes from regulators and commissioners and highlight gaps in clinical confidence or assessment processes. They may impact the home’s reputation and inspection outcomes, leading to stress and pressure amongst staff. If increased staffing, paperwork and follow-up care is needed then this may drive costs up and cause the home to struggle financially. Staff can become frustrated when callouts feel avoidable and they are pressured to escalate “just in case.”
Ambulance callouts are disruptive, stressful, and costly for care homes. While some are unavoidable, many can be reduced through better pain recognition and treatment, confident clinical assessment, clear documentation, and proactive care planning, helping residents stay safely at home while easing pressure on staff and emergency services.
On the Care England website, there is helpful advice on how care providers can navigate NHS delays in urgent situations. It emphasises the importance of appropriately using local pathways, requesting clinical re-triage if necessary, involving the GP at an early stage and arranging alternative transport with prior clinical agreement. All these measures are supported by more accurate pain assessment from the outset, that can be completed by any caregiver, regardless of their clinical background. Understanding the presence or absence of pain can help guide the right local pathway.
Why traditional pain assessment falls short
Most conventional pain assessment tools rely on the resident self-reporting their pain, which is not a reliable source for those living with dementia or a cognitive impairment. Traditional pain assessment methods rely on clinical observations of behaviours and are assessment tools only – they do not meet medical device grade. Consequently, they can be inadequate, time-consuming, underused and unreliable.
As a result of using traditional pain assessment methods:
- Pain is typically under-recognised
- Assessments are inconsistent across staff members
- Use is restricted to clinical or senior staff
- Documentation is subjective
- Clinical decision-making is delayed or reactive
Care homes need a standardised, objective and easy-to-use solution that can be used by any caregiver and identifies pain even when residents cannot verbalise it themselves. This is where PainChek® comes in.
How PainChek® supports better pain management
As a regulatory cleared medical device, evidence shows that PainChek® can increase the number of pain assessments conducted and surpasses traditional methods in terms of performance, as it is medical device grade with a high interrater reliability. Its ability to be easily embedded into care routines means that carers can deliver consistent pain management and high-quality care.
Using AI and smart technology, PainChek®:
- Analyses facial expressions using the device’s camera
- Guides carers through behavioural, verbal and physical pain indicators
- Generates a clinically meaningful pain score in seconds
- Creates consistent, objective documentation
- Enables regular pain monitoring over time
This allows care teams to identify pain earlier, intervene appropriately and evaluate the effectiveness of treatments.
Guidance from Care England emphasises that pain should never be overlooked following a fall and advises providers to avoid repeatedly administering PRN medication without further clinical input, as this can mask signs of deterioration. A recent update from the Care Quality Commission offers best practice guidance on PRN protocols and the safe use of these medications. By using a tool such as PainChek®, care providers can more accurately determine whether a resident is in pain following a fall, identify early signs of deterioration and make well-informed decisions about when medication is appropriate.
When pain is managed effectively
When pain is identified and managed in an effective manner, residents are:
- More comfortable during movement
- Less likely to rush, resist care or move unsafely
- More confident with mobility and transfers
- Less prone to sudden behavioural changes linked to discomfort
Here are some real-world examples of how effective pain management has reduced falls in UK care homes:
Orchard Care Homes, a dementia-specialist care home provider with 23 homes across the UK, implemented PainChek® and since then has found a 91% reduction in accidents and incidents and a 20% reduction in falls.
Dovehaven Care Homes carried out a study where residents who experienced frequent falls had their pain levels assessed four times a day using PainChek®. This included residents with leg, knee and ankle pain, as well as those without painful lower body conditions. Within a six-month period, the group saw a 45% reduction in falls, demonstrating the positive impact of effective pain assessment and management.
Dovehaven CEO, Jenny Davies said:
“PainChek® gets to the root cause rather than masking symptoms. For me, PainChek® felt like a truly sustainable solution – enabling people to lead more fulfilling lives in the long-term.
“We’re also seeing a strong correlation between the use of PainChek® and positive clinical outcomes, including a noticeable reduction in falls.”
Jo Hadfield-Cubbin, Head of Clinical Governance said:
“PainChek was utilised to explore its impact on falls reduction. Additional coaching supervisions were delivered, and services with the highest incidence of falls were enrolled in a “four assessments per day” project. I reviewed daily that all residents enrolled in the project received four correctly completed PainChek assessments per day over a 12-week period. Upon completion, falls among participating residents had reduced by 45%. This practice has been sustained and embedded within organisational policy. All newly admitted residents with osteoarthritis are now automatically placed on four daily PainChek assessments until pain is consistently well managed, thereby reducing the risk of falls.”
The Care Inspectorate piloted PainChek® in an independent study conducted by Edinburgh Napier University across 21 care settings in Scotland. Over the initial six-month data collection period, PainChek® was linked to a 42% reduction in falls as well as a 42% reduction in stress and distress. As a result of the pilot, the Care Inspectorate included PainChek® in its Quality Improvement Plan for 2023/24, positioning the tool as a key technology in its three-year quality improvement strategy.
By integrating PainChek® into routine care – such as during personal care, mobility assistance, or post-fall reviews – care homes can proactively address pain before it contributes to instability or risk-taking behaviour.
Preventing avoidable ambulance callouts
Enhanced pain management also helps to support more confident clinical decision-making. With PainChek® staff can:
- Assess pain levels immediately after a fall
- Monitor changes in pain over time
- Provide clear, objective information to GPs, nurses or out-of-hours services
- Demonstrate appropriate assessment and intervention that focuses less on guesswork and more on data-led decision making
This can help to reduce unnecessary emergency escalations by reassuring clinicians that pain is being monitored and supporting on-site management where appropriate. It also helps to streamline and improve documentation for remote clinical advice.
Through use of PainChek®, Belmont Care Home in Southwest London has seen a 36% reduction in incidents necessitating ambulance call outs. Three of Southwest London ICB’s care homes have also seen the rate of conveyance from the home to hospital increase from 74% to 82% with PainChek® due to the fact residents’ pain levels were being accurately measured.
A proactive approach to safer care
Fall prevention is not just about environmental checks or mobility aids, it’s about understanding the resident as a whole and knowing how best to support them. Pain is a key risk factor for falls, and it can no longer afford to be invisible.
By adopting innovative medical devices like PainChek®, care homes can move from reactive crisis management to proactive person-centred care. This will reduce falls, avoid unnecessary ambulance callouts and ensure residents live in greater comfort outside of the hospital.
