Notes

Fall Risk Assessment for Older Adults
Falls in older adults can have severe consequences, including a hip fracture that leads to prolonged hospitalizations and nursing home placement. Fall prevention can significantly reduce morbidity and mortality.

Clinical guidelines recommend that primary care clinicians screen for falls and assess for modifiable underlying risk factors in every older patient visit. Several assessment tools are available.
Age

Fall-related injuries are a serious concern for older adults, and most falls result in some sort of injury. These injuries can range from mild bruising to broken bones, and in severe cases, even death. Many older adults assume that falling is just a part of getting older, but most falls are predictable and preventable.

A comprehensive fall risk assessment can help identify underlying factors that contribute to falls and recommend interventions that can reduce the chances of a fall. Typically, these assessments are performed by healthcare or aging-in-place professionals and include a functional assessment, gait and balance assessment, and exercise evaluation. Other recommendations may include medication management, footwear assessment, vitamin D supplementation, and referral to a physical therapist.


Most guidelines recommend a simple fall screening questionnaire with emphasis on the most common risk factors. They also recommend reserving gait and balance tests for those who screen positive. Several of the reviewed guidelines also provide risk stratification algorithms for identifying individuals at higher fall risk, but the sensitivity of these methods is not known.

The bottom line is that it is critical for healthcare providers to ask about fall history and assess the risks of their patients. By doing so, they can reduce the risk of serious injury and help their patients live independently for as long as possible.
Physical Condition

Fall-related injuries often result in hospitalization and disability. Patients hospitalized for falls are at risk of subsequent mortality and a decreased rate of return to baseline function. Falls can cause a loss of independence and a lack of confidence in the ability to continue living at home and lead to social isolation.

Multiple clinical practice guidelines recommend that all adults over the age of 65 should undergo a fall screening. The majority of these guidelines also recommend a multifactorial assessment that addresses intrinsic factors (eg, gait/balance, vision, cognitive functioning) and environmental or exercise interventions.

However, there are barriers to implementing effective fall screening and prevention. The reluctance of many patients to volunteer information regarding falls and fear of falling is one of the most significant barriers. This results in a gap between recommended and actual fall screening and preventive interventions.

To improve the quality of fall risk assessments, clinicians should use a tool that provides an objective and reliable measure of each patient's unique risk for falling. Such a tool should be integrated into the electronic health record to increase the frequency and accuracy of assessments, allow for detection of changes in condition that are related to fall risk, and support the development of holistic and cross-continuum care plans that foster safe mobility. A tool that measures movement during structured exercises (eg, 30-second chair stand test or four-stage balance test) has been shown to be an accurate and cost-effective method of assessing fall risk.
Medications

Many older adults are taking multiple medicines and it is not unusual for some of these medications to increase the risk of falling. A comprehensive medication review is a key component of a fall risk assessment.

It is important to note that a single fall can lead to serious injury such as broken bones and head trauma [Moreland, 2020]. As a result, falls are considered the leading cause of death in people age 65 or over [CDC].

In the US, Medicare requires all Part B enrollees to attend an annual wellness visit where their fall risk is assessed. This assessment includes a discussion of current medications and a home safety check to identify potential hazards. Additionally, private health insurance can cover the cost of a home assessment by a physical or occupational therapist and some non-profit organizations offer this service for free.

A number of fall-risk screening tools have been developed but it is important that the tool is tailored to the population and setting in which it will be used. For example, the FRAST screen has been designed for use in primary care by including only 4 risk items other than medicines (the original Morse Fall Score had 37). The list of high fall-risk medicines was developed basing on statutory medicines information presented in the summaries of product characteristics approved by EU authorities.
Lifestyle

A person's lifestyle factors can increase his or her risk for falling. This includes having a history of falls, fear of falling, poor diet and hydration, avoiding physical activity, and taking certain medications, particularly psychoactive drugs like antipsychotics and tranquilizers. The environment can also play a role; people living in one-story homes or apartments are at greater risk for falls than those who live in high-rise buildings.

Fall-related injuries can cause pain, fractured bones, head trauma and death. They can also impair mobility and limit independence, which increases the risk of a future fall. Many older patients do not report falls to their physicians, due to embarrassment, fear of losing their autonomy or other reasons. However, unexplained bruises and changes in cognition and balance can signal a fall.

A fall risk assessment is a tool used by healthcare professionals to determine whether a patient's risk of falling is low, moderate or high. It takes into account the patient's age, physical condition, medications, home hazards and a brief cognitive test. The assessment can be done by a healthcare or aging-in-place professional, and can include a 30-second chair stand test, a Timed Up and Go (TUG) test to measure gait speed (in which the patient sits in a chair, stands up and walks 10 feet at their usual pace then returns to the chair), and a four-stage balance test. fall detector for elderly

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