Notes

Fall Risk Assessment Tool for Elderly People
Fall risk assessment is a vital part of preventing falls in older people. Fall-related injuries can lead to loss of independence, hospitalization, injury-related death and increased use of health care services.

Currently the most suitable way of identifying high fall risk among community-dwelling older people in primary care involves asking about their falls history. This requires little time and effort, is low cost and does not require specialised equipment or training.
Physical Function

As an individual gets older, physical functioning may decline and this can contribute to falls risk. A fall risk assessment tool focuses on identifying specific factors, such as depressive symptoms, polypharmacy or balance and gait problems that can be mitigated. This is especially important when assessing individuals on hospital admission as well as in residential care settings.

alarms for seniors Health care professionals use a number of tools to assess an individual’s fall risk. These include tests that measure strength, balance and gait (the way an individual walks). They also ask questions about the person’s history of falling. They might even ask if the person has had any recent injuries or if they have been hospitalized for a fall in the past year.

The most commonly used tool is the 30-second chair stand test which involves sitting in a chair and then standing up and walking forward for 30 seconds at a normal pace. Another is the Timed Up and Go test which measures an individual’s ability to move from a seated position to a standing one and then back again in a given amount of time. Other tests are more focused on measuring balance and involve holding different positions for up to a minute at a time, such as the four stage balance test. These tests are often done with a nurse or physiotherapist who will monitor the results and can make recommendations for further assessment and intervention.
Mental Health

Fall risk is multifactorial, and it is important to understand how an individual’s mental health can affect their falls. Depression is a common condition in older adults, and this can be exacerbated by certain medications. In addition, people with cognitive decline are at increased risk for falling. This can be due to underlying conditions such as dementia and delirium or a combination of these and other factors. A thorough assessment by a health professional can help identify any potential mental health issues and provide treatment or referral as needed.

A comprehensive assessment is best done by an interprofessional team, with nursing staff often performing the screening. A patient could then be referred to various professionals such as a social worker, dietician or physical therapist, depending on the findings of the assessment. Often these assessments result in changes to a person’s lifestyle, such as wearing shoe inserts or taking an antidepressant. In other cases, an individual might be referred to a physiotherapist for exercise and balance training, incontinence management or medication review.

A variety of assessment tools have been developed, including checklists of risk factors and numerical indexes. However, a recent study found that none of these tools have good predictive performance, so it is important to use clinical judgement to determine whether an individual’s fall risk is high. This approach is particularly useful in primary care, where it can be performed with minimal time, equipment and space.
Social Support

The physical risks of falling are often influenced by factors that cannot be changed, such as age and muscle weakness. But there are also social and environmental risk factors that can impact an individual's fall risk, such as poverty and a lack of community connection. These can also lead to poor nutrition, a lack of exercise and the use of medications that increase the risk of falls, such as psychoactive medicines.

Using a clinical assessment tool, healthcare providers can determine an individual's level of risk and develop a management plan of care to reduce the risk of future falls. Currently, healthcare professionals can assess their patients' fall risk using tools such as the 30-second chair stand test and the four stage balance test which requires the individual to hold each position for 10 seconds.

The FROP-Com screen and the more comprehensive FROP-Com multifactor fall risk assessment definition and scoring options offer an alternative to single-item screening tools, enabling healthcare professionals to identify individuals at high fall risk with greater confidence. However, these tools are unable to accurately predict a patient's risk of falling. This is due to the multifactorial etiology of falls, which makes it difficult to accurately predict risk with a simple screening tool. This is why it is vital that healthcare professionals take the time to assess a patient's history, current health and function and other risk factors to provide an accurate diagnosis of their fall risk.
Environment

Considering the number of people living in the community with multiple fall risk factors, there is a need to develop screening tools that can identify those at high risk for falls. These tools should allow healthcare professionals to assess the person’s home environment and their ability to manage hazards in the environment based on individual needs. These assessments should be integrated with clinical judgement.

This is especially important since it is estimated that up to half of all fall-related injuries are due to environmental factors. Assessment of fall risk must go beyond the ageist bias that assumes all older adults are at high risk of falling simply because they are older. The assessment must be complete and include not only physical function but also mental health, social support and underlying causes of gait/balance dysfunction such as depression or polypharmacy.

The most suitable tool for identifying a person’s risk of falling in primary care settings seems to be asking about their falls history. This is easy to do, requires no equipment and has good predictive performance (AUC>0.7). It is also a useful tool for determining the need for further assessment and intervention. Moreover, it may help healthcare professionals decide whether to screen a patient for Medicare’s incentive-based reporting program that comes into effect in January 2015. The program will result in a 1.5% reduction of Medicare reimbursement to non-participating providers.
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