For Healthcare Providers

Have You Identified Your Patients at Risk for Falling?

As a healthcare provider, your patients trust and depend on you to treat their health conditions as well as to help prevent them. Familiarizing yourself with the factors that put your patients at risk for falling will help you to identify patients at risk for falling and prescribe a program that is tailored to their needs.

Falling is often the result of many complex and interconnected risk factors. Risk factors for falling can be internal or external.

Risk Factors

Internal Risk Factors Considerations
Cardiovascular Dysrhythmias
Neuromuscular Lower-extremity weakness, loss of movement, functional decline, hypotension, CVA, Parkinson’s, stroke, neurological disorders, seizure disorder, syncope, unsteady gait, chronic/acute conditions
Orthopedic Joint pain, arthritis, hip fracture, limb amputation, osteoporosis, foot disabilities
Perceptual Impaired hearing/vision, somatosensory deficits/neuropathies, dizziness/vertigo
Psychiatric or cognitive Delirium, cognitive decline, dementia, Alzheimer’s disease, depression, wandering, confusion/disorientation, fear of falling
Medication side effects Hypotension, muscle rigidity, impaired balance, extrapyramidal symptoms (tremors, uncontrolled movements), decreased alertness
External
Risk Factors
 Considerations
Medications Anti-hypertensives, diuretics, laxatives, anti-psychotic agents, antihistamines, tranquilizers, narcotics, hypnotics, H-2 blockers, proton pump inhibitors, anti-diabetic agents, anti-coagulants, aspirin and other non-steroidal anti-inflammatories
Appliances and devices Pacemaker, assistive devices, restraints, poorly fitting wheelchair
Environmental hazards Glare, poor lighting, slippery floors, uneven surfaces, foreign objects, patterned carpets, reaching, incontinence, crowded area
Other Suboptimal care, fall in last 30 days, multiple diagnosis, history of falls, sleep disorders

 

Reducing falls in older adults often require multifaceted interventions in order to be successful. Additionally, a program should also be tailored to the patients’ needs because risk factors vary among patients.

Prior to prescribing a fall prevention program, it is recommended that healthcare professionals complete a falls assessment on their patient. Please refer to the Tools page to access resources commonly used to aid with a fall risk assessment. Additionally, the Guideline for the Prevention of Falls in Older Persons, published by the American Geriatrics Society is useful resource for healthcare providers.


Recommended Intervention Strategies

  • Download STEADI toolkit from CDC that contains handouts, special tests and case studies about fall injury prevention
  • Perform a falls risk assessment on patients annually.
  • Recommend patients begin an exercise and strength training program.
  • Review medication and side effects with patients.
  • Recommend patients modify their home environment and personal risk factors.
  • Counsel patients about risk factors for falling and how to reduce their risk.
  • Some patients may benefit from protective devices (hip pads), which can be used to prevent hip fractures if a person
  • does fall (be aware that hip pads are often associated with low compliance rates among patients).
  • Remind patients that additional calcium and vitamin D intake (via dairy or supplements) is important to prevent bone loss or reduce fracture risk.
  • Referrals to specialists (Physical Therapists, Occupational Therapists, etc.) if necessary.
Risk Factors  Considerations
Postural hypotension:
a drop in systolic blood pressure of >20mmHg or <90mmHg

Behavioral recommendations such as ankle pumps or hand clenching and elevation of the head on the bed

Decrease dosage of a medication that may contribute to hypotension: if necessary, discontinuation of the drug or substitution of another medication

Pressure stockings

If indicated, fludrocortisone (Florinef), in a dosage of 0.1mg two or three times daily to increase blood pressure. If indicated, midodrine (ProAmatine), in a dosage of 2.5 to 5mg three times daily to increase vascular tone and blood pressure

Use of a benzodiazepine or other sedative-hypnotic drug

Education about appropriate use of sedative-hypnotic drugs

Nonpharmacologic treatment of sleep problems, such as sleep restriction

Tapering and discontinuing of medications

Use of four or more prescription medications Review of medications
Environmental hazards or falling or tripping Home safety assessment with appropriate changes
Any impairment in gait Gait training
Any impairment in balance or transfer skills

Balance exercises and training in transfer skills, if indicated

Environmental alterations, such as installation of grab bars or raised toilet seats

Impairment in leg or arm muscle strength or range of motion (hip, ankle, knee, shoulder, hand or elbow) Exercises with resistive bands, putty resistance training two or three times a week, with resistance increased when the patient is able to complete 10 repetitions through the full range of motion

 

Special Considerations for Emergency Department (ED) Personnel and EMTs

Many senior adults do not have a medical home and rely on ED personnel and EMTs as their first line of defense after a fall. This provides a unique opportunity to provide counseling and preventive services to senior adults who otherwise may not receive information about fall prevention. Listed below are simple steps ED personnel and EMTs can take to help prevent falling in senior adults.

  •  Make written fall prevention information available to your patients. Patient education via written advice is found to have a positive effect on patient recall and behavior change. Furthermore, directly providing this information to each patient who suffers a fall or is at risk for a fall is an effective way to manage time constraints often seen in the ED or while responding to 911 calls. It is also a good way to reinforce what was said to the patient about fall prevention. SAFE brochure
  • Perform a Falls Risk Assessment on the Patient. It is important to identify as many senior adults who are at risk for falling as possible so they can receive appropriate follow up care. The U.S. Preventive Services Task Force recommends fall screenings to take place in the ED; doing so significantly reduced the risk of falls among senior adults screened in the ED.
  • Make referrals for in-home care and for specialty physician care.Falls are most likely to happen at home and it is important to reduce those hazards. Additionally appropriate referrals to specialists (physical therapists, occupational therapists, optometrists, neurologists, etc.) are an effective way of reducing falls in ED patients and patients who have called the paramedics.

Web Information References

To access references for information found on this website, please visit the References page.