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Preventing Falls: Understanding Fall Risk Assessments For Seniors

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Did you know that 3 million older people go to the hospital due to fall-related injuries? Every year, over 800,000 people are hospitalized for a fall. Additionally, if a person has a  history of falls, this puts them at an increased risk for future falls

Unfortunately, falls can potentially lead to: 

  • Broken Bones

    • Hip fractures

      • The CDC says 300,000 older adults are hospitalized for a hip fracture a year! 

  • Traumatic brain injuries may lead to confusion

  • Isolation due to concern of future falls

  • Neglecting activities of daily living

  • Hospitalization or Nursing Home admission

Preventing your loved one from falling is the best way to avoid injuries. Fall risk assessments are great for preventing falls from happening in the future. 


Where and Why do Falls Occur?


Fall incidences increase with age which puts older adults at a higher risk. The reason for this, however, is multifactorial

Some factors that put an older person at an increased risk of falling include:


  • Side effects of medications

  • Medical conditions such as osteoporosis or orthostatic hypotension (low blood pressure when standing)

  • Balance Problems

  • Visual Impairments

  • Cognitive Impairments

  • Hazards in the home, such as loose carpets or wires


Medication reviews and an environmental assessment are key parts of the assessment and risk factors

Some medications, especially antidepressants and psychotropic drugs may cause unsteadiness. Diuretics may increase the need for a person to try and quickly go to the bathroom. When someone has to get up quickly, or if the bathroom is too far away, a person may fall from trying to move too quickly. 


What's The Impact Falls Can Have?

Not all falls cause injuries. However, seeing as the risk of falls increases after one fall, it’s important to determine the reason for your loved one falling sooner than later

Unfortunately, more than half of older adults do not alert their primary care physician or other providers when they fall. So be sure to inform your loved one’s doctor about their most recent falls if applicable.

According to the Centers for Disease Control and Prevention (CDC), the fear of falling can lead to an individual isolating themselves from their day-to-day activities in an attempt to avoid a fall.

Falls can occur within any care setting and can impact both community-dwelling older adults, as well as older adults who may reside in a nursing home.

For older adults, falls can have a drastic impact on their quality of life. A fall risk assessment examines all risk factors to determine the older adult’s risk of falls, and which interventions may reduce their risk of falling in the future.


What Does A Fall Risk Assessment Involve?

Fall risk assessment tools examine the possible causes of a fall and how they pertain to an individual. 

A fall risk assessment will look at the risk factors to determine how high of a risk someone is at for falling - and typically mark them as low, moderate, or high. Depending on the older adult’s deficits, the provider will provide suggested interventions.

A fall risk screening is generally completed by a person’s primary care physician or a physical therapist. Two different screening tools that the clinician may complete are the STEADI Test from the CDC and the Timed Up and Go test. While there are slight differences , both tests aim to provide interventions based on a well-rounded assessment.

The first part of the assessment generally includes general questions. If a person responds positively to either of the questions, the provider will proceed with the assessment. 

  • Have you had recent falls? 

  • Any feelings of unsteadiness? 

Previous falls are the greatest predictor of future falls.

If the patient has not responded positively to either of the questions, the health care provider generally provides fall education resources and will reassess at the next appointment. 

Afterwards, a physician will review the patient’s medical conditions, both cognitive and physical. They may look for things such as:

  • Physical Pain

  • Balance issues

  • Medications and their side effects & interactions

  • Visual assessments

  • Cognition

A physician will also assess the patient’s gait and steadiness through a balance test.They may also conduct a postural screening, which will look at the patient’s alignment. 

The physician may provide the patient or family member with a home safety checklist to complete at home. The checklist will identify environmental factors that may put a person at a higher risk of falling

 A home safety checklist may include fall risk factors such as: 

  • Loose carpets

  • Extra furniture blocking pathways

  • Stairs

  • Wires 

  • Long distances to and from the bathroom or phone

The CDC offers an at-home safety checklist which is a great resource for caregivers to add to their caregiving toolkit. This checklist can be found at:https://www.cdc.gov/steadi/pdf/check_for_safety_brochure-a.pdf


What Happens After the Assessment?

Depending on the results of your loved one’s fall risk assessment, the provider will likely make intervention recommendations. Below are some suggested interventions based on risk level according to the CDC.


Low Risk:

    • Fall Prevention Education

    • Supplements such as Vitamin D

    • Strength and balance training- the provider may offer resources on finding classes 

Moderate Risk:

    • All things suggested to a low risk individual along with,

    • Referral to physical therapy (PT) 

    • Participation in a fall risk prevention program

High Risk:

    • All of the low risk and high risk interventions as well as:
      • Management of physical pains

      • Review of medications

      • Visual aides

      • A formal in-home assessment (often completed by a physical therapist or occupational therapist) 

What Resources Are There For Fall Risk Assessments?


Many local senior centers or community centers offer strength and balance classes on a regular basis. They may also offer more formalized fall prevention programs. A provider may be able to point you and your loved one to local resources. If in-person classes are not possible, there are virtual fall prevention programs as well. 

Medication reviews and an environmental assessment are key parts of the assessment and risk factors

A fall risk assessment is not a definitive predictive tool of a person’s fall potential and because of this, an older adult should be routinely reassessed. 

Clinicians should also assess if suggested interventions are accessible to your loved one, or if there are barriers. These interventions are key to reducing the chance of falls, especially for those who have experienced a fall in the past year


What To Know About Working with a Physical Therapist Following a Fall Risk Assessment


Following a fall risk assessment, an older adult may be referred to a physical therapist. The physical therapist may provide exercises to improve balance and strength that can be done both in the office with the therapist, as well as at home. 

The physical therapist will also assess for adaptive devices including:

  • Appropriate footwear

  • Devices such as walkers or canes

The suggestions from the physical therapist will be documented as part of your loved one’s care plan and will be shared (as appropriate) with their  caregiver

For some older adults, it may be difficult to follow through with recommendations on their own and they may require the support and encouragement from you as their caregiver


Need Additional Fall Safety Tips?


While preventing your loved one from falling is always the goal, there may be circumstances when a fall happens anyways. Because of this, automatic fall detection devices, or even video cameras in some circumstances, can make sure your loved one gets the help that they need as soon as possible after a fall.

Working with your loved one’s healthcare professional team can help you understand their specific risk factors for falling and how best to intercede.

Laurel McLaughlin

Laurel McLaughlin has over a decade worth of experience in various sectors of the elder care field- home care, senior living, and non-profits. She has a Master’s in Gerontology and is a certified dementia practitioner.

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