Summary

In summary, this course covered common risk factors for falls in older adults and examples of recommended assessments. While clinical judgment is important to identify patients who may be at risk for falls, a formal risk assessment will help to identify specific risk factors which should be addressed in an effort to prevent initial or recurrent falls.

A checklist to review risk factors can include patient and caregiver interviews and chart review. Fall history is a strong risk factor for future falls, and a review of past events and interventions should be included in a risk assessment. In addition, diseases or conditions that may be associated with the risk for falls or injuries from falls may include diabetes, cardiovascular disease, neuromuscular conditions, osteoporosis, anemia, cognitive deficits, and others. Psychotropic medications are strongly associated with falls and the risk for falls may increase in the first few days of changes in these medications. Visual impairment or changes in visual acuity can also increase risk. While the use of assistive devices is important to improve balance control, devices that are not well-matched to the patient’s needs and characteristics, or those that are improperly used may increase risk. The fear of falling may cause a patient to alter their activities and lead to an increased risk for falling. And, of course, environmental hazards, such as rugs that slip, uneven surfaces, pets, or other obstacles may be of concern.

Functional and mobility testing can help to identify gait and balance problems. Testing may include tasks such as sit to stand, reaching, turning, walking up steps and curbs. Functional tests allow for the evaluation of balance, including balance during mobility tasks. For instance, maintaining balance while walking and turning. Walking speed during these tests can further help to evaluate patient capabilities.

The musculoskeletal systems can also be assessed for strength, range of motion, and changes in posture or gait. Changes related to pain or other problems can help to establish another set of risk factors. And the complex sensory system that includes vision, vestibular balance, and somatosensory input should be evaluated for targeted interventions, especially if one of the systems is compromised. 

Interventions are generally related to treating fall-related injuries and shoring up any compromised systems or risk factors to prevent recurrent falls. Based on fall evaluation and re-evaluation of risk factors, strategies to prevent recurrence can be implemented. Multifactorial programs may be the most successful strategy and may include patient and caregiver education and counseling, exercise programs to improve strength and balance, medical management of diseases and conditions associated with an increased risk for falls, and a variety of assistive and protective devices to improve balance and protect against injury.

Because of the costs of falls, both to the patient and financially speaking, it is urgent to understand, recognize, and intervene to reduce risk and incidence of falls in our growing older adult population. As the CDC states: “falls are not an inevitable part of aging”, and prevention is possible.  

In order to be awarded CE credit for this course you will need to fill out a course evaluation and pass the post-test with eight or more correct answers in order to receive CE credit.