Instructions
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Risk Assessment
Age >65 years
Visual
impairment
Imbalance,
unsteady gait, weakness, other mobility problems
Disorientation
and psychotropic medications, including polypharmacy
Environmental
hazards
Reliance on
assistive devices (crutches, cane, walker, etc)
Because older adults are more at risk for falls, healthcare professionals should routinely ask about fall history in this population. Have they fallen in the past year? And, if so, what circumstances led to the fall? If there was more than one fall, details should be collected on each. Most falls occur during walking and more than half are due to tripping. Risk assessment for falls includes two things: evaluating the patient against a list of risk factors and an assessment of physical conditions that could lead to a fall, such as balance and gait.
Risk Screening To assess fall risk, rehabilitation therapists, nurses, doctors, other health care professionals, and the patient and their family should all provide input. A checklist of other tools may be used and often includes information on general demographics, physical condition (including vision or hearing impairments), mental status, medications, and any ambulation devices that may be used.
Specific risk factors used in shortened and validated risk assessment tools may include:[6] [7] [8] Age over 65 years History of falls Visual impairment or alterations in vision Imbalance, weakness, or unsteady gait Changes in mobility, the ability to transfer from bed to a chair Disorientation, inability to understand instructions, or impaired judgment or memory Polypharmacy (4+ medications and/or drugs associated with cognitive impairment) including the use of diuretics, hypotensive medications, and especially central nervous system suppressants Environmental hazards (poor lighting, pets, uneven floor surfaces, bed and toilet height, etc.) Reliance on a cane/crutches/walker, wheelchair, braces or other assistive devices
Additional risk factors include:
A lack of routine physical activity
and muscle weakness The inability to break the impact of a fall History of stroke, Parkinson's disease, or other neuromuscular disease Urinary incontinence and other factors that can lead to a general decline in health
If the patient has a history of falls, or if they have not yet fallen but have an abnormal gait or balance problems, a multi-factorial assessment should be provided that includes looking for: Gait, balance, and/or mobility issues Muscle weakness and/or lack of routine physical activity A history of osteoporosis and anemia A mismatch between the patient’s perceived functional ability and their actual capability Fear of falling Visual impairment, or a recent change in visual acuity Cognitive impairment or neurological deficits Urinary incontinence Hazards in the home setting
Practical Assessment Several risk factors can be assessed by nurses or other medical professionals. Balance assessments can be conducted to assess the patient’s risk for falls related to balance. While the eyes, inner ears, joints, muscles and skin provide sensory information that the brain uses to assess balance and prevent falls, this complex system is difficult to assess, requiring a multi-faceted approach. Balance assessment is an important part of an initial evaluation and when a balance deficit is suspected. There are four parts to a balance assessment: * subjective assessment * functional mobility and gait assessment * musculoskeletal evaluation * assessment of movement strategies and sensory systems used for balance
[6] Brians LK et al. The development of the RISK tool for fall prevention. Rehabilitation Nursing. 1991;16:67-69. [7] Papaioannou A et al. Prediction of falls using a risk assessment tool in the acute care setting. BioMed Central Medicine. Available at: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=333435&blobtype=pdf. [8] Missouri Alliance for Home Care. Home Care Fall Reduction Initiative: Risk Assessment Screening Tool. Available at:
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