How do you assess for high fall risk?

According to the CDC, over one in four adults age 65 and older fall each year, with many falls causing serious injury. Knowing how do you assess for high fall risk is the critical first step toward prevention and helping seniors maintain their safety and independence.

Quick Summary

Assessing for high fall risk is a multifactorial process that includes initial screening questions, physical performance tests like the Timed Up and Go and Chair Stand, a comprehensive medication review, and an environmental safety check to identify potential hazards.

Key Points

• Screening is Step One: Start with simple questions about fall history, unsteadiness, or fear of falling to identify those who need further assessment [2].

• Use Performance Tests: Objective tools like the TUG and 30-Second Chair Stand assess physical functions like mobility, balance, and strength [2, 6].

• Review All Medications: Many drugs can increase fall risk and require a comprehensive review by a healthcare professional [3, 6].

• Check the Environment: A home safety check can reveal simple but effective modifications to lighting, flooring, and clutter to reduce hazards [3].

• Multifactorial Assessment is Best: A high fall risk is often caused by multiple factors, so a comprehensive evaluation is most effective [3, 4].

• Tailor Interventions: Assessments should lead to personalized action plans, including exercise, medication adjustments, or home modifications [2, 4].

• Know the Factors: Intrinsic factors like vision and chronic disease, along with extrinsic factors like home hazards, all play a role in increasing fall risk [3, 4].

The Multi-Layered Approach to Fall Risk Assessment

Assessing a person's risk of falling is a comprehensive process that looks at various factors. Healthcare professionals often use a systematic approach, such as the CDC's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative, which involves screening, assessing, and intervening. This process moves beyond a single test to build a complete picture of an individual's fall risk profile.

Step 1: Initial Screening and Patient History

The assessment begins with screening questions to identify individuals who may need a more in-depth evaluation [2, 6]. These questions are key to understanding a person's history and fear of falling:

• Have you fallen in the past year? [2]
• Do you feel unsteady when standing or walking? [2]
• Do you worry about falling? [2]

A 'yes' to any of these warrants a more detailed assessment [2]. A full fall history should be taken, including the number of falls, circumstances, resulting injuries, and whether the person could get up afterward [3, 4].

Step 2: Physical Performance-Based Tests

Objective, performance-based tests are a core part of a high fall risk assessment, providing measurable data on balance, gait, and strength. The CDC recommends several key tests [2].

The Timed Up and Go (TUG) Test

The TUG test measures mobility by timing how long a person takes to stand from a chair, walk 10 feet, turn, walk back, and sit down [2, 6]. A score of 12 seconds or more suggests a high fall risk [2].

The 30-Second Chair Stand Test

This test assesses lower body strength by counting how many times a person can sit and stand from a chair in 30 seconds [2, 6]. A low score indicates weakness, a major contributor to fall risk [2].

The Four-Stage Balance Test

This test evaluates static balance by having the person hold four progressively challenging positions. Inability to hold a tandem stance for 10 seconds or stand on one foot for 5 seconds indicates a significant balance deficit [2].

Step 3: Comprehensive Medication Review

Many medications can increase fall risk due to side effects like dizziness or sedation [3, 4]. A thorough review of all medications, including prescriptions, over-the-counter drugs, and herbal supplements, is essential [3, 6]. Medications commonly associated with falls include psychoactive drugs, antihypertensives, and diuretics [3]. Adjusting or discontinuing medications in consultation with a healthcare provider can lower fall risk [3].

Step 4: Assessing Environmental Hazards

Environmental hazards contribute to falls in older adults [3]. An assessment identifies and helps modify risks such as clutter, loose rugs, poor lighting, slippery floors, and lack of handrails [3]. Simple home modifications can significantly impact safety [3].

Step 5: Clinical Risk Factor Evaluation

A complete assessment includes evaluating individual health conditions that increase risk [3, 4]. This involves reviewing medical history and a physical examination focusing on intrinsic factors [3, 4].

Common intrinsic risk factors include:

• Vision problems [3, 4]
• Chronic illnesses like Parkinson's or arthritis [3]
• Orthostatic hypotension [3, 4]
• Musculoskeletal issues [3, 4]
• Cognitive impairment [3, 4]
• Vitamin D deficiency [3]
• Fear of falling [3]

Comparison of Common Assessment Tools

Tool	Primary Focus	Best Used For	Key Assessment Areas
Timed Up and Go (TUG)	Mobility & Gait Speed	Quick screening for functional mobility issues.	Time to rise, walk 10 feet, turn, and sit.
30-Second Chair Stand	Lower Body Strength	Assessing leg strength and endurance.	Number of sit-to-stands in 30 seconds.
4-Stage Balance Test	Static Balance	Identifying balance deficits.	Ability to hold feet in various positions.
Morse Fall Scale (MFS)	Comprehensive Risk Score	Acute care settings.	Fall history, secondary diagnoses, gait, mental status, ambulation aids, IVs [5].

Tailoring Interventions Based on Assessment

A personalized intervention plan is created based on identified risks [2, 4]. This might include targeted exercises, medication adjustments, or home modifications [2, 4]. Ongoing monitoring is crucial as risk factors can change [4]. The CDC's STEADI initiative provides evidence-based recommendations for addressing multifactorial risks [1]. Empowering individuals with information is key to effective fall prevention [1].

Conclusion: Empowering Seniors with Knowledge

Assessing for high fall risk is a critical aspect of senior care that considers multiple factors systematically. By combining screening, history, physical tests, medication review, and environmental assessment, specific risks can be identified [2, 3, 4, 6]. This leads to personalized plans that reduce fall likelihood and improve well-being [2, 4]. For comprehensive resources on fall prevention strategies, visit the CDC STEADI website [1].

Frequently Asked Questions

What is a high fall risk score on the Morse Fall Scale?

On the Morse Fall Scale, a score of 45 points or higher indicates a high risk for falling. This scale assesses six variables, including a history of falling, gait, and mental status, and is commonly used in hospital and long-term care settings [5].

How does the Timed Up and Go (TUG) test assess fall risk?

The TUG test measures the time it takes a person to stand up from a chair, walk 10 feet, turn, and sit back down. Completing this task in 12 seconds or more is an indicator of high fall risk, suggesting issues with mobility and balance [2, 6].

Which medications increase the risk of falls?

Medications that can increase fall risk include sedatives, antidepressants, antipsychotics, certain blood pressure medications, and opioids. It is important to review all medications with a healthcare provider [3].

Can environmental factors in the home be assessed for fall risk?

Yes, an environmental assessment is a key part of the process. It involves checking for hazards such as loose throw rugs, poor lighting, and lack of grab bars [3]. Occupational therapists can perform a detailed home safety evaluation [3].

What is the CDC's STEADI initiative for fall prevention?

STEADI stands for Stopping Elderly Accidents, Deaths, and Injuries. It is a CDC initiative that provides healthcare professionals with a coordinated, evidence-based approach to screen, assess, and intervene to reduce an older adult's fall risk [1].

How can family members assess for fall risk at home?

Families can use simple checklists and observation to assess fall risk. They can ask key screening questions, observe their loved one's balance and gait, and perform a home safety check to identify potential hazards [2, 3].

What is the purpose of the 30-Second Chair Stand Test?

This test is used to evaluate leg strength and endurance. A low score compared to age-based norms indicates weakness in the lower body, which is a significant predictor of falls in older adults [2].