How do you get a falls assessment? A comprehensive guide for senior care

According to the CDC, over one-fourth of Americans aged 65 and older fall each year. For many older adults and their families, the question of how do you get a falls assessment is a proactive and critical step toward maintaining safety and independence.

Quick Summary

Obtaining a falls assessment is typically initiated by speaking with a primary care provider who can perform an initial screening and refer to specialists like physical or occupational therapists for a more comprehensive evaluation, which may include reviewing medications, testing balance, and checking the home environment.

Key Points

• Start with Your Doctor: The first and most important step is to discuss your fall concerns with your primary care provider, who can perform an initial screening and refer you to specialists for more detailed evaluations.

• Specialized Assessments: For a comprehensive look, your doctor may refer you to a physical therapist for testing strength and balance, or an occupational therapist to evaluate and modify your home environment.

• In-Home Evaluation: An in-home assessment is crucial for identifying environmental hazards like loose rugs, poor lighting, or stairs without handrails, which can be addressed through simple modifications.

• Multidisciplinary Approach: A full falls assessment often involves multiple health professionals, including a medication review to check for side effects that increase fall risk, and possibly other specialists for vision or balance issues.

• Utilize Community Resources: Supplement clinical assessments with community-based programs like Tai Chi or local workshops that focus on improving balance and mobility, often listed by organizations like the National Council on Aging.

• Insurance Coverage: Many assessments, especially those deemed medically necessary and ordered by a doctor, are covered by insurance, including Medicare.

Understanding the importance of a falls assessment

A falls assessment is a multi-faceted evaluation designed to identify a person's individual risk factors for falling. This proactive approach is crucial because falls are not an inevitable part of aging; they are often preventable. Beyond the immediate risk of serious injury, such as hip fractures or head trauma, falls can have profound long-term consequences. They can lead to a fear of falling, which reduces physical activity, weakens muscles, and paradoxically increases the risk of future falls. Furthermore, falls can lead to a loss of independence and a diminished quality of life.

Identifying risk factors through a thorough assessment allows healthcare providers to create a personalized prevention plan. This can include targeted exercises, medication adjustments, and home safety modifications, all of which contribute to better health outcomes and greater peace of mind for both the individual and their family.

The first step: talking to your primary care provider

For most people, the journey to getting a falls assessment begins with a conversation with their primary care physician (PCP). The Centers for Disease Control and Prevention (CDC) provides guidelines for screening older adults for fall risk. Your doctor will likely ask three key questions:

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

If you answer yes to any of these, your doctor will proceed with a more detailed assessment. Medicare Part B covers a fall risk assessment as part of the annual wellness visit for those who qualify. The initial assessment by your PCP will help determine if further, more specialized testing is necessary. Your doctor is the central hub for coordinating care, and they can refer you to the appropriate specialists.

Specialists involved in a comprehensive assessment

A comprehensive falls assessment often involves a multidisciplinary team to address the various factors that can contribute to falls. Depending on the initial screening, your doctor may refer you to:

• Physical Therapists (PT): A PT will conduct tests to evaluate your strength, balance, and gait. They use standardized tools like the Timed Up and Go (TUG) test, the 30-Second Chair Stand test, and the Four-Stage Balance Test. The PT will then develop a customized exercise program to improve stability and mobility.
• Occupational Therapists (OT): An OT focuses on assessing a person's ability to perform daily activities safely. They often perform an in-home evaluation to identify environmental hazards and recommend modifications, such as installing grab bars, improving lighting, or removing tripping hazards like loose rugs.
• Other Specialists: In some cases, a fall can be linked to other health conditions. Your doctor may refer you to an audiologist for vestibular testing (the inner ear system responsible for balance), an optometrist for vision changes, or a neurologist if a medical condition like Parkinson's disease is a factor.

How to get an in-home assessment

An in-home assessment is one of the most effective ways to identify and address environmental risk factors. There are two primary ways to arrange this service:

1. Through a healthcare provider: If medically necessary, your PCP can refer you to a physical or occupational therapist who will conduct a home-based evaluation, which may be covered by insurance.
2. On your own: You can also contact an aging-in-place expert or a Certified Aging-in-Place Specialist (CAPS) directly. These professionals are trained to identify and address home safety hazards. Your local Area Agency on Aging can provide resources and referrals.

What to expect during the assessment process

A falls assessment is a thorough and interactive process. The professional will gather information through interviews and physical tests. Here's what you can generally anticipate:

1. History and Medication Review: The healthcare provider will ask about your history of falls, current symptoms, and a comprehensive list of your medications, as certain drugs can increase fall risk.
2. Physical Examination: This includes checking your vision, blood pressure (especially orthostatic blood pressure, which measures changes when you stand up), and your cardiovascular system.
3. Functional Testing: You will perform simple movements and tasks to evaluate your strength, balance, and mobility. Common tests include the Timed Up and Go test and the 30-Second Chair Stand Test.
4. Environmental Evaluation (if applicable): The specialist will assess your living environment, looking for clutter, poor lighting, stairs without railings, and other potential hazards.
5. Personalized Plan: Based on the findings, the healthcare team will create an individualized fall prevention plan. This may include referrals for physical or occupational therapy, medication changes, footwear recommendations, or home modifications.

Comparing different assessment types

Feature	Physician Screening	Physical/Occupational Therapy Assessment	In-Home Assessment (by an OT or CAPS)
Who performs it?	Primary Care Provider	Physical Therapist or Occupational Therapist	Occupational Therapist or Certified Aging-in-Place Specialist
Focus	Initial identification of risk through patient history and basic gait/balance observation	Detailed functional testing of strength, balance, and gait; development of a targeted exercise plan	Comprehensive evaluation of the home environment and its impact on daily activities
Scope	Broad, preliminary screening	Focused on physical function	Focused on environmental hazards and behavioral risks
Coverage	Often covered by insurance, including Medicare Annual Wellness Visits	Often covered by medical insurance if medically necessary	May be covered if referred by a doctor; otherwise, out-of-pocket or potentially supported by community programs

Seeking help through community programs and resources

Beyond clinical settings, many community-based programs focus on falls prevention. These are excellent resources for accessing assessments and interventions. The National Council on Aging (NCOA) provides an extensive list of evidence-based programs proven to help older adults reduce their risk of falling. Examples include Tai Chi classes for improving balance, exercise programs like 'A Matter of Balance,' and local workshops. Your Area Agency on Aging is also a valuable resource for connecting with local services and support networks. Visit the official Administration for Community Living website to learn more about evidence-based falls prevention programs.

Conclusion: A proactive approach to senior safety

Getting a falls assessment is a proactive and vital component of healthy aging and senior care. It’s a process that empowers individuals to take control of their health by understanding their unique risk factors and implementing effective prevention strategies. By starting with a conversation with your primary care doctor and following through with any recommended specialized assessments, you can significantly reduce the risk of falls, prevent serious injuries, and continue to live a safe, mobile, and independent life for years to come. Ultimately, a falls assessment is not about admitting weakness; it's a powerful tool for building resilience and ensuring a higher quality of life as we age.

Frequently Asked Questions

What happens during a falls assessment?

During a falls assessment, a healthcare provider will review your medical history, current medications, and any past falls. They will also perform physical tests to evaluate your strength, balance, and gait. If done by an occupational therapist, they may also conduct an environmental assessment of your home.

Does insurance or Medicare cover a falls assessment?

Yes, in many cases, a falls assessment is covered by insurance, particularly Medicare. Medicare Part B covers a falls risk assessment as part of the Annual Wellness Visit if it is deemed medically necessary and ordered by your doctor.

How often should you get a falls assessment?

It is generally recommended that adults aged 65 and older receive a falls risk screening annually. A more thorough assessment is recommended if you have a history of falls, feel unsteady, or have medical conditions that increase your risk.

What is the difference between a falls assessment and a home safety assessment?

A falls assessment evaluates your personal health risks, including balance, strength, and medications, while a home safety assessment focuses on environmental hazards in your living space, such as clutter, lighting, and bathroom safety features. An occupational therapist can often perform both.

What kind of exercises are recommended after a falls assessment?

Based on the assessment, you may be prescribed exercises to improve strength, balance, and flexibility. Common examples include Tai Chi, specific balance exercises, and strength training. A physical therapist can provide a customized exercise plan.

Can I do a falls assessment on my own?

While there are screening tools available online (like the CDC's STEADI toolkit), a professional assessment is crucial. These tools can help raise awareness, but a healthcare provider is needed to interpret the results and create a medical intervention plan.

What are common risk factors identified during a falls assessment?

A professional assessment can identify a range of risk factors, including muscle weakness, balance problems, certain medications, poor vision, footwear issues, and environmental hazards in the home. Underlying medical conditions can also be a factor.