How often should you review a falls risk assessment? Your Guide to Senior Safety

Over one-fourth of people aged 65 and older fall each year, with many falls causing serious injury. To protect against this risk, it is vital to know how often should you review a falls risk assessment and what factors trigger more frequent evaluations for proactive senior safety.

Quick Summary

Healthcare guidelines recommend annual falls risk screening for all adults 65 and older, but an assessment should be reviewed immediately after a fall, upon changes to medication, or with a decline in health.

Key Points

• Annual Screening is Standard: For all adults 65+, an annual falls risk screening is recommended by organizations like the CDC to identify baseline risks.

• Triggered Reviews are Essential: A comprehensive assessment should be reviewed immediately after a fall, a significant health change, or an adjustment to medications.

• Holistic Assessment is Best: A multifactorial assessment evaluates not just gait and balance, but also medications, vision, physical strength, and environmental hazards.

• CDC's STEADI is a Key Framework: Healthcare providers often use the CDC's STEADI (Screen, Assess, and Intervene) framework to coordinate a fall prevention plan.

• Empowerment is Prevention: Seniors and caregivers can proactively reduce risk by adopting balance-focused exercises, performing home safety checks, and communicating openly with providers.

Why Regular Falls Risk Assessments are Crucial for Senior Health

Falls are a leading cause of injury and death among older adults, but they are often preventable. A falls risk assessment is a systematic way for healthcare professionals and caregivers to identify and manage the unique risk factors that can increase a person's chances of falling. This proactive approach helps to reduce risks before an incident occurs and ensures a swift, targeted response if a fall does happen.

The Standard: An Annual Review

The Centers for Disease Control and Prevention (CDC) and the American Geriatrics Society (AGS) recommend that all adults 65 and older receive an initial falls risk screening and a follow-up assessment at least once a year. This annual review is often part of a routine checkup or the Medicare Annual Wellness Visit. The annual review serves as a preventative measure, identifying potential new risk factors that may have developed over the past year due to normal aging or changes in health.

During this annual assessment, a healthcare provider will typically:

• Review the individual's history of falls over the past year.
• Ask about feelings of unsteadiness while walking or standing.
• Assess balance and gait through standardized tools like the Timed Up and Go (TUG) or the 4-Stage Balance Test.
• Evaluate overall health, including vision and foot health.
• Review all medications to identify any that could increase fall risk.

Triggers for More Frequent Assessments

While an annual assessment is a standard baseline, the review schedule must be more frequent for individuals with elevated risk. A review should always be triggered by any of the following events:

• After a fall: If a fall occurs, a comprehensive re-assessment is necessary to understand the cause and modify the care plan. This includes a review of the circumstances, potential injuries, and any contributing factors like poor lighting or a medication side effect.
• Change in medical condition: New diagnoses, worsening of chronic illnesses, or recent surgery can significantly alter a person's balance, strength, and mobility, requiring a new assessment.
• Medication changes: Adding a new medication or altering the dose of an existing one can introduce new side effects, such as dizziness or drowsiness, that increase fall risk. A re-evaluation is critical.
• Changes in cognition: Progressive cognitive decline can affect judgment and awareness of hazards. For individuals with dementia or other cognitive impairments, assessments should be more frequent and ongoing.
• Environmental or functional changes: Significant changes to a living environment or a decline in the ability to perform daily living activities warrants a new risk assessment.

Comparison: Annual vs. Triggered Risk Assessment

Understanding the differences between scheduled and event-based reviews is key to a robust fall prevention strategy.

Feature	Annual Review	Triggered Review
Timing	Once per year, or as part of a routine health check.	Promptly after a fall, medication change, or health event.
Purpose	Proactive screening to identify emerging, subtle risks.	Reactive assessment to address immediate, known risk factors.
Scope	Broad assessment covering multiple potential risk areas.	Focused re-evaluation to address specific, incident-related factors.
Driving Factor	Standard clinical protocol and age-related changes.	An incident, specific symptom, or change in circumstances.

The Multifactorial Approach: A Deeper Look at Assessment

A comprehensive falls risk assessment, as promoted by the CDC's STEADI (Stopping Elderly Accidents, Deaths, & Injuries) initiative, is a multifactorial process. It goes beyond simple screening questions to include a detailed evaluation of several key areas.

• Physical Examination: In addition to balance and gait tests, this can include checking for orthostatic (postural) blood pressure drops, assessing muscle strength, and reviewing vision.
• Medication Review: Identifying and potentially adjusting or discontinuing high-risk medications is a critical part of the process.
• Home Safety Evaluation: A professional (often an occupational therapist) can assess the home environment for hazards like loose rugs, inadequate lighting, or lack of grab bars.
• Functional Assessment: Assessing the ability to perform activities of daily living (ADLs) helps to determine the level of functional impairment and risk.

Proactive Steps for Seniors and Caregivers

Beyond the formal assessment, there are many practical steps that can be taken to reduce fall risk. These actions can be initiated at any time, but are especially important following an assessment or trigger event.

1. Engage in regular, balance-focused exercise. Activities like Tai Chi have been proven to reduce the risk of recurrent falls.
2. Talk openly with your healthcare provider. Immediately report any falls, near-falls, or feelings of unsteadiness.
3. Perform a home safety check. Remove tripping hazards, add grab bars, and improve lighting in key areas.
4. Wear appropriate footwear. Choose well-fitting shoes with good support and non-slip soles.
5. Have regular eye and foot exams. Keep glasses and prescriptions updated to ensure the best possible vision.

The Final Word: The Role of Regular Review in Healthy Aging

Falls are not an inevitable part of aging, and regular, proactive assessment is the best defense. The answer to how often should you review a falls risk assessment depends not only on a yearly schedule but also on responding promptly to significant changes in a person's health, medications, or environment. By embracing a continuous cycle of screening, assessment, and intervention, seniors can significantly reduce their risk, maintain independence, and ensure a higher quality of life. For more in-depth resources on fall prevention, the CDC STEADI website offers comprehensive information and tools for patients and providers.

Conclusion

For older adults, the falls risk assessment review is a dynamic process. While annual checkups provide a crucial baseline, a responsive approach to health changes and incidents is paramount. Working closely with healthcare providers to monitor and adjust preventative strategies is the most effective way to protect against the risks of falling and to promote healthy, safe aging.

Frequently Asked Questions

Why is an annual falls risk assessment review important, even if no falls have occurred?

An annual review is crucial because a person's risk factors can change subtly over time. Factors like muscle weakness, vision changes, or new medications can increase risk without an incident occurring. A yearly check-in helps catch these changes proactively.

What specifically triggers a falls risk assessment to be reviewed more frequently?

Key triggers include experiencing a fall, even if it's a minor one; a new medical diagnosis; a change in cognitive status; a modification to medication; or a noticeable decline in balance or mobility.

Can I review a falls risk assessment at home, or does it need a healthcare provider?

While a healthcare provider's comprehensive assessment is vital, caregivers and seniors can perform regular home safety checks and self-monitor for changes in balance and mobility. However, any significant findings should prompt a consultation with a professional for an official review.

What is the CDC's STEADI program, and how does it relate to reviewing fall risk?

STEADI stands for Stopping Elderly Accidents, Deaths, & Injuries. It is a CDC initiative that provides a framework for screening, assessing, and intervening to reduce fall risk. It guides healthcare providers on how and when to review a patient’s risk and implement preventative steps.

How do medications impact the frequency of reviewing a falls risk assessment?

Certain medications, especially psychoactive drugs, can increase fall risk. A falls risk assessment should be reviewed anytime a new medication is started, an existing one is adjusted, or new side effects are reported, to ensure the medication plan is still safe.

What are some common risk factors identified during a falls risk assessment review?

Common risk factors include gait and balance problems, lower extremity weakness, poor vision, home environmental hazards (like loose rugs), certain medications, and underlying medical conditions.

Who is typically involved in reviewing a falls risk assessment?

The review typically involves a team that includes the senior, their caregiver, a primary care physician, and potentially other specialists like an occupational therapist, physical therapist, or pharmacist, depending on the risk factors identified.