What Assessments Should Be Performed After a Fall?

According to the Centers for Disease Control and Prevention (CDC), more than 36,000 people 65 or older die annually from fall-related injuries. This makes understanding what assessments should be performed after a fall crucial for immediate care and future prevention. The steps range from immediate injury evaluation to a more comprehensive medical and environmental assessment.

Quick Summary

A post-fall assessment is a critical, multi-step process for evaluating a person after an incident to check for injuries and determine the root cause. It involves immediate injury checks, a physical examination, and a comprehensive look at medical, cognitive, and environmental factors to prevent future falls.

Key Points

• Initial Assessment: Immediately check for severe injuries like head or spinal trauma before moving the person. If unconscious or bleeding heavily, call emergency services.

• Medical Evaluation: Schedule a comprehensive medical exam within 72 hours, even without obvious injuries, to check for latent problems and underlying causes.

• Orthostatic Vitals: Measure blood pressure lying down and standing to identify orthostatic hypotension, a common cause of dizziness and falls.

• Medication Review: A healthcare provider should review all medications, as many can increase the risk of falling due to side effects like dizziness.

• Fall Risk Factors: Assess balance, gait, vision, and cognition to identify specific risk factors contributing to the fall.

• Preventative Measures: Implement long-term strategies such as strength exercises, home modifications, and regular vision checks to prevent future falls.

• Monitor and Document: Continue to monitor the individual for any new or worsening symptoms in the days following the fall and document all relevant details.

Immediate Assessment: The On-Scene Evaluation

The moments following a fall are crucial for determining the immediate need for care. The assessment begins right where the person has fallen, before any attempt to move them, to identify potential severe injuries like spinal or head trauma.

Assess the Situation and Person

First, check for immediate danger in the environment, then focus on the individual. This initial check should include:

• Consciousness: Determine if the person is responsive. If they are unconscious, not breathing, or have no pulse, immediately call emergency services and initiate CPR if trained.
• Injury check: Ask the person what happened and where it hurts. Look for visible injuries, such as bleeding, bruising, or deformities. Check for head and neck pain, as these may indicate serious trauma.
• Spinal injury precautions: If a spinal injury is suspected (e.g., from a fall over a distance or if neck pain is present), do not move the person. Immobilize the head and neck and wait for emergency medical services (EMS) to arrive.

Comprehensive Medical Evaluation

Even if no major injuries are apparent, a thorough medical assessment is necessary to uncover less obvious issues and identify risk factors. This evaluation often takes place over the next 24 to 72 hours and may involve several healthcare professionals.

Physical Examination and Vitals

• Orthostatic vital signs: This test measures blood pressure and heart rate while the person is lying down, and again after standing for one and three minutes. It is critical for identifying orthostatic hypotension, a significant cause of falls.
• Head-to-toe check: A full physical examination should be performed to check for any missed injuries. This includes palpating extremities for pain, swelling, or deformities and a thorough neurological assessment.
• Neurological assessment: A detailed evaluation of motor and sensory skills, strength, balance, and coordination is vital. Special attention should be paid to symptoms that might indicate a concussion or traumatic brain injury, such as persistent headaches, confusion, or changes in vision.

Review of Medical and Environmental Factors

• Medication review: Many medications can increase fall risk. A healthcare provider will review all prescriptions and over-the-counter drugs to identify those causing drowsiness, dizziness, or affecting balance.
• Cognitive and mental health screening: Conditions like dementia or depression can affect judgment, balance, and environmental awareness. Screening tools like the Mini-Mental Status Exam (MMSE) or Montreal Cognitive Assessment (MoCA) may be used.
• Functional and gait assessment: Standardized tests, such as the Timed Up and Go (TUG) test, evaluate a person's balance and mobility to identify impairments that contribute to falls.
• Environmental assessment: Healthcare providers often recommend a review of the living space to identify and mitigate hazards such as loose rugs, poor lighting, or lack of grab bars.

Comparative Analysis of Post-Fall Assessment Stages

Feature	Immediate On-Scene Assessment	Comprehensive Medical Evaluation	Environmental Hazard Assessment
Goal	Ensure immediate safety and identify life-threatening injuries.	Uncover latent injuries, diagnose contributing medical issues, and determine fall causes.	Identify and mitigate risks within the living space to prevent recurrence.
Who Performs	Witness, family member, first responder.	Nurse, physician, physical therapist.	Occupational therapist, family, caregiver.
When to Perform	Immediately after the fall.	Within 24-72 hours, or sooner if needed.	Following a comprehensive medical assessment.
Key Actions	Check consciousness, vital signs, and immobilize spine if needed. Call EMS for severe symptoms.	Review medications, perform neurological exams, conduct postural blood pressure tests, and evaluate gait.	Inspect home for clutter, lighting, flooring, and assistive device needs.
Required Tools	None for basic checks; emergency services for advanced care.	Standard medical equipment (BP cuff, stethoscope) and specific screening tools (TUG test).	Home safety checklist.
Example	Witness sees person fall, asks if they are okay, and checks for visible injury.	Doctor performs physical exam, reviews medication list, and orders blood tests.	OT checks bathroom for grab bars and removes loose rugs from hallways.

Long-Term Fall Prevention and Monitoring

A thorough post-fall assessment is not complete without implementing a long-term plan to prevent future incidents. This plan involves lifestyle adjustments, home modifications, and continued monitoring.

• Strength and balance exercises: A physical therapist can recommend exercises to improve muscle strength, balance, and gait. Regular activity is key to reducing future fall risk.
• Vision checks: Yearly vision checks ensure glasses and contact lens prescriptions are up-to-date, as poor eyesight is a common fall risk factor.
• Home modifications: Adding grab bars in bathrooms, installing handrails on stairways, improving lighting, and securing loose rugs can significantly enhance home safety.
• Ongoing monitoring: For individuals with identified risk factors, a follow-up plan should be established. This includes monitoring for changes in symptoms, documenting future falls, and reassessing prevention strategies periodically.

Conclusion

A fall is not an inevitable part of aging but a sign that a person's risk factors need to be addressed. By performing a diligent series of assessments—from the immediate, on-site evaluation for severe trauma to a comprehensive medical and environmental review—healthcare providers, family, and caregivers can effectively manage the consequences and prevent recurrence. This systematic approach not only addresses acute injuries but also empowers individuals with strategies to maintain their safety and independence over the long term.

Authoritative Link: CDC STEADI Initiative for Healthcare Providers

Frequently Asked Questions

What is the very first thing you should do after someone falls?

First, ensure the area is safe. Do not move the person immediately. Check for responsiveness and ask if they are in pain or have hit their head. Look for any visible injuries like bleeding or deformities.

When is it necessary to go to the emergency room after a fall?

Seek emergency care if the person is unconscious, has a severe headache, is on blood thinners and hit their head, has repeated vomiting, cannot bear weight on a limb, or shows signs of confusion or changes in consciousness.

How long after a fall should a comprehensive medical assessment take place?

A comprehensive medical evaluation should ideally take place within 24 to 72 hours of the fall, especially for older adults. This helps to identify any underlying medical issues or injuries that may not have been immediately apparent.

What kind of neurological symptoms should I watch for after a fall?

After a fall, watch for signs of head injury such as persistent or worsening headaches, dizziness, confusion, nausea, vomiting, slurred speech, or changes in vision or behavior.

What is orthostatic hypotension and why is it assessed after a fall?

Orthostatic hypotension is a drop in blood pressure upon standing that can cause dizziness and fainting, leading to falls. It is assessed by taking blood pressure while a person is lying down, and again after they stand up.

How can a home environment contribute to falls?

Many environmental factors can cause falls, including loose rugs, poor lighting, cluttered walkways, and a lack of safety features like handrails. An occupational therapist can perform a formal assessment to identify and correct these hazards.

What are some steps to prevent future falls?

Preventive measures include regular strength and balance exercises, yearly vision tests, reviewing and adjusting medications with a doctor, and making home modifications such as installing grab bars and improving lighting.