What is a fall score of 35? A Guide to Interpreting Risk Scales

According to the Centers for Disease Control and Prevention (CDC), over one in four older adults falls each year, but fewer than half report it to their healthcare provider. Understanding what is a fall score of 35 requires knowing which specific assessment tool was used, as different scales interpret this number in varied ways.

Quick Summary

A fall score of 35 most commonly indicates a moderate risk for falling on the widely used Morse Fall Scale (MFS), falling within the 25–45 point range. However, it can also signify a high risk on other tools, such as the Johns Hopkins Fall Risk Assessment Tool (JHFRAT).

Key Points

• Score Interpretation Depends on the Scale: A fall score of 35 signifies moderate risk on the Morse Fall Scale but high risk on the Johns Hopkins Fall Risk Assessment Tool. Always clarify the tool used.

• Morse Fall Scale Breakdown: A 35 on the MFS falls within the moderate risk category (25-45 points), prompting specific fall prevention interventions.

• Johns Hopkins Fall Risk: A 35 on the JHFRAT is at the top of the high-risk range (14-35 points), requiring immediate and robust safety protocols.

• Holistic Risk Assessment: Fall scores are based on multiple factors, including fall history, medication use, mobility, and cognitive status. Identifying these is crucial for effective prevention.

• Actionable Prevention Strategies: Regardless of the scale, a score of 35 warrants interventions like regular exercise, medication reviews, home safety modifications, and vision checks to reduce fall risk.

• Proactive Approach is Key: Do not ignore a fall risk score. Use it as a prompt to develop a comprehensive, personalized plan in consultation with healthcare professionals.

Understanding the Morse Fall Scale (MFS)

For healthcare providers and patients alike, interpreting a fall risk score is crucial for implementing appropriate safety measures. The most common tool where a score of 35 is relevant is the Morse Fall Scale (MFS). The MFS is a rapid and simple method used by nurses and other healthcare professionals to assess a patient's risk for falls, particularly in inpatient settings like hospitals and long-term care facilities.

The MFS scores six variables: fall history, secondary diagnosis, ambulatory aid, intravenous therapy/heparin lock, gait, and mental status. Each variable is assigned a specific point value, and a total score is calculated. The standard interpretation of MFS scores is as follows:

• 0–24 Points: Low Risk
• 25–45 Points: Moderate Risk
• 45+ Points: High Risk

Therefore, a fall score of 35 on the MFS places a patient squarely in the moderate risk category. This indicates that while the risk is not minimal, it's not at the highest level either, warranting specific fall prevention interventions and heightened attention from care providers.

The Johns Hopkins Fall Risk Assessment Tool (JHFRAT)

While the Morse Fall Scale is very common, other assessment tools exist, and their scoring systems vary significantly. The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) is another prominent scale used in healthcare. For the JHFRAT, the scoring range is 0 to 35, with the following risk classifications:

• 0–6 Points: Low Risk
• 7–13 Points: Moderate Risk
• 14–35 Points: High Risk

Unlike the MFS, a fall score of 35 on the JHFRAT indicates a high risk for a fall. This example highlights why simply knowing the numerical score is insufficient without identifying the specific tool used to calculate it. Confusing the two could lead to misjudging a patient's risk level and, as a result, implementing insufficient safety protocols.

Deconstructing the Risk Factors

Both the MFS and JHFRAT evaluate several key factors to determine a patient's fall risk. These factors are important to understand individually to address the underlying causes of instability. For a score of 35 on the MFS, the contributing factors might include:

• History of Falls: A recent fall (within the last three months) significantly increases the risk and adds 25 points to the MFS score.
• Secondary Diagnosis: Having an additional medical diagnosis can contribute 15 points.
• Ambulatory Aid: Needing a cane, crutches, or walker adds 15 points, while relying on furniture adds 30 points.
• Gait and Mental Status: Impaired gait and certain cognitive issues are also risk factors considered in the calculation.

Understanding the components of the score allows healthcare providers and family members to tailor prevention strategies to the patient's specific needs. For instance, if a score of 35 is due to impaired gait, physical therapy and gait training would be a key intervention.

Comparison of Major Fall Risk Scales

To provide clarity on how different scores can mean different things, consider this comparison table for two major scales:

Assessment Tool	Scoring Range	Interpretation for a Score of 35
Morse Fall Scale (MFS)	0–125	Moderate Risk
Johns Hopkins Fall Risk Assessment Tool (JHFRAT)	0–35	High Risk

This demonstrates the crucial need for context when discussing fall risk scores. What is considered a moderate risk on one scale can be a high risk on another, emphasizing the importance of accurate reporting and standardized tool usage within a care setting.

Implementing Effective Fall Prevention Strategies

Identifying a patient's fall risk is only the first step. The more important step is to implement effective prevention strategies. Based on a moderate or high-risk score, a comprehensive action plan should be developed. This can include a variety of interventions aimed at reducing the risk of a fall.

• Regular Exercise: Programs that focus on balance and leg strength, such as Tai Chi, can significantly reduce the risk of falling. Consult with a healthcare provider for the best type of activity.
• Medication Review: Have a doctor or pharmacist review all medications, including over-the-counter drugs. Some medications or combinations can cause dizziness, drowsiness, or balance problems.
• Home Safety Modifications: Address environmental hazards in the home. This involves:
  • Removing clutter and loose cords from walking paths.
  • Securing or removing throw rugs.
  • Improving lighting in all areas, especially stairways and hallways.
  • Installing grab bars in bathrooms and handrails on both sides of staircases.
• Vision and Hearing Checks: Have regular check-ups with an ophthalmologist and an audiologist. Poor vision and hearing can impact balance and spatial awareness.
• Appropriate Footwear: Wear supportive, low-heeled shoes with non-skid soles. Avoid walking in socks or slippers that offer little traction.
• Talk with Your Healthcare Provider: Discuss any fears of falling or feelings of unsteadiness. Open communication is key to identifying the root cause and developing an effective plan.

For more detailed guidance on fall prevention, the CDC's STEADI (Stopping Elderly Accidents, Deaths & Injuries) program offers excellent resources and is highly recommended. The program is designed to help healthcare providers screen, assess, and intervene to reduce their patients’ fall risk and can be accessed at cdc.gov/steadi.

What to Do with a Fall Score of 35

If you or a loved one receive a fall score of 35, it is time to take proactive steps. Regardless of whether the score indicates moderate or high risk, it signifies that there are factors contributing to an increased likelihood of a fall. The best course of action is to collaborate with healthcare professionals to identify and address these specific risk factors.

1. Confirm the Assessment Tool: The first and most important step is to confirm which fall risk assessment tool was used to calculate the score. This will provide the correct context for interpretation.
2. Review the Risk Factors: Ask for a detailed breakdown of the assessment to understand which specific behaviors, conditions, or environmental factors contributed to the score.
3. Implement Targeted Interventions: Based on the identified risk factors, develop a personalized plan. This may include physical therapy, medication adjustments, or home modifications.
4. Engage in Preventive Measures: Adopt the general fall prevention strategies outlined above, such as regular exercise, maintaining good vision, and wearing proper footwear.
5. Monitor and Re-evaluate: Fall risk is not static. It can change with health status, medication changes, or environmental factors. Regular re-assessment is important to ensure the prevention plan remains effective.

Conclusion

While the numerical value of a fall score of 35 can seem ambiguous, its meaning becomes clear when understood within the context of the specific assessment tool used, such as the Morse Fall Scale or the Johns Hopkins Fall Risk Assessment Tool. A score of 35 is a strong indicator that proactive measures are needed to mitigate fall risk. By partnering with healthcare providers and implementing a multi-faceted prevention plan, individuals can significantly reduce their risk of falling and maintain their independence and well-being. Focusing on targeted interventions based on the identified risk factors is key to creating a safer environment and healthier future.

Frequently Asked Questions

Does a fall score of 35 mean I will definitely fall?

No, a fall score is a predictive tool, not a guarantee. It identifies the presence of risk factors that increase the likelihood of a fall. A score of 35 means caution and proactive prevention measures are necessary.

What is the most common scale that uses a fall score of 35?

The Morse Fall Scale (MFS) is the most common tool that uses a scoring range where 35 falls into the 'moderate risk' category. Other scales, like the Johns Hopkins Fall Risk Assessment Tool (JHFRAT), interpret 35 as 'high risk'.

What are some immediate steps to take after receiving a fall score of 35?

First, confirm which scale was used. Then, work with your healthcare provider to identify the specific risk factors contributing to your score. Immediately begin implementing safety measures such as clearing home clutter, securing rugs, and reviewing your medications.

Can I lower my fall score?

Yes, by addressing the risk factors. Improving balance and strength through exercise, ensuring proper medication management, and making environmental changes can all help reduce your risk and, potentially, your future score.

How often should fall risk be re-evaluated?

Fall risk is dynamic and should be re-evaluated regularly, especially after a health status change, new medication, or hospital stay. Your healthcare provider can recommend a specific schedule for re-assessment.

What kind of exercises are best for fall prevention?

Exercises that improve balance, strength, and flexibility are most effective. Tai Chi is often recommended, as are specific strength and balance training programs. Always consult a healthcare provider or physical therapist before starting a new exercise regimen.

Are there other assessment tools besides the Morse Fall Scale?

Yes, many other tools exist, including the Johns Hopkins Fall Risk Assessment Tool (JHFRAT), the Timed Up and Go (TUG) test, and the Berg Balance Scale. The appropriate tool often depends on the clinical setting and individual needs.