Who needs a falls risk assessment?
While a proactive, annual screening is recommended for all adults 65 and older, a falls risk assessment is particularly crucial for individuals who show signs of increased vulnerability. This includes people who have a history of falls, express concerns about their balance, or exhibit unsteadiness while walking. Specific health conditions, like Parkinson's disease, dementia, or stroke, can also significantly increase fall risk and necessitate a thorough evaluation. A comprehensive assessment helps identify both intrinsic (personal health) and extrinsic (environmental) factors that contribute to a person's risk, allowing for a personalized prevention plan.
Intrinsic risk factors
Intrinsic factors are those related to a person's individual health and physical condition. They can include:
- Mobility and balance problems: Issues with gait, balance, or muscle weakness are among the most significant predictors of future falls.
- Chronic health conditions: Diseases such as arthritis, diabetes, heart conditions, and thyroid issues can affect strength, balance, and blood pressure control.
- Vision and hearing impairments: Decreased vision, poor depth perception, and hearing loss can make navigating a space safely difficult.
- Medications: Polypharmacy (taking multiple medications) or using psychoactive drugs can cause side effects like dizziness, drowsiness, or confusion.
- Cognitive issues: Impairments in memory, judgment, or spatial awareness, often associated with dementia, can increase fall risk.
Extrinsic risk factors
Extrinsic factors are environmental hazards that can be identified and modified to reduce risk. These include:
- Home hazards: Common culprits are loose rugs, cluttered walkways, poor lighting, and a lack of grab bars in the bathroom.
- Inadequate footwear: Ill-fitting shoes, slippers, or walking in socks can increase the likelihood of slipping and falling.
- Improper use of assistive devices: Using a walker or cane incorrectly, or having one that is not properly fitted, can be a safety hazard.
Key moments for assessment
Beyond the annual screening for older adults, certain life events and health changes should trigger an immediate falls risk assessment. Healthcare professionals often look for specific triggers that indicate a heightened need for evaluation and intervention.
Following a fall
After a person experiences a fall, regardless of whether they sustained an injury, it is a critical moment for a comprehensive assessment. The fact that a fall occurred doubles the chance of falling again. The assessment should examine the circumstances of the fall to pinpoint the underlying cause and prevent future incidents.
Changes in health or medication
Any significant change in a person's health status warrants a new assessment. This could include a new diagnosis, a recent illness, or a decline in overall physical function. A review of all medications, including over-the-counter drugs, is also necessary, particularly if a new medication has been introduced or the dosage has been altered. Many drugs can cause side effects like dizziness, contributing directly to fall risk.
Hospitalization or transfer of care
In an acute care setting, such as a hospital, a fall risk assessment is performed upon admission and with any change in the patient's condition or transfer to another unit. This continuous monitoring is vital to ensure patient safety in a new, unfamiliar environment where mobility aids and routines may be different.
Expressing fear or unsteadiness
Sometimes, the most important trigger is a person's own fear of falling or their report of feeling unsteady. Fear can lead to reduced physical activity, which in turn causes muscle weakness and a greater risk of falling, creating a vicious cycle. Taking a patient's concerns seriously is a vital first step in effective fall prevention.
Tools and techniques for assessment
Healthcare providers use a variety of tests and questionnaires to conduct a falls risk assessment. These tools provide a systematic way to evaluate an individual's specific risk factors.
| Assessment Tool | Evaluates | Method | Target Area | Score Interpretation |
|---|---|---|---|---|
| Timed Up-and-Go (TUG) | Mobility and gait | Time how long it takes to stand up, walk 10 feet, turn, and sit back down | Gait, balance, mobility | >12 seconds indicates high fall risk |
| 30-Second Chair Stand | Lower body strength | Count how many times an individual can stand and sit from a chair in 30 seconds | Strength, balance | Lower scores indicate higher fall risk |
| 4-Stage Balance Test | Static balance | Hold four progressively challenging standing positions for 10 seconds each | Balance | Inability to hold a tandem or single-leg stand indicates higher risk |
| Morse Fall Scale | Comprehensive risk | Questionnaire covering history, secondary diagnosis, mobility, etc. | Multiple factors | Cumulative score indicates risk level |
How to get a falls risk assessment
For individuals and families, the first step is to speak with a primary care physician about concerns regarding falls. A doctor can perform an initial screening and then, if necessary, refer to specialists for a more in-depth assessment. The assessment can be conducted in various healthcare settings, including a doctor's office, a hospital, or even at home by a physical or occupational therapist. A comprehensive assessment often involves a multidisciplinary approach to identify and address all contributing factors.
Once risk factors are identified, interventions can be tailored to the individual's needs. This may include a personalized exercise program to improve strength and balance, a review of medications by a pharmacist, or an environmental assessment of the home to remove hazards. Staying informed and proactive is key to maintaining independence and safety. For further information and resources on evidence-based fall prevention programs, visit the Administration for Community Living.
Conclusion
Timely and thorough falls risk assessments are not just a reactive measure after a fall has occurred; they are a vital proactive tool for maintaining the health, independence, and safety of older adults. By adhering to regular screenings, seeking assessments after a significant health event, and addressing both personal and environmental risks, individuals can significantly reduce their likelihood of experiencing a fall. The investment in prevention through a professional assessment and tailored interventions pays dividends in long-term quality of life.
