Who needs a falls risk assessment?
Medical guidelines and organizations like the CDC and American Geriatrics Society recommend routine screening and comprehensive assessments for specific patient populations. The primary candidates for a falls risk assessment are older adults, typically defined as those aged 65 and over. Beyond this age-based criteria, several factors can prompt a healthcare provider to initiate an evaluation, regardless of a person's age.
Routine screenings for older adults
For all adults 65 and older, a falls risk screening should be conducted at least once a year as part of their routine wellness visit. This initial screening often involves a simple set of questions to gauge a person's risk:
- Have you fallen in the past year?
- Do you feel unsteady when standing or walking?
- Are you worried about falling?
Answering "yes" to any of these screening questions indicates the need for a more thorough assessment.
Indications for a comprehensive assessment
Even for those under 65, a comprehensive falls risk assessment is necessary if specific risk factors are present. These factors include:
- Recent falls or near-falls: A patient who has fallen, or even had a close call, should receive an immediate and thorough evaluation. A previous fall doubles the risk of falling again.
- Changes in mobility: Increased unsteadiness while walking, a shuffling gait, or needing to grab furniture or walls to maintain balance are all red flags.
- Medication changes: Adjustments to medications, especially those affecting blood pressure, alertness, or balance, can increase falls risk. A provider should perform an assessment after any significant medication change.
- Acute health changes: A sudden change in a patient's health status, such as a hospitalization, new illness, or worsening of a chronic condition, warrants a falls risk assessment.
- In-patient admissions: For hospital patients and those in long-term care facilities, an assessment should be completed upon admission, at shift changes, and after any change in condition or location within the facility.
Components of a comprehensive falls risk assessment
A full evaluation goes beyond simple screening questions. It is a multi-faceted process designed to identify the numerous contributing factors to a person's fall risk. A comprehensive assessment typically includes:
- Medical history review: The healthcare provider will ask about previous falls, chronic conditions (e.g., osteoporosis, diabetes), and any other factors that could influence balance.
- Medication review: A detailed review of all prescription and over-the-counter medications, and supplements is conducted to identify any drugs that may cause dizziness, drowsiness, or instability.
- Physical examination: This includes tests of strength, balance, and gait. Standardized tools like the "Timed Up-and-Go" test or the "30-Second Chair Stand Test" are often used.
- Vision screening: Poor eyesight can be a significant risk factor, so a basic eye exam may be performed.
- Environmental assessment: The provider may ask questions about potential hazards in the patient's home, such as loose rugs, poor lighting, or lack of grab bars.
Comparison of assessment timelines by healthcare setting
The frequency and timing of falls risk assessments can vary depending on the patient's environment and care setting. The table below illustrates the different guidelines.
| Setting | Trigger for Assessment | Frequency | Example Scenarios |
|---|---|---|---|
| Primary Care (Outpatient) | Age 65+, history of falls, fear of falling, mobility issues | Annually for all 65+ or as needed for concerning symptoms | A 70-year-old having their annual wellness visit. A 55-year-old reporting new-onset dizziness. |
| In-Patient (Hospital) | Admission, change in status, transfer to new unit | Upon admission, daily, with any status change | A patient admitted for pneumonia is assessed upon entry and re-evaluated if they become weaker or disoriented. |
| Long-Term Care Facility | Admission, change in status, quarterly review | Within 24 hours of admission, quarterly, and with acute changes | A new resident is assessed right away. Every three months, the nursing staff re-evaluates their fall risk. |
| Post-Fall Evaluation | Any fall event | Immediately following a fall | An elderly patient falls in their home. The paramedics or emergency room staff will perform an assessment. |
The importance of proactive assessment
Many patients and even some healthcare providers may overlook the signs of increasing fall risk, believing that falls are a natural part of aging. However, this is a dangerous misconception. The reality is that falls are often preventable, and a proactive assessment is the first step toward effective prevention. By identifying modifiable risk factors such as poor balance, improper footwear, or problematic medications, providers can implement targeted interventions.
Interventions may include physical therapy to improve strength and gait, medication adjustments, recommendations for home modifications, and exercises like Tai Chi. Without a formal assessment, these opportunities to prevent serious injury and improve patient quality of life can be missed. A falls risk assessment is not just a regulatory requirement in many healthcare settings; it is a fundamental tool for safeguarding patient well-being.
Conclusion
Understanding when should patients have a falls risk assessment completed is a critical part of modern healthcare, especially for geriatric care. Standard guidelines call for routine, annual screenings for adults aged 65 and older, but assessments are also triggered by new or persistent mobility issues, recent fall history, and changes in health status or medication. By proactively evaluating a patient's risk factors, healthcare providers can implement effective interventions that significantly reduce the likelihood of a fall and its associated, often severe, consequences.
