Who Is Classified As Fall Risk? A Comprehensive Guide

According to the Centers for Disease Control and Prevention (CDC), more than one in four older adults experiences a fall each year. Recognizing who is classified as fall risk is the foundational step for implementing proactive strategies that can significantly reduce the likelihood of a fall and enhance overall safety and independence.

Quick Summary

An individual is typically classified as a fall risk based on a multi-faceted assessment that considers intrinsic factors, like age and health, and extrinsic factors, such as environmental hazards.

Key Points

• Age and History of Falls: Individuals over 65, and especially those over 80, with a history of previous falls are at a significantly higher risk of falling again.

• Health and Mobility Factors: People with gait and balance problems, muscle weakness, vision or hearing impairments, and chronic diseases are more likely to be classified as a fall risk.

• Medication Management: The use of four or more medications, or specific types like sedatives and antidepressants, can cause side effects that impair balance and increase fall risk.

• Environmental Hazards: Hazards within the home, such as clutter, poor lighting, and loose rugs, are major external factors that contribute to falls.

• Comprehensive Assessment: Fall risk is determined through clinical screenings and assessments that evaluate an individual's intrinsic and extrinsic risk factors to create a tailored prevention plan.

• Beyond Older Adults: While most common in seniors, fall risk can affect people of all ages due to health issues, medication use, and environmental dangers.

Understanding the Concept of Fall Risk

Fall risk is not a single condition but rather a combination of factors that increase an individual's susceptibility to falling. While most people associate fall risk with older age, it's a concern that can affect individuals of all ages due to various health conditions, medications, or environmental factors. Identifying a person as a fall risk is a clinical process involving screening and comprehensive assessment to pinpoint the specific issues that need to be addressed for effective prevention.

Intrinsic Factors: Conditions Within the Individual

Intrinsic risk factors are physiological and health-related issues that increase the likelihood of a fall. These are often complex and can accumulate with age or illness, making it essential to identify and manage them proactively.

Key intrinsic risk factors include:

• Age: The risk of falling increases significantly with age, particularly for adults over 65, due to natural changes in strength, balance, and gait. For those over 80, the risk increases even more.
• History of falls: A past fall is one of the strongest predictors of future falls. Falling once doubles the chance of falling again.
• Mobility and balance impairments: Issues with walking, standing, or shifting weight can lead to instability. Conditions like Parkinson's disease, neuropathy, or arthritis significantly affect gait and balance.
• Medical conditions: Chronic illnesses such as heart disease (e.g., arrhythmias), diabetes, stroke, and thyroid dysfunction can all contribute to dizziness, weakness, or impaired mobility, increasing risk.
• Vision and hearing problems: Impaired sensory input can affect spatial awareness and balance. Conditions like cataracts, glaucoma, and poor depth perception are major contributors.
• Cognitive impairment: Dementia, delirium, or poor judgment can affect a person's ability to recognize and respond to hazards, making them more vulnerable to falls.
• Fear of falling: Paradoxically, a fear of falling can lead to limited activity, which in turn causes deconditioning and increases the actual risk of a fall.

Extrinsic Factors: Hazards in the Environment

Extrinsic risk factors are external elements that pose a risk to an individual's safety, especially when combined with intrinsic vulnerabilities. Addressing these is often a more direct path to prevention.

Common extrinsic factors to consider:

• Medication use: Taking four or more medications (polypharmacy) is a major risk factor, as is the use of specific drugs like sedatives, antidepressants, or blood pressure medication, which can cause dizziness or confusion.
• Home hazards: Environmental dangers like clutter, loose throw rugs, poor lighting, wet floors, and lack of grab bars in bathrooms can lead to trips and slips.
• Footwear: Poor-fitting shoes, slippers with poor traction, or walking barefoot can all contribute to falls.
• Assistive device misuse: Improper use or selection of a cane, walker, or other mobility aid can actually increase fall risk.

Tools and Criteria for Assessing Fall Risk

Healthcare professionals use various tools to systematically evaluate and classify an individual's fall risk. These assessments are crucial for creating a tailored prevention plan.

1. Screening Questions: Clinicians often start by asking simple questions, such as whether a person has fallen in the past year, how many times, or if they feel unsteady when walking.
2. Performance-Based Tests: These clinical tests measure physical ability. A widely used example is the Timed Up and Go (TUG) test, where a person is timed as they rise from a chair, walk 10 feet, turn, and sit back down. A time of 12 seconds or more suggests a higher risk of falling. Other tests include the 30-Second Chair Stand and the 4-Stage Balance Test.
3. Comprehensive Assessment: For individuals who screen positive, a more in-depth assessment is performed. This includes a review of medications, evaluation of vision, gait, balance, and cognitive function, and a home safety check.
4. Scoring Models: Some healthcare settings use standardized scoring models like the Hendrich II Fall Risk Model. In this model, a patient's risk score is calculated based on factors like gender, mental status, and medication use. A score of five or higher indicates a high fall risk.

Assessment Category	Intrinsic Factors	Extrinsic Factors
Patient-specific issues	Age, chronic diseases, cognitive status, vision, strength, balance, history of falls	Medication side effects, assistive device use, footwear
Environmental issues	N/A	Home hazards (clutter, rugs), lighting, unfamiliar surroundings
Assessment Method	Physical exams, screening tools (TUG), medication review	Home safety checks, reviewing patient routines

Creating a Personalized Fall Prevention Plan

Once an individual is identified as a fall risk, the focus shifts to creating a personalized prevention plan. This is not a one-size-fits-all approach but rather a combination of strategies tailored to the individual's specific risk factors.

• Exercise and strengthening: Programs that focus on improving strength, balance, and gait can significantly reduce fall risk. Exercises like Tai Chi have been shown to be particularly effective.
• Medication management: A healthcare provider or pharmacist can review all current medications (including over-the-counter drugs) to identify and potentially adjust those that increase fall risk.
• Home safety modifications: Simple changes can make a big difference. This includes installing grab bars, improving lighting, removing trip hazards like rugs and clutter, and ensuring stairways have handrails on both sides.
• Foot care: Regular foot care and wearing supportive, well-fitting, and nonskid footwear are important for maintaining stability.
• Vision checks: An annual eye exam can ensure vision problems, like poor depth perception, are addressed.
• Vitamin D supplementation: Low vitamin D levels have been linked to muscle weakness and an increased risk of falls. A healthcare provider can check levels and recommend appropriate supplementation.
• Addressing other conditions: Treating underlying conditions such as osteoporosis, cardiovascular problems, or depression is a critical component of a holistic fall prevention strategy.

Conclusion

Understanding who is classified as fall risk empowers individuals, family members, and caregivers to take preventive action. A fall risk classification is not a label but a vital piece of information used to initiate a process of assessment and intervention. By addressing the intrinsic and extrinsic factors that contribute to falls, it is possible to enhance safety, maintain independence, and improve quality of life. For reliable resources and information on fall prevention, the Centers for Disease Control and Prevention's STEADI initiative is an excellent place to start: Prevent Older Adult Falls with STEADI.

How to get started

Taking the first step toward fall prevention is straightforward. Schedule a conversation with a healthcare provider to discuss concerns about falls or to request a fall risk screening, especially for adults aged 65 and older. By working together with a healthcare team, a personalized plan can be developed to address the unique risk factors for any individual, making a safer future possible.

Frequently Asked Questions

What is a fall risk?

A fall risk refers to a person's increased susceptibility to falling due to a combination of internal (intrinsic) factors, like health and mobility, and external (extrinsic) factors, such as environmental hazards. Classification as a fall risk is a medical designation used to guide preventative care.

Who is at the highest risk for falls?

Older adults, particularly those aged 65 and over, have the highest risk. People with a history of falls, balance or mobility issues, vision problems, cognitive impairment, or who take multiple medications are also at very high risk.

How do medications affect fall risk?

Certain medications, including sedatives, antidepressants, tranquilizers, and some blood pressure drugs, can cause side effects like dizziness, drowsiness, and impaired balance. The more medications a person takes (polypharmacy), the higher their risk of these side effects and subsequent falls.

What are some common environmental hazards that increase fall risk?

Common hazards include loose throw rugs, clutter on floors, inadequate lighting in hallways and stairwells, slippery bathroom surfaces, and a lack of proper handrails. A home safety assessment can identify and help resolve these dangers.

How can I assess my own fall risk at home?

While not a substitute for a professional assessment, you can perform simple tests like the 'Timed Up and Go' test. Time how long it takes you to stand up from a chair, walk 10 feet, turn around, and sit back down. A time over 12 seconds suggests a higher risk.

Does a fear of falling actually increase my risk?

Yes, a fear of falling can cause individuals to limit their physical activity. This leads to reduced strength and poor balance, which in turn increases the actual risk of a fall. Overcoming this fear with safe exercise programs is key.

What kind of exercises can help with fall prevention?

Exercises that focus on improving balance, strength, and flexibility are most effective. Tai Chi is often recommended, as are specific balance and leg-strengthening exercises. A physical therapist can provide a personalized exercise plan.

What should I do if I think someone is at risk of falling?

Schedule an appointment with their healthcare provider to discuss your concerns. The provider can perform a fall risk assessment and recommend appropriate interventions, such as physical therapy, medication review, or home modifications.