assessing fall risk and preventing falls in community-living elderly

Assessing Fall Risk

Falls have many different causes and elders may have several predisposing risk factors.

Examples of risk factors:

poor vision
orthostatic hypotension
cognitive impairment
gait/balance disturbances
muscular weakness
degenerative joint disease of hips/knees
foot disorders
peripheral neuropathy
bladder dysfunction
polypharmacy (multiple medications)

The relative contribution of each risk factor differs according to the elder's underlying medical condition, functional level, and environmental circumstances (in other words, the presence of hazardous conditions such as poor lighting, slippery floor surfaces, cluttered pathways, and bathrooms without hand rail support). The more risk factors an elder has, the higher his/her risk of falling will be.

Certain gait and balance abnormalities are good predictors of recurrent falls:

difficulty with rising or sitting down
instability immediately after standing
staggering on turns
and walking with short, discontinuous steps.

Mobility tests such as the Get Up & Go Test can be used to quickly assess gait and balance. Elders who report two or more falls in the past year and/or imbalance and need to use their hands to rise from a chair of standard height have twice the risk of falls compared to individuals of similar age.

Preventing Falls
Goals of fall prevention are to maximize mobility, reduce the threat of falls and their complications, and maintain autonomy. Potential interventions are based on known risk factors and consist of medical, rehabilitative, environmental and behavioral approaches.

Medical

Assess elders for falls, regardless of whether injury results from falls. Because falls may be the presenting complaint of many disease processes, it is important to identify and treat any immediate acute conditions.
Assess fall risk (including mobility) on a regular basis and attempt to reduce factors identified. Because the risk of falling increases with the number of risk factors, modifying even a few factors may substantially reduce risk of falls.
Review and adjust medications on a regular basis. Attempt to stop drugs that may lead to confusion, sedation, and balance instability.

Rehabilitative

Exercises targeted to the patient's specific gait and balance impairment can improve instability (ability to withstand threats to balance) and reduce risk of falls. Additionally, exercise programs can increase an elder's confidence and reduce fear of falling.
Canes or walkers can support ambulation and improve stability. Ambulation devices also provide reassurance to individuals who are afraid of falling.
A hip protector (consists of two pads that are worn in pockets of a stretchy undergarment) can help to absorb the force of a fall and reduce the risk of a hip fracture.

Environmental

A home safety assessment, conducted by physical/occupational therapists, can help eliminate hazardous conditions; especially in those elders with chronic mobility problems.

Behavioral

Counseling elders on ways to prevent falls, and helping individuals to develop safety-related skills and habits allows individuals to regain confidence in their mobility and reduce the likelihood of falling.

Posted October 2005