Free Fall Prevention Handout: Assessing and Managing Fall Risk

Fall-related injuries among older adults cost the U.S. healthcare system around $50 billion annually, and that number is expected to increase as the population ages. Clinicians are the front lines to address this crisis by being competent and observant when it comes to fall assessment and fall risk. Fall prevention, a combination of proper patient and environmental assessment, is essential in curbing the mounting costs. However, many providers and their organizations do not know where to start. The fall prevention handout below can provide a good baseline on building clinical capacity and competency as it relates to fall prevention.

Another great place to start is the Centers for Disease Control and Prevention’s (CDC) STEADI program. The STEADI program provides specifics in implementing the AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons recommendations for standardized assessments, professional education materials, and informative brochures for patients and families.

How Do I Assess the Risk of Falling?

There are many screenings or evaluations you can use to prevent future falls or a fear of falling in older adults. From home assessments to psychological evaluations of patients, falls can be prevented in a number of different ways. From an occupational therapy perspective, screenings and assessments may include:

• Home assessments
• Functional assessments
• Fear of falling screenings
• Depression and anxiety screenings
• Cognition screenings
• Vision assessments
• STEADI recommended assessments and incorporation of OT assessments and screenings

For more fall prevention ideas and assessments that Occupational Therapists and Occupational Therapy Assistants can use, it’s recommended clinicians take the Medbridge course Comprehensive Guide for Fall Prevention in Occupational Therapy.

Fall Prevention Case Study

Case studies are one way clinicians can prove out different fall prevention methods. Recently in our Falls Risk Assessment Clinic, I saw a 74-year-old lady with a history of falls and decreased activities. I conducted the screening below and produced the following recommendations.

Multi-disciplinary Screening

For the occupational therapy portion of the multi-disciplinary falls risk screening, I administered several tests:

• Risk of fall and fear of falling. STEADI’s Fall Risk Checklist; Falls Efficacy Scale-International (fear of falling);
• Mental state. Lawton ADL, Geriatric Depression Scale, Short Form; Generalized Anxiety Disorder-7 (GAD-7); Mini-Mental State Exam.
• Vision. MARS for contrast sensitivity; Frisby Stereopsis (depth perception);
• Home safety. A home assessment checklist.

Fall Prevention Recommendations

To address her identified risk of falls, I took the following steps:

• Home Assessment. I recommended a more in-depth occupational therapy home safety assessment.
• Medication. I discussed with the geriatrician and geriatric pharmacist her severe depression (13 out of 15 points) and anxiety scores (17 out of 21 points) in relation to her current medications and possible referral to psychiatrist. They recommended her anti-depressant medication to be adjusted and for her to return to her psychiatrist.
• Physical Therapy. I talked to a physical therapist about her complaint that her legs were so weak she could no longer stand to prepare meals, tend to her garden, walk to her mailbox, or get in/out of her shower. The physical therapist had performed the STEADI’s Timed Get Up and Go, 30-second stair stand, and 4-stage balance tests. Based on the results, he recommended a more comprehensive PT evaluation and treatment for core strengthening, balance, gait, and dual tasking activities.
• Fall Prevention Handout. A fall prevention handout is an essential tool designed to educate patients, caregivers, and healthcare providers on strategies to reduce the risk of falls. This comprehensive guide includes practical tips on improving home safety, strengthening exercises to enhance balance and mobility, and guidelines for proper medication management. By providing clear and accessible information, the handout aims to empower individuals to take proactive steps in preventing falls, thereby promoting safety and well-being. Easy to distribute and understand, it serves as a vital resource in any fall prevention program.

This is just one example of how we can assess and manage fear of falling and fall risk. It is up to the occupational therapist to assess the various risk fall factors and help our clients achieve health, wellbeing, and participation in the life through occupation engagement.