Assessment of Fall Risks: A Must for All Rehab Professionals
Carla is a 78-year-old woman who lived independently in Destin, Florida. Her favorite activities were traveling and spending time with her daughter. One day, while out shopping, Carla fell in a public restroom. The fall broke her hip, and she was trapped in a stall, unable to get herself out.
Fortunately, a good Samaritan entered the restroom and help finally arrived. Finding Carla alone and in pain, this good Samaritan helped Carla, calling both her daughter and an ambulance. As is the case for so many older adults, this first fall led to a series of other issues for Carla, and she was never able to live independently again.
The Costs of Fall-Related Injuries in the U.S.
Falls are a serious and common problem, especially for older people in our aging population. In the United States each year, over one in four adults aged 65 years and older suffers a fall. Of these, 37 percent reported the need for medical treatment and activity restriction. Over 27,000 older adults per year die because of fall injuries.1 Falls are the leading cause of injury-related deaths in adults aged 65 and older.2
In 2015, medical costs associated with nonfatal falls were an estimated $49.6 billion.3 But in addition to this immense financial burden, injury-related losses in functional independence impact the economic, social, and psychological well-being of affected older adults, their family members, and their caregivers. It’s no wonder then that reducing fall-related injuries among older adults is one of the nation’s top health objectives.4
Intrinsic and Extrinsic Fall Risks
Falls don’t just occur out in the community. They are also prevalent in many healthcare settings.
Older adults, admitted to unfamiliar environments, may find themselves at an increased risk for falls due to difficulty navigating new areas and routines. This risk for falls may be compounded by changes in the person’s abilities and reduced self-awareness related to those new limitations. It is, therefore, essential that nurses, occupational therapists, physical therapists—and in fact all healthcare professionals—be knowledgeable about the risks for falls, the factors that cause falls, the proper response when a fall occurs, and guidelines to prevent falls.
Fall risks are comprised of both intrinsic and extrinsic factors. The intrinsic factors are the aspects of the person that may lead to falls, and the extrinsic factors are those aspects of the environment that may cause a person to fall. Falls are caused by an interaction between these intrinsic and extrinsic factors.
When assessing these risks, it’s crucial to go beyond the number on an intake sheet to examine all of the internal and external risk factors and how they might interact in the current setting. An adequate assessment of fall risks should include an examination of all of the following intrinsic and extrinsic factors.
Intrinsic Factors
- Gait and mobility
- Balance
- Weight-bearing status
- Muscle strength
- Sensation, such as proprioception
- Vision and visual perception
- Cognition
- Heart rate and rhythm
- Orthostatic responses (hypotension)
- Medication side effects
- Bowel and bladder function
- Risky reaching or climbing habits
- Foot health and footwear
- Sleep patterns
Extrinsic Factors
- Hard or slippery surfaces
- Glaring or dim lighting
- Clutter
- Multilevel surface transitions
- Insufficient grab bars
- Throw rugs
- Wires or cords
- Bed height
- Furniture height
- Toilet height
- Poor furniture placement
- Animals
Responding to Falls
In addition to assessing these risk factors, health care professionals need to know how to respond to and prevent future falls. Fall response should involve a team huddle and requires quick response and processing of the event. Prevention education for people at risk for falls is also an important aspect of treatment, and this requires health care providers to have an understanding of the importance of health literacy.
For a deeper dive and detailed training on these areas, watch this five-course series from Pat Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAANP:
- Fall Program Assessment, Evaluation, and Spread
- Fall and Injury Risk Assessment Is More Than a Score
- Post-Fall Management for Rehabilitation Nurses
- Reducing Fall Risks Associated with Toileting
- How Effective Is Your Patient Fall Prevention Education?
If you are a PT or OT, don’t let the title of these courses and the fact that they are presented by a nurse deter you from learning this important information about the assessment and treatment of falls. These courses will give you the tools you need to provide a comprehensive assessment of fall risks, educate people at risk for falls, manage a situation in which a fall occurs, and prevent and reduce the number of falls in your healthcare setting.
- Bergen, G., Stevens, M. R., & Burns, E. R. (2016). Falls and fall injuries among adults aged ≥ 65 years—United States, 2014. Morbidity and Mortality Weekly Report, 63(37), 993–998.
- Burns, E. & Kakara, R. (2018). Deaths from falls among persons aged ≥ 65 years—United States, 2007–2016. Morbidity and Mortality Weekly Report, 67(18), 509–514.
- Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693–698.
- Office of Disease Prevention and Health Promotion. (updated 2020). Health People 2020: Older Adults. Retrieved August 21, 2020, from http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=31
