Fall Risk Screening and Prevention

Part 2: How do we find out who is at risk for a fall?

The American Geriatric Society published clinical practice guidelines recommending that adults aged 65 and older should be screened annually for fall risk. But, what does this entail? Your risk assessment will include a fall history, medication review, physical examination, and functional assessment.

Fall History: Previous falls are a predictor of future falls. So, we will discuss your fall history with particular interest in falls that have occurred within the past 6 months to a year. We will also delve into  the circumstances of the falls (within the home or outside, if it was light or dark, shoe type, etc).

Medication Review: Certain medications can contribute to feelings of dizziness, light headedness, and decreased balance. As an example, psychoactive medications are independent predictors of falls and tend to alter balance and gait. If it is determined that your medications could be contributing to fall risk this will need to be discussed with your primary care physician.

Physical Examination: An effective physical examination is essential in helping to determine fall risk. We use specific and well researched tests to compare your balance scores against others within your demographic to predict fall risk. Some common tests include the Timed Up and Go and 5 Time Sit to Stand. These tests are non-taxing and do not require high levels of endurance or strength. In fact, in most cases each of these tests can be completed in less than 1 minute. Other elements of your physical examination might include vital signs for postural hypotension (taking blood pressure in sitting and standing), neurological testing, strength testing, gait assessment, a quick musculoskeletal evaluation, and a vision check.

It may be necessary to see your ophthalmologist as vision changes can affect balance and walking. Studies have shown that older adults tend to rely more heavily on visual input for balance and orientation and therefore changing or worsening eye sight, improper prescription lenses, etc. can have an impact on fall risk.

Functional Assessment: A functional assessment might be as simple as asking about your home environment and discussing how you’re able to navigate and live within this space. It also usually involves a quick questionnaire on general function and independence. An example will be discussing how many steps you have and then watching you ascend/descend stairs. From this information we will be able to suggest interventions or modifications to be made within the home.

HOME MODIFICATIONS

The home should be a safe place, but a majority of older adult falls occur within the home. If it determined that you are at risk for falls, or even if it is not, it is important to safe guard your home and environment. Here are examples of some changes you can do to make your house a safer place:

• Install more lights
  • Navigating your home in the dark can easily result in a trip or fall. It’s important to put more lights in dimly lit areas and have a lamp within reach of your bed when night time needs arise.
• Move cords, electrical wiring or hoses
  • These items can be a dangerous tripping hazard especially when they are in a walk way or heavily trafficked area.
• Remove loose rugs and mats
  • Loose rugs are easily displaced and should be removed or reinforced.
• Declutter
  • Less items to trip on!
• Optimize your kitchen
  • Many cabinets are too high for many people to reach so keep important items in areas that are easier to access.
• Safe guard your bathroom:
  • Put grab bars near toilets/shower
  • Install non-slip pads in the shower
  • Obtain a shower seat
• Have a plan in case you fall
  • Keep your cell phone or medical alert device on you at all times especially when going outside.

It’s important to make changes within the home to reduce risk of falls but it is arguably even more important to make lifestyle changes. The next blog entry penned by Dr. Lauren Baier, PT, DPT will discuss these changes and additional ways to prevent future falls. Be sure to attend Paradigm’s free Fall-Risk Screening Clinic on Saturday, February 24, 2017 from 10 AM to 2 PM at our Los Lunas location to assess your fall risk and find out how to decrease your risk!