Falls
Carole K. H. Bartoo
The Centers for Disease Control and Prevention has screening tools available for providers to download (www.cdc.gov/steadi/pdf/STEADI-Brochure-StayIndependent-508.pdf) as well as a full toolkit called STEADI (Stopping Elderly Accidents, Deaths, and Injuries; www.cdc.gov/steadi/materials.html).
Definition
Coming to rest unintentionally on the ground or lower level, not due to an acute overwhelming event (like a stroke, seizure, loss of consciousness) or external event to which any person would be susceptible (Phelan, Mahoney, Voit, & Stevens, 2015). Reasons for falls are based on two categories: individual factors and environmental factors.
A.Individual factors:
1.Age-related changes.
2.Cognitive deficits.
3.Gait, strength, or balance.
4.Sensory deficits.
5.Chronic conditions.
6.Acute illnesses.
7.Behaviors/choices.
B.Environmental factors:
1.Medication.
2.Footwear.
3.Assistive devices.
4.Home/neighborhood features.
5.Alcohol/drugs.
6.Support from caregiver.
Older adults may think falls are an expected risk of aging and can underestimate their personal risk of falling. They often report believing factors like rushing or being distracted are the reason for falls rather than physical or environmental factors listed above.
Screening
At the minimum, older adults should be asked how many times they have fallen since their last visit. A reported fall should trigger questions about whether the fall led to injury, a visit to the urgent care or to the hospital ED, and/or a hospital admission.
Physical assessments can include the following:
1.The Timed Up and Go (TUG) is a test of functional mobility that involves timing a person standing up from a chair with armrests (using their assistive device if they normally use one), walking 3 m (10 feet) at their usual pace, turning, returning to the chair, and sitting down. A TUG time greater than or equal to 12 seconds suggests high fall risk.
2.The 30-second chair stand test assesses lower extremity strength and balance. Inability to stand up from a chair without using one’s arms indicates increased fall risk.