Falls risk screening tool

Section 2 lists possible intervention to consider for identified risk factors. The tool is available as a PDF and a Word document. The FRAT pack includes: validated risk assessment tool FRAT and guidelines multidisciplinary intervention strategies to reduce falls and falls injury staff development and training information and material a range of other material related to quality improvement, guidelines for prescribing medication, an incident form, environmental checklists, brochures, and additional resources and recommended reading etc.

Please call 03 Community Falls Prevention Program sustainability guidelines The Community Falls Prevention Program sustainability guidelines help agencies to plan program sustainability, so falls prevention programs are effective over the longer term.

Falls prevention resources contains best practice guides and fact sheets for preventing falls in community care, residential aged care and hospitals National Safety and Quality Health Service NSQHS Standards improve the quality of health care in Australia. Standard 10 covers preventing falls and harm from falls. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer.

Home Healthy living Preventing falls Help and support Falls risk screening. Falls risk screening. What happens during screening? You'll then be asked about a range of risk factors that may have contributed to your fall, including: your walking, balance, strength and mobility and how you're managing to carry out daily activities your home environment the medications you currently take your vision and hearing your feet and footwear what you eat and drink anxiety, and fear, about falling depression bladder and bowel conditions that cause you to have to rush to the toilet, use the toilet frequently or get up to use the toilet during the night You'll also be asked about your bone health and any symptoms you might have experienced, including: memory loss, confusion and difficulties with thinking and problem solving blackouts dizziness or lightheadedness palpitations Agreeing an action plan An action plan will then be agreed with you based on the outcomes of the screen.

Your personalised plan may include: exercises to improve your strength, balance and walking. Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. Find us on Social. Key Takeaways Falling is not a normal part of aging. Was this helpful? Yes No. Related Articles. Less than half of older adults who fall talk with their health care providers about it.

This screening consists of asking patients whether they have fallen 2 or more times in the past year or sought medical attention for a fall, or, if they have not fallen, whether they feel unsteady when walking. Patients who answer positively to any of these questions are at increased risk for falls and should receive further assessment.

People who have fallen once without injury should have their balance and gait evaluated; those with gait or balance abnormalities should receive additional assessment. A history of 1 fall without injury and without gait or balance problems does not warrant further assessment beyond continued annual fall risk screening. A fall risk assessment is required as part of the Welcome to Medicare examination.

PCPs can receive reimbursement for fall risk assessment through the Medicare Annual Wellness visit and incentive payments for assessing and managing fall risk through voluntary participation in the Physician Quality Reporting System.

PT, physical therapist. From Centers for Disease Control and Prevention. Accessed November 11, The algorithm highlights that even individuals at low risk no history of falls, no problems with gait or balance can benefit from a primary prevention approach, namely education about fall risk factors, strength and balance exercises, and vitamin D supplementation.

A risk assessment consists of a falls history, medication review, physical examination, and functional and environmental assessments. A falls history should include determining the number of falls in the past year as well as their circumstances, including any premonitory symptoms, location, activity, footwear, use of assistive device if prescribed , use of glasses if typically used , ability to get up after the fall, time of day, any injuries sustained, and any medical treatment received.

Corroboration by a witness can be helpful in cases of recurrent, unexplained falls, because such falls may be caused by unrecognized syncope. A critical part of risk assessment is a medication review. Several classes of medications increase fall risk Table 2. Psychoactive medications in particular are independent predictors of falls. Other medications eg, antihypertensives, nonsteroidal antiinflammatory drugs, diuretics are more weakly associated with falls.

Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med ; A key strategy is to reduce the dose of any indicated medications that contribute to fall risk and to taper and stop any medications that are no longer indicated.

Postural hypotension is defined as a reduction in systolic blood pressure of at least 20 mm Hg or in diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing. Patients may experience lightheadedness, blurred vision, headache, fatigue, weakness, or syncope within 1 to several minutes of standing up, or they may be asymptomatic. In contrast, patients may experience postural lightheadedness without a measured blood pressure reduction; this should be considered equivalent to postural hypotension for fall risk.

Use of above-the-knee support hose and sleeping with the head of the bed elevated may also reduce postural reductions in blood pressure. The recommended elements of a fall-focused physical examination are shown in Box 1. The TUG, a test of functional mobility, 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. The Second Chair Stand test assesses lower extremity strength and balance. The 4-Stage Balance test assesses static balance by having the patient stand in 4 positions, each progressively more challenging. Positions include the parallel, semi-tandem, tandem, and single-leg stand.

Cognitive testing is also an important part of the fall-related physical examination and may consist of a brief cognitive screen such as the Mini-Cog. The risk of falling and the circumstances and location of falls vary by functional ability. Gauging functional ability can help determine the degree of fall and injury risk, indicate risk factors, and suggest interventions.

A comprehensive assessment may involve laboratory tests. These tests could include thyroid-stimulating hormone, vitamin B 12 level, complete blood count, hydroxy vitamin D level, and other laboratory tests if clinically indicated.

A dual-energy x-ray absorptiometry scan should be done if bone mineral density has not been assessed. No other radiographic imaging study is routinely necessary. However, based on signs and symptoms, such as evidence of head injury or a new focal neurologic deficit, computed tomography or MRI of the brain may be indicated.

An assessment for causes of syncope should be conducted only if there is strong suspicion, as in the case of recurrent, unexplained falls. Environmental assessment, which is typically conducted by a trained health professional eg, occupational therapist [OT] on referral from the PCP, is intended to identify hazardous conditions within the home, such as obstacles in pathways or on stairs, unsupportive or ill-fitting footwear, unsuitable assistive devices, inadequate lighting, and slippery surfaces.

It also identifies hazards outside the home, such as cracked pavement or sloped yards. Identifying and modifying environmental factors is an effective intervention as part of a comprehensive multifactorial approach to preventing falls. Goals for fall risk management include 1 reduce the chances of falling, 2 reduce the risk of injury, 3 maintain the highest possible level of mobility, and 4 ensure ongoing follow-up.

Approaches that facilitate behavior change include presenting the information that falls can be prevented, providing choices, personalizing options, and focusing strategies on enhancing quality of life eg, maintaining independence. There are examples of patients in various stages of readiness to make changes to reduce their fall risk, with possible provider responses for each stage.

Exercise interventions that focus on improving strength and balance are the most effective single intervention for reducing falls and fall-related injuries. To be effective, exercise must 1 focus on improving balance, 2 be of moderate to high challenge and progress in difficulty, and 3 be practiced a minimum of 50 hours, which equates to 2 hours weekly for 25 weeks. It is important to emphasize that the effects of exercise will not be apparent for several months, and that practice must be ongoing in order to maintain the benefits.

Evidence-based exercise programs may be either home based eg, Otago Exercise Program 33 or group classes offered in community settings eg, tai chi Because the risk of falling increases with the number of risk factors, risk can be reduced by modifying even a few contributing factors. Three key risk factors balance, medications, and home safety should be addressed in everyone at high risk.

In our experience, most high-risk patients are amenable to decreasing medication dosages and appreciate having their physician reduce the number of prescription medications. Most older adults are willing to consider balance training, especially if the instructions are not complicated and the exercises can be done at home.