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Harborview Fall Prevention Clinic: For Providers
What you can do:
- Ask patients once/year about falls, and fear of falling
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- No unsteadiness → no further assessment
- Unsteady → referral/fall evaluation by specialist (e.g. Fall Prevention Clinic, geriatrician)
- If a patient reports >/= 1 fall, abnormal gait or balance, or recurrent falls in the past year → referral/fall evaluation by specialist (e.g. Fall Prevention Clinic, geriatrician)
What do I need to know as a provider?
Current State of the Evidence:
According to the 2001 and revised 2006 Fall Guidelines, good quality evidence with a high degree of benefit exists for community-dwelling, cognitively intact elders for:
- environmental modification
- environmental factors implicated in 35% to 40% of falls
- elder should be involved in intervention
- assessment may not be beneficial in non-fallers or unknown-risk persons
- exercise
- individually or in a group
- tailored to individual’s capabilities
- includes strength and coordination training
- no specific exercise best for fall prevention
- balance and gait training
- medication modification
- according to epidemiologic studies, increasing the number of medications increases the risks of falling
- according to clinical trials, reducing medications lessens fall risk
- managing visual concerns
- addressing orthostatic hypotension
- other cardiovascular considerations if indicated by the assessment
This multifactorial approach can reduce falls 30-40%.
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It is important to appreciate differences in this population: community dwelling vs. long-term care dwelling elders, and cognitively intact vs. cognitively impaired elders.
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Limited evidence exists on primary prevention of falls.
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Providing risk factor assessment and multifactorial management accordingly is superior to targeting only a single risk factor.
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In the long-term care setting, evidence is not sufficient to make a strong recommendation. Recommendations do however include:
- elder should be involved in intervention
- assessment may not be beneficial in non-fallers
- staff training with feedback
- environmental modification is recommended
- balance and strength training
- instruction in the use of an assisted device (when appropriate)
- reducing psychoactive medication use also seems to reduce fall risk
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Environmental evaluation and intervention as part of a multifactorial intervention may reduce fall risk in LTC settings.
- The benefits of exercise to reduce falls in nursing homes are less clear.
Related Links for Providers
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Fall Prevention Center of Excellence – a wealth of information for providers, researchers and educators in downloadable PDF documents, web links and articles on balance & mobility, environmental management, medication management, and resources. Also includes basic information on fall prevention in 14 languages!
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- CDC’s National Center for Injury Prevention and Control: Falls and Hip Fractures Among Older Adults – statistics and additional information on the risks for falling and how to prevent falls.
- Falls in the Elderly, a thorough article by George F. Fuller discussing the epidemiology of falls, evaluation of patients who fall, including risk factor assessment, and fall prevention. Includes tables and figures on fall risk factors, common causes of falls, medications/drugs that may increase fall risk, key physical findings in elderly patients who fall, a home safety checklist, “Up & Go” Test, interventions to decrease risk of falls, and critical steps to reducing fall risk.
- Practicing Physician Education in Geriatrics – Falls Tool Kit. Supported by a grant through the American Geriatrics Society to assist physicians in understanding Geriatric Care. Contains educational materials, suggested guidelines, forms, and tools for patient evaluation, diagnosis, and treatment.
- National Center for Patient Safety (NCPS) – Falls Toolkit. An online “binder” for providers/facilities that have or would like to start a Fall Prevention Program. Notebook includes background information on falls and fall prevention, guide to developing a multi-disciplinary falls team and falls policy, interventions to reduce fall risk and injuries, guide to measuring intervention success, and detailed references and resources.
- Consumer Product Safety Commission – Special Report: Emergency Room Injuries, Adults 65 and older. Information and graphs highlighting falls and injuries among elders relative to household products and appliances.
- National Resource Council- Resources on Falls and Fall Prevention. Links to information from federal agencies, universities, associations and other organizations, and NSC Chapters.
- Supercourse on Falls in Elderly from University of Pittsburgh. PowerPoint presentation on falls: statistics, causes/factors related to falls, and prevention.
- The American Geriatrics Society. Contains Professional tools (i.e. Falls Evaluation and Get Up and Go Test), Patient Forms (i.e. Medical history), Patient Handouts, and additional web-linked resources.
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