By Jordan Hoffman, PT, DPT
SLC Lead Clinician, Pennsylvania

A third of older adults fall at least once over a year^[1]. These frequent falls result in far more than just a risk of injury at the time of the incident. One fall may lead to an ongoing fear of falling, which then leads to decreased activity and a subsequent decline in conditioning. All of these factors are common after experiencing a fall — and unfortunately, they make future falls even more likely.

That’s why it’s important to be aware of an older adult’s risk of falling at any given time.

Many factors contribute to an increased risk of falls, such as reduced postural responses, decreased sensory input, impaired musculoskeletal, neuromuscular, and cardiopulmonary systems, deconditioning, depression, polypharmacy, and environmental factors. That’s a lot of factors to consider, and a lot to assess during an evaluation!

Three Areas for Assessing Fall Risks in Older Adults

Staying up-to-date on how to properly and accurately assess fall risk is important for any physical therapist treating older adults. Lusardi, et al set out to find what medical questions, performance-based measures, and self-report measures were the best predictors of fall risk when used in conjunction with another.

The following criteria provide an assessment to help understand your patient’s or loved one’s fall risk: 

5 Medical Questions

These medical questions cover scenarios commonly seen in older adults who have experienced a fall. The likelihood of a fall increases with each question answered “yes.”

1. Do you have a previous history of falls?
2. Do you take any psychoactive medications?
3. Do you need assistance with any ADLs?
4. Are you fearful of falling?
5. Do you use an assistive device?

2 Performance-Based Measures

These two performance indicators test strength and agility, which impact fall risk. Testing these areas can provide insight that will help you address the increased fall risk.

1. Single-limb stance
   1. If a patient cannot maintain for 6.5 seconds, the patient is at an increased fall risk.
2. Gait Speed
   1. If a patient walks less than 1.0 m/s the patient is at an increased fall risk.

2 Self-Report Measures

Self-report measures give a great insight into how the patient is feeling and perceiving their condition. With these results, clinicians can be more effective in treating the whole person including physical and mental condition.

1. Geriatric Depression Scale
   1. If positive, the patient is at an increased fall risk
2. Fall Efficacy Scale[2]
   1. If positive, the patient is at an increased fall risk

With the information from each of the areas, you can most effectively assess your patient’s fall risk, and tailor their treatment accordingly. You can also empower them to take better care of themselves. This can reduce fear, and lead to improved conditioning as patients feel more confident.

Predict and Prevent Falls for Better Outcomes

These predictors can help you better treat your patients and empower them to take steps to prevent falls. These predictors don’t take very much time to assess. Many of the medical questions are already covered by clinicians during an initial evaluation. The performance-based measures take less than 5 minutes to complete combined. It’s worthwhile to spend time assessing fall risk so you can predict and prevent future incidents.

These clinical predictors are the most effective to determine an increased risk for falls in the geriatric population. Lusardi, et al also went a step further, stating that the listed questions and measures will help determine if more in-depth performance-based measures are needed. Those additional performance-based measures to determine risk for falls are the Berg, Timed Up and Go, and Five Time Sit to Stand.

In my practice, I have been implementing these questions and measures in evaluations in which a fall risk is present, and I have noticed that my evaluation time is much more productive and serves my patients better. Learning how to assess fall risk is a vital tool to help geriatric populations and older adults gain the best outcomes from their treatment.

Reference:

1. Lusardi, Michelle M. PT, DPT, PhD1; Fritz, Stacy PT, PhD2; Middleton, Addie PT, DPT, PhD3; Allison, Leslie PT, PhD4; Wingood, Mariana PT, DPT, GCS5; Phillips, Emma PT, DPT, GCS6; Criss, Michelle PT, GCS7; Verma, Sangita PT, DPT, GCS8; Osborne, Jackie PT, DPT, GCS9; Chui, Kevin K. PT, DPT, PhD, GCS, OCS10. Determining Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability. Journal of Geriatric Physical Therapy 40(1):p 1-36, January/March 2017. | DOI: 10.1519/JPT.0000000000000099 ↩︎