Assessment Helps Lower Fall Risk

Abstract

Just as there are many causes for falls among older adults, there also are many prevention strategies. The key to finding the right ones for each patient is to perform a thorough fall risk assessment, according to experts speaking in a Web-based conference sponsored by ECRI, a nonprofit health services research agency. Effective fall prevention can make a big difference in quality of life for seniors and give residents and caregivers a greater sense of peace. And, as with all safety measures, effective fall prevention also can mean savings for long-term care facilities. The majority of falls (60%) occur in the home environment, and 30% of falls occur in an institutional setting. It's estimated that 30% of falls in acute care facilities and 20% of falls in long-term care facilities result in “serious injury,” said Karen Holloway, a risk management analyst at ECRI and primary author of the organization's new guide “Falls Prevention Strategies in Healthcare Settings.” Of those who sustain hip fractures, 50% never return to their normal level of functioning. The cost of treating the 20% of falls resulting in serious injury in long-term care facilities in 2005 is estimated at $4.9 billion, excluding physician fees, according to the Center for Injury Prevention and Control and Treatment Costs data. Defensive barriers form the core of fall prevention strategies, according to Patricia Quigley, Ph.D, deputy director of the Veterans Health Administration's Patient Safety Center of Inquiry in Tampa. Fall prevention with defensive barriers may best be described through the “Swiss cheese theory,” she said. Defensive barriers to falls can be thought of as holes in a block of Swiss cheese. For a fall to occur, all of the holes have to line up—in other words, all of the barriers have to fail. Fall prevention assessments can be invaluable in pulling together the most effective defensive barriers for each patient. One effective model has been established at several VA centers, where fall risk assessments are performed for all patients at these clinics. The assessment team spans several disciplines, including a geriatrician, an advanced registered nurse practitioner, a physical therapist (who specializes in balance problems), and a pharmacist. The 2-hour fall risk assessment attempts to identify potential causes for falls and includes evaluations of vital signs, visual acuity and depth perception, and deep tendon reflexes, lower extremity sensory testing, a neurologic assessment, laboratory tests, and imaging. In an ongoing analysis of the reasons patients were referred to her falls clinic, accident and environmental factors accounted for 37%, followed by weakness and balance and gait disorders (12%), dizziness and vertigo (8%), and orthostatic hypotension (5%). Other reasons (acute illness, confusion, poor eyesight, and drugs) together accounted for 18%. Certain medications also contribute to fall risk, especially psychotropics, diuretics, antiarrhythmics, and digoxin. When assessing the home environment, an assessment team looks for uneven ground, and scrutinizes steps or ramps into the house and entry stairs. It also looks for clutter, throw rugs, problem floor surfaces, quality of lighting, and bathroom issues such as nonslip shower mats and grab bars. The team also tries to determine whether assistive devices are being used or are appropriate. Once the assessment is completed, the team evaluates the findings to develop an individualized fall prevention plan. In cases where a fall has occurred, the mnemonic SPLATT (Symptoms, Previous Falls, Location, Activity, Time, and Trauma) can provide a framework for doing a postfall evaluation to identify risk factors for additional falls. The algorithm could help narrow in on interventions to reduce fall risks, Dr. Quigley said. The ECRI guide is available for purchase by visiting www.ecri.org/Products_and_Services/Products.