Fall Risk Management
The American Medical Association and the American Academy of Orthopaedic Surgeons have recently identified falling as a significant health risk; falls are dangerous and costly. Every year, one third to one half of the population age 65 and over experience falls; half of them do so repeatedly. Falls cause approximately 350,000 hip fractures annually. They frequently result from disorders of balance and equilibrium.
Falls: How big is the problem?
- One in three adults age 65 and older fall each year.
- Less than 50% talk to their healthcare providers about falling or their fear of falling.
- Among older adults (those 65 or older), falls are the leading cause of death from injury.
- In 2009, about 20,400 older adults died from accidental fall injuries.
What outcomes are linked to falls?
- 20% – 30% of falls result in moderate to severe injuries; lacerations, hip fractures, or head trauma.
- Falls are the most common cause of traumatic brain injuries (TBI).
- In 2000, TBI accounted for 46% of fatal falls among older adults.
- Most fractures among older adults are caused by falls; Over 95% of hip fractures are caused by falls.
- Fear of falling results in limited functional activities; in turn increasing a person’s fall risk.
What can be done to improve my balance and reduce my risk of falling?
SCREENING AND ASSESSMENT
We undertake a comprehensive screening and multifactorial assessment of your Fall Risk Index. Using guidelines offered by the American Geriatric Society and its fall prevention recommendations we:
1. Take a Focused History
- Including history of falls and/or near misses, detailing the circumstances of the fall(s), their frequency, symptoms at time of a fall, injuries sustained and any other consequences.
- Review of medications: All prescribed and over-the-counter medications with dosages.
- History of relevant risk factors: Acute or chronic medical problems (e.g., osteoporosis, urinary incontinence, cardiovascular disease).
- Administer established fall risk measurement instruments.
2. Perform a Physical Examination
- Detailed assessment of gait, balance, and mobility levels and lower extremity joint function.
- Neurological function: Cognitive evaluation, lower extremity peripheral nerves, proprioception, reflexes.
- Muscle strength and coordination of the lower extremities.
- Cardiovascular status: Heart rate and rhythm, postural pulse, blood pressure, and, if appropriate, heart rate and blood pressure responses to carotid sinus stimulation
- Assessment of visual acuity
- Examination of the feet and footwear
- Computerized Dynamic Posturography [CDP] using NeuroCom Smart Balance Master technology; composite scoring offers Fall Risk Index.
3. Render Functional Assessment
- Assessment of activities of daily living (ADL) skills including use of adaptive equipment and mobility aids, as appropriate
- Assessment of the individual’s perceived functional ability and fear related to falling
- CDP using state-of-the-art NeuroCom technology
4. Environmental Assessment
- Environmental assessment including home safety; through interview.
- On-site evaluation upon special request.
5. Intervention Recommendations may include:
- Direct interventions tailored to the identified risk factors, coupled with an appropriate exercise program.
- A strategy to reduce the risk of falls, including:
- multifactorial assessment of known fall risk factors,
- management of the risk factors identified,
- adaptation or modification of home environment.
- The intervention can include mitigation of identified hazards in the home, and evaluation and interventions to promote the safe performance of daily activities.
- All older adults who are at risk of falling will be offered:
- A therapeutic exercise program incorporating balance, gait, and strength training. Flexibility and endurance training will also be offered,
- But not as sole components of the exercise program.
- Supervised directly
- Monitored closely
- Guided remotely
- A community based exercise program that targets strength, gait and balance, such as Tai Chi, yoga or other group classes.