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:

  1. Direct interventions tailored to the identified risk factors, coupled with an appropriate exercise program.
  2. 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.
  3. The intervention can include mitigation of identified hazards in the home, and evaluation and interventions to promote the safe performance of daily activities.
  4. 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
  5. A community based exercise program that targets strength, gait and balance, such as Tai Chi, yoga or other group classes.

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