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Risk assessments & personalized approaches to fall prevention among older adults

Health Factors: Quality of Care Community Safety
Decision Makers: State Government Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 10-19% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Risk assessments that gauge an individual’s risk of falling allow providers to personalize fall prevention interventions based on that individual’s needs. Such assessments are typically provided to older adults by health professionals such as registered nurses or physicians and can include a functional assessment, balance and gait assessments, and/or exercise assessments. Following assessment, individuals are provided multifactorial interventions designed to reduce their poersonal fall risk, which may include exercise (i.e., balance, strength, and endurance training), home or environmental modification, medication optimization, education, or vitamin D supplementation. Patients can also be referred to specialists such as physiotherapists for further care (Cochrane-Cameron 2012). Falls can lead to long-term physical injuries, increased risk of early death, and psychological concerns such as fear of falling and loss of confidence (CDC-Falls, Cochrane-Gillespie 2012).

Expected Beneficial Outcomes

Reduced falls
Reduced injuries

Evidence of Effectiveness

There is strong evidence that individual risk assessments and personalized fall prevention interventions reduce the rate of falls among older adults in hospitals, especially those with longer lengths of stay, and among those in community settings (Cochrane-Cameron 2012, Cochrane-Gillespie 2012). Such interventions may also reduce the risk of falls among older hospital patients and appear to reduce fall-related injuries in nursing care facilities (Cochrane-Cameron 2012). The combination of interventions varies by individual and by setting; additional evidence is needed to determine the most effective combination for each setting.

Implementation

United States

As of July 2014, 11 states have laws that require funding for a variety of risk assessment and fall prevention activities in community, clinical, and nursing care settings. Some of these laws include provisions that incentivize primary care providers to integrate risk assessments and prevention activities into their practice (NCSL-Falls).

Wisconsin

In 1991, the Wisconsin Falls Prevention Initiative (FPI) was developed to reduce falls, and fall-related complications across the state. In 2014, the coalition included health care providers, researchers, educators, and state and local government officials. FPI promotes the implementation of tested fall prevention interventions, including Sure-Step, a multifactorial, individualized intervention for older adults conducted by a physical therapist or a registered nurse (WI DHS-Falls).  

Implementation Resources

CDC-Falls - Centers for Disease Control and Prevention (CDC). Falls - older adults. Accessed on January 26, 2016
CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients. Accessed on February 2, 2016
IHI-TCAB* - Institute for Healthcare Improvement (IHI). Transforming Care at the Bedside how-to guide: Reducing patient injuries from falls. Accessed on January 26, 2016
Mayo Clinic-Falls - Mayo Clinic. Fall prevention: Simple tips to prevent falls. Accessed on February 3, 2016
NCOA-Falls prevention - National Council on Aging (NCOA). National falls prevention resource center. Accessed on January 26, 2016

Citations - Description

CDC-Falls - Centers for Disease Control and Prevention (CDC). Falls - older adults. Accessed on January 26, 2016
Cochrane-Cameron 2012* - Cameron ID, Gillespie LD, Robertson MC, et al. Interventions for preventing falls in older people in care facilities and hospitals: Review. The Cochrane Database of Systematic Reviews. 2012;(12):CD005465. Accessed on January 26, 2016
Cochrane-Gillespie 2012* - Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community: Review. The Cochrane Database of Systematic Reviews. 2012;(9):CD007146. Accessed on January 26, 2016

Citations - Evidence

Cochrane-Cameron 2012* - Cameron ID, Gillespie LD, Robertson MC, et al. Interventions for preventing falls in older people in care facilities and hospitals: Review. The Cochrane Database of Systematic Reviews. 2012;(12):CD005465. Accessed on January 26, 2016
Cochrane-Gillespie 2012* - Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community: Review. The Cochrane Database of Systematic Reviews. 2012;(9):CD007146. Accessed on January 26, 2016

Citations - Implementation

NCSL-Falls - National Conference of State Legislatures (NCSL). Elderly falls prevention legislation and statutes. Accessed on January 26, 2016
WI DHS-Falls - Wisconsin Department of Health Services (WI DHS). Falls prevention--older adults. Accessed on January 26, 2016

Page Last Updated

February 3, 2016

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