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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 Federal 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 exercise assessments. Following assessment, individuals are provided multi-component interventions designed to reduce their fall risk, which may include exercise (i.e., balance, strength, and endurance training), home or environmental modification, medication management, education, or vitamin D supplementation. Patients can also be referred to specialists such as physical therapists for assessment and personally adapted interventions (Stubbs 2015). Falls can lead to physical injuries with long lasting effects, increased risk of early death, and psychological concerns such as fear of falling and loss of confidence (CDC-Falls, Cochrane-Gillespie 2012). Fall prevention efforts are covered as part of the Medicare Annual Wellness Visit (Van Voast Moncada 2017).

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 living in community settings (Tricco 2017, Hill 2015a, Cochrane-Gillespie 2012, Stubbs 2015). Such interventions may also reduce falls among older hospital patients, especially those with longer lengths of stay (Cochrane-Cameron 2012, Cochrane-Gillespie 2012).

Individual risk assessments and tailored home-based exercise programs significantly reduce falls, and improve balance, strength, and function among older adults in community settings (Hill 2015a). Exercise, a typical component of personalized programs, has been shown to reduce fall rates (Sherrington 2017). Approaches that combine exercise and vision assessments with treatment have been shown to reduce injury rates, and including vitamin D and calcium supplements can reduce falls and fractures (Tricco 2017). Tailored balance-challenging exercises have been shown to reduce falls among people with Parkinson's disease (Canning 2014).

Personalized fall prevention efforts can be incorporated into standard practice in both primary care and long-term care settings (Eckstrom 2016). Experts suggest that clinicians inquire about depression (Kvelde 2015) along with foot pain and chronic pain during fall risk assessments, as each is associated with an increased risk of falling (Stubbs 2014).

Implementation

United States

As of 2018, 12 states have laws that require funding for risk assessment and fall prevention activities in community, clinical, and nursing care settings (NCSL-Falls); 6 states have bills pending (NCSL-IPLD-Elderly falls). Some of these laws include provisions that incentivize primary care providers to integrate risk assessments and prevention activities into their practice (NCSL-Falls).

The Centers for Disease Control and Prevention’s (CDC’s) older adult fall prevention program, STEADI (Stopping Elderly Accidents, Deaths, & Injuries), provides tools, online trainings, and educational materials for patients and providers on how to prevent falls, including methods to incorporate STEADI in primary care and family medicine practices (CDC-STEADI, Sarmiento 2017).

Wisconsin

In 1991, the Wisconsin Falls Prevention Initiative (FPI) was developed to reduce falls and fall-related complications across the state. FPI includes health care providers, researchers, educators, organizations serving older adults, social service professionals, and state government officials (WI DHS-Falls).  

As of 2018, Wisconsin has two bills pending which would require health insurance plans to cover fall prevention, counseling, and preventive medications for fall prevention for community-dwelling older adults (NCSL-IPLD-Elderly falls).

Implementation Resources

CDC-Falls - Centers for Disease Control and Prevention (CDC). Older adult falls. Accessed on April 3, 2018
CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients. Accessed on April 3, 2018
CDC-Stevens 2015 - Stevens JA, Burns ER. CDC compendium of effective fall interventions: What works for community-dwelling older adults. 3rd edition. Atlanta: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC). 2015. Accessed on April 3, 2018
IHI-TCAB - Institute for Healthcare Improvement (IHI). Transforming Care at the Bedside how-to guide: Reducing patient injuries from falls. Accessed on April 3, 2018
Mayo Clinic-Falls - Mayo Clinic. Fall prevention: Simple tips to prevent falls. Accessed on April 3, 2018
NCOA-Falls prevention - National Council on Aging (NCOA). National falls prevention resource center. Accessed on April 3, 2018

Citations - Description

CDC-Falls - Centers for Disease Control and Prevention (CDC). Older adult falls. Accessed on April 3, 2018
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 April 3, 2018
Stubbs 2015* - Stubbs B, Brefka S, Denkinger MD. What works to prevent falls in community-dwelling older adults? Umbrella review of meta-analyses of randomized controlled trials. Physical Therapy. 2015;95(8):1095-1110. Accessed on April 3, 2018
Van Voast Moncada 2017* - Van Voast Moncada L, Mire LG. Preventing falls in older persons. American Family Physician. 2017;96(4):240-247. Accessed on April 3, 2018

Citations - Evidence

Canning 2014* - Canning CG, Paul SS, Nieuwboer A. Prevention of falls in Parkinson’s disease: A review of fall risk factors and the role of physical interventions. Neurodegenerative Disease Management. 2014;4(3):203-221. Accessed on April 3, 2018
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 April 3, 2018
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 April 3, 2018
Eckstrom 2016 - Eckstrom E, Neal MB, Cotrell V, et al. An interprofessional approach to reducing the risk of falls through enhanced collaborative practice. Journal of the American Geriatrics Society. 2016;64(8):1701-1707. Accessed on April 3, 2018
Hill 2015a* - Hill KD, Hunter SW, Batchelor FA, Cavalheri V, Burton E. Individualized home-based exercise programs for older people to reduce falls and improve physical performance: A systematic review and meta-analysis. Maturitas. 2015;82(1):72-84. Accessed on April 3, 2018
Kvelde 2015* - Kvelde T, Lord SR, Close JCT, et al. Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning. Archives of Gerontology and Geriatrics. 2015;60(1):190-195. Accessed on April 3, 2018
Sherrington 2017 - Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(24):1750-1758. Accessed on April 3, 2018
Stubbs 2014 - Stubbs B, Binnekade T, Eggermont L, et al. Pain and the risk for falls in community-dwelling older adults: Systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2014;95(1):175-187.e9. Accessed on April 3, 2018
Stubbs 2015* - Stubbs B, Brefka S, Denkinger MD. What works to prevent falls in community-dwelling older adults? Umbrella review of meta-analyses of randomized controlled trials. Physical Therapy. 2015;95(8):1095-1110. Accessed on April 3, 2018
Tricco 2017* - Tricco AC, Thomas SM, Veroniki AA, et al. Comparisons of interventions for preventing falls in older adults: A systematic review and meta-analysis. JAMA. 2017;318(17):1687-1699. Accessed on April 3, 2018

Citations - Implementation

CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients. Accessed on April 3, 2018
NCSL-Falls - National Conference of State Legislatures (NCSL). Elderly falls prevention legislation and statutes. Accessed on April 3, 2018
NCSL-IPLD-Elderly falls - National Conference of State Legislatures (NCSL). Injury prevention legislation database (IPLD). Database search: Elderly falls. Accessed on April 3, 2018
Sarmiento 2017* - Sarmiento K, Lee R. STEADI: CDC’s approach to make older adult fall prevention part of every primary care practice. Journal of Safety Research. 2017;63:105-109. Accessed on April 3, 2018
WI DHS-Falls - Wisconsin Department of Health Services (WI DHS). Falls prevention for older adults. Accessed on April 3, 2018

Page Last Updated

April 2, 2018

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