Doctor and Patient

Clinical Practice Guidelines

Algorithm for Fall Risk Screening, Assessment and Intervention

The Algorithm for Fall Risk Screening, Assessment and Intervention outlines the recommended process to address fall risk factors of concern with your older patients. Keep in mind that your clinical judgement should also take into account the older person's ability of readiness to address their risk factors, the availability of family support and their preferences, in addition to their risk of falling.

 

This tool will be updated on an ongoing basis as new research, best practice and resources are available. 

START HERE

Patient completes the Staying Independent brochure

Screening for fall risk

Patient scores ≥4 on the Staying Independent brochure

OR

Patient answers YES to any of the 3 key questions:

    1. Fell in the past year?

          -If YES ask, How many times? Were you injured?

    2. Feels unsteady when standing or walking?

    3. Worries about falling? 

Score < 4

OR

Answers NO to all questions

Individualized Interventions 

LOW RISK

  • Educate patient about fall prevention

  • Assess vitamin D intake:

    • If deficient, recommend daily​ vitamin D supplement +/- calcium

  • Encourage the completion of the Home Safety Checklist

  • Reassess yearly, or any time the patient presents after an acute fall

AND

Refer to a community exercise program either done alone or in a group setting

Patient score on the Staying Independent brochure

OR

Patient answers YES to any of the key questions

Evaluating gait, strength and balance

  • Timed Up and Go

  • 4 Stage Balance Test

  • 30-Second Chair Stand Test

Older patient without any gait, strength or balance problems*

Individualized Interventions 

Moderate RISK

  • Educate patient about fall prevention

  • Assess vitamin D intake:

    • If deficient, recommend daily​ vitamin D supplement +/- calcium

  • Encourage the completion of the Home Safety Checklist

  • Reassess yearly, or any time the patient presents after an acute fall

AND

Refer to a physical therapist to improve gait, strength and balance

OR

Refer to a community exercise-based   fall prevention program

Older patient with a gait, strength or balance problem

 2 Falls

No Falls

1 Fall

With an injury

Without any injury

Conducting a multifactorial  fall risk assessment

  • Review the Staying Independent brochure with the patient

  • Obtain a complete history of falls

  • Identify all comorbidities such as:

    • Depression​

    • Cognitive impairment

    • Osteoporosis / Vitamin intake

  • Complete a medication review

  • Physical examination including:

    • Postural dizziness /          postural hypotension​

    • Feet and footwear check

    • Use of assistive devices

    • Visual acuity assessment

  • Ask about potential hazards found in and around the home​

  • Ask about potential use of alcohol and/or other substances 

Individualized Interventions 

HIGH RISK

  • Develop an individualized care plan

  • Educate patient about fall prevention

  • Recommend daily​ vitamin D supplement +/- calcium, if deficient

  • Optimize the treatment of all identified comorbidities

  • Minimize medications

  • Manage and monitor hypotention

  • Manage foot and footwear problems

  • Refer to physical therapist to enhance functional mobility and improve gait, strength and balance

  • Optimize vision

  • Optimize home safety

    • Consider a referral to occupational therapy ​to help address concerns

Individualized Interventions 

FOLLOW UP

  • Completed with patient within 30 to 90 days following their last visit

  • Review the care plan

  • Assess and encourage fall risk reduction behaviors

  • Discuss ways to improve patient receptiveness to the care plan and address any barriers to adherence

AND

Transition to maintenance with an  exercise-based fall prevention program when the patient is ready

*For these patients, consider additional fall risk assessment (e.g. medication review, cognitive screen, syncope).

 

Adapted from the STEADI (Stopping Elderly Accidents, Deaths & Injuries) Algorithm for Fall Risk Screening, Assessment and Intervention.

Developed by the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (CDC).

Resources

 

  • Algorithm for Fall Risk Screening, Assessment and Intervention

  • Staying Independent - Self Screening Tool

MEDICAL DISCLAIMER

The information contained on this website is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your primary care provider or a qualified healthcare professional with any questions you may have regarding any medical condition, or before beginning any exercise program.

Toll Free Senior Line 

 

The toll-free Seniors Information Line provides  a traditional method of speaking with a bilingual, customer-service oriented telephone agent. For basic information on government programs and services for seniors, their families and caregivers please contact:

1-855-550-0552

Tele-Care 

 

If you or someone you know requires non-urgent health advice or information, call Tele-Care. A registered nurse will assess your needs and provide information, education and/or advice as required. For access to this confidential and bilingual toll-free telephone service, 24 hours a day, seven days a week please dial:

8-1-1

For medical emergencies, immediately call  911  or visit your local emergency department.

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