Doctor and Patient

CLINICAL PRACTICE GUIDELINES

Algorithm for Fall Risk Screening, Assessment and Intervention

The Algorithm for Fall Risk Screening, Assessment and Intervention describes the systematic process of decision-making and intervention that should occur to address fall risk factors of concern with older adults who live in a community setting. This algorthm is based on the Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons in addition to recommended practice from the CDC’s STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative and other evidence-based literature.

For more information about each section of the algorithm, please click on its corresponding box or click on the following links:

NOTE: The Algorithm, it's accompanying Fall Risk Factor Checklist and other fall prevention resources will be updated on an ongoing basis as new research and best practice are available. 

START HERE

Patient completes the Staying Independent Checklist

Screening for fall risk

 

Calculate the patient's score on their 

Staying Independent Checklist

AND / OR

Ask the patient the following 3 key questions:

    1. Have you fallen in the past year?

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

    2. Do you feel unsteady when standing or walking?

    3. Are you worried about falling? 

Older patient who reports no falls in the past year obtains a score of  3 or less

OR

The patient answers NO to all key questions

Individualized Interventions 

LOW RISK

  • Assess vitamin D intake:

    • Recommend calcium rich foods  and daily​ vitamin D supplement  +/- calcium if deficient

  • Provide relevant fall prevention  information and handouts

  • Encourage the completion of the      Home Safety Checklist

  • Reassess yearly or if the patient presents with any significant change in health status

AND

Recommend 150 minutes of
 moderate- to vigorous-intensity aerobic activity per week with muscle and bone strengthening activities at least twice a week to help with posture and balance

OR

Refer the patient to a community exercise-based fall prevention program

The patient obtains a score of 4 or more on their

 Staying Independent Checklist

OR

The patient answers YES to any of the key questions

Evaluating gait, strength and balance

  • Timed Up and Go (TUG)

  • 4 Stage Balance Test

  • 30-Second Chair Stand Test

Older patient without any gait, strength or balance problems who reports a single fall or less in the past year*

Older patient who demonstrates or report

difficulties with their gait, strength or balance

Conducting a multifactorial  falls risk assessment

  • Complete a Focused History :

    • Review the Staying Independent Checklist with the patient

    • Obtain a history of falls and near-falls

    • Obtain a history of relevant risk factors such as:

      • Urinary / Bowel incontinence 

      • Depression​ / Loneliness

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

    • Assess bone health / nutritional status

    • Complete a medication review according to Beers criteria

  • Complete a Physical Examination :

    • Cognitive screening

    • Visual acuity assessment

    • Cardiovascular examination

      • Measure orthostatic hypotension​

    • Check leg strength / joint function 

    • Pain assessment

    • Assessment for other neurological disorders

    • Feet and footwear check

  • Complete a Functional Assessment :

    • ADL / iADL assessment

    • ​Use of assistive devices

    • Fear of falling (Review the Staying Confident Checklist with the patient)

  • Complete Environmental Assessment :

    • Ask about potential hazards found in and around the home

Individualized Interventions 

HIGH RISK

  • Develop an individualized care plan

  • Provide relevant fall prevention  information and handouts

  • Recommend calcium rich foods    and daily​ vitamin D supplement      +/- calcium, if there is a deficiency

  • Optimize the treatment of all identified comorbidities

  • Minimize medications according to deprescribing guidelines, as appropriate

  • Manage and monitor hypotension

  • Optimize vision

  • Manage foot and footwear problems

  • Optimize home safety

    • Recommend the completion of the Home Safety Checklist

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

AND

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

OR

Refer the patient to a community exercise-based fall prevention program

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 

  • Address any barriers to adherence to the care plan

  • Reassess yearly or if the patient presents with any significant change in health status

AND

Transition towards a community 

exercise-based fall prevention program when the patient is ready, willing and able to participate

*If the patient presents for medical attention because of a fall, reports recurrent (≥2) falls in the past year or reports difficulties with their gait or balance    (with or without activity curtailment), complete a multifactorial fall risk assessment.

 

Based on the Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011; 59(1): 148-157 and adapted from the 2017 STEADI (Stopping Elderly Accidents, Deaths & Injuries)  Algorithm for Fall Risk Screening, Assessment and Intervention by the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (CDC).

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