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CLINICAL PRACTICE GUIDELINES

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Individualized Fall Prevention Interventions - HIGH RISK PATIENT

Key Recommendations

  • The healthcare professional or the team that conducted the fall risk assessment should develop the individualized care plan and complete the interventions or ensure that other qualified healthcare professionals conduct the interventions.

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  • Education of older patients and caregivers is important for implementation and sustained use of fall prevention strategies.

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  • Studies have shown a beneficial effect of vitamin D supplementation in fall prevention distinct from its effect on bone health.

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  • Vitamin D deficiency contributes to impaired muscle strength and neuromuscular function.

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  • Prochaska and DiClemente's Stages of Change Model can be used to facilitate conversations with older patients and assist with their acceptance of fall prevention strategies such as exercising regularly and making home safety modifications.

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  • In addition to providing verbal information, effective education efforts include opportunities to obtain fall prevention resources in the older patient's language and format of choice. (e.g. links to electronic copies, giving printed handouts, videos)​​

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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

  • We encourage you to refer your older patients to this website for access to electronic copies of our fall prevention resources which are available in both official languages.

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NOTE: In addition to the results of the multifactorial fall risk assessment, when developing an individualized care plan your clinical                          judgement should take into account: the older patient's ability and willingness to address their risk factors; their choices and                        preferences and the availability of social support such as caregivers, family members and friends.

Minimization of Medications

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  • Try to minimize medications according to deprescribing guidelines, as appropriate. If discontinuation of a particular high-risk medication is not possible, dose reduction should be considered.

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  • Higher fall risk occur with psychotropic medication use and polypharmacy.

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  • Older adults covered under the NB Prescription Drug Program who take three or more prescriptions for chronic conditions are eligible to have a publicly-funded, annual medication review with their pharmacist as part of the NB PharmaCheck program.

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Addressing Home Hazards

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  • Older patients should complete their Home Safety Checklist along with its accompanying Personal Action Plan checklist to help identify and manage some of the most common hazards in and around the home.​

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  • Examples of home safety improvements can include enhancing doorway lighting, fixing uneven floors or installing a stairlift system. 

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  • A referral to the New Brunswick Extra-Mural Program may be necessary for certain older patients to help address home hazards and ensure a proper implementation of comprehensive home safety measures. To request a referral, click on the provided link for a copy of the EMP Referral Request Form and follow the instructions to submit.

Physical Activity

 

  • Exercise in the form of strength training and balance, gait and coordination training may be considered as a single intervention. However, studies show that exercise may be more effective when applied alongside other interventions. 

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  • Exercise programs should be initiated with caution. Some studies have shown that exercise may increase the rate of falls in older adults with limited mobility who are not accustomed to physical activity.

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  • A referral to a physical therapist or to the New Brunswick Extra-Mural Program may be necessary for certain older patients for in-person sessions in a clinical or a home-care setting to safely enhance functional mobility and improve gait, strength and balance. 

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  • Participation in a physical activity program which focuses on improving mobility, balance and coordination may be of greater benefit for certain older patients at higher risk of falls. Some exercise-based fall prevention programs also include the delivery of fall prevention information and handouts to participants during each session.

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  • For more information about available exercise-based fall prevention programs within New Brunswick, please click on the following link.

Next Step:

Complete a FOLLOW UP of individualized interventions with the older patient within 30 to 90 days of their last visit.

Resources

 

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  • NB PharmaCheck Guidance Document

    • Developed by NB Department of Health

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Additional Resources

for

Healthcare

Professionals

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