CLINICAL PRACTICE GUIDELINES

Multifactorial Fall Risk Assessment

Key Recommendations

  • A multifactorial falls risk assessment is not considered necessary for older patients reporting only a single fall in the past year without reported or demonstrated difficulty or unsteadiness during the evaluation.

  • Conduct a multifactorial fall risk assessment if the older patient meets one of the following conditions:​​

  • Presents for medical attention because of a fall

  • Reports recurrent (≥2) falls in the past year

  • Obtains results of the mobility assessment tests which indicates that the patient scored below the normal range for their age

  • Reports difficulties with their gait or balance        (with or without activity curtailment)

  • Consider obtaining support from other members of the collaborative team to complete certain aspects of the clinical evaluation. 

Conducting a multifactorial falls risk assessment

  • Complete a Focused History including:

    • Reviewing the Staying Independent Checklist with the patient

    • Obtaining a history of falls and near-falls

    • Obtaining a history of relevant risk factors such as:

      • Urinary incontinence 

      • Depression​ / Loneliness

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

    • Assessing bone health / nutritional status

    • Completing a medication review according to Beers criteria

  • Complete a Physical Examination including:

    • Cognitive screening

    • Visual acuity assessment

    • Cardiovascular examination

      • Measure orthostatic hypotension​

    • Lower extremity muscle strength / joint function assessment

    • Pain assessment

    • Assessment for other neurological disorders

    • Feet and footwear examination

  • Complete a Functional Assessment including:

    • ADL / IADL assessment

    • ​Use of assistive devices

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

  • Complete an Environmental Assessment including:

    • Asking about potential hazards found in and around the home

NOTE: The multifactorial fall risk assessment should include a Focused History, a Physical Examination, a Functional Assessment                and an Environmental Assessment.

Focused History

  • The history of falls and near-falls should include a detailed description of the circumstances surrounding each incident such as frequency, symptoms at the time of the fall, the presence of fall-related injuries and other consequences.

  • The history of relevant risk factors should include efforts to identify acute or chronic medical problems which would contribute a significant increase in the older patient's risk of falling or a fall-related injury.

  • The medication review according to Beers criteria should include an account of all prescribed and over-the-counter medications with dosages.

Physical Examination

 

  • In addition to a cognitive screen, the evaluation of neurological function should include tests of cortical, extrapyramidal and cerebellar function and an assessment of proprioception, reflexes and peripheral nerves for possible impaired sensation.

  • Screening for possible cognitive impairment should be completed with the help of validated tests such as the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Exam (MMSE) or the Mini-Cog.

  • Remember to assess the older patient for possible postural dizziness and/or orthostatic hypotension during the cardiovascular examination.

Functional Assessment

  • In addition to an assessment of Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL), the functional assessment should include an account of the use of adaptive equipment and mobility aids, as appropriate.

  • An assessment of perceived functional ability and fear of falling should also be completed with attention to the extent to which concerns about falling are appropriate given the older patient's abilities or their level of deconditioning.

  • We encourage you to review the Staying Confident Checklist with the patient to help determine their level of concern about falling. For a copy of the checklist, please click on the following image. 

Staying Confident - English.png

Environmental Assessment

  • Most fall-related injuries in older adults occur inside the home. However, it is important to remember that a significant number of falls occur outside but near the home such as on curbs or sidewalks.

  • Exposure to certain environmental hazards such as black molds and asbestos may increase an older patient's risk of falling by impairing their lung function.

  • Consider obtaining support from the NB Extra-Mural Program to proceed with a comprehensive home environment assessment, if needed. To request a referral, click on the provided link for a copy of the EMP Referral Request Form and follow the instructions to submit.

Next Step:

After completing a Multifactoriral Fall Risk Assessment, proceed with the development of an individualized care plan outlining all recommended interventions for the older patient at HIGH RISK for falls.

Resources

 

Additional Resources

for

Healthcare

Professionals