Introduction

Falls are the leading cause of injury in adults over age 65.3 In the United States, one third of community-dwelling elders fall each year, with 10% of falls resulting in serious injury.1 Injuries from falls can lead to disability, loss of independence, and fear of falling among the elderly, with subsequent implications for overall health and well-being.1 Adults over age 85 are at highest risk of suffering falls, and many of them are fatal.2 Older adults with impaired cognition and judgement, altered level of consciousness, sensory disturbances, dehydration, infection, electrolyte imbalances, incontinence, medication toxicity, depression, and recent history of falls are at high risk of falling.2,3

Interprofessional Assessment and Collaborative Interventions

Interprofessional fall prevention programs are essential to reducing falls in both the clinical and community setting. Nurses play a key role in assessing patients for fall risk and enforcing general safety precautions in the hospital, including frequent environmental assessment, close patient surveillance, safety rounds, toileting rounds, and one-to-one observation of patients at risk.2 Commonly used tools for assessing fall risk include the Falls Risk Assessment Tool and the timed Get-Up-and-Go test.3 Health care providers and pharmacists are instrumental in evaluating appropriateness of patients’ medications, including those carrying dangerous side effects such as drowsiness, mental confusion, orthostatic hypotension, and functional incontinence that increase fall risk. Psychotropic medications such as benzodiazepines, sedatives hypnotics, antidepressants, antiarrhythmics, digoxin, and diuretics also pose a risk, and patients’ response to these medications must be carefully monitored to ensure safety.2,3

In addition to ordering bed and chair alarms for patients to alert staff to potential falls, acute care providers can refer patients to physical and occupational therapy services for help with ambulation and use of assistive devices to improve strength, balance, and gait.1,2 For patients in the community, visiting nurses and providers should assess the home environment for potential hazards and make adjustments accordingly, such as clearing clutter from the hallways, removing rugs and carpeting, and ensuring adequate lighting. It will also be important for patients to have corrective lenses and assistive devices within reach while at home.1,2 Along with regular exercise and physical therapy for older adults at increased risk for falls, vitamin D supplementation is recommended by the U.S. Preventive Services Task Force to improve muscle strength and balance and subsequently reduce falls.3 Pharmacists and registered dietitians can be consulted by providers to consider adding supplementation to a patient’s daily medication regimen.

The American Geriatric Society (AGS) recommends that primary care providers complete a multifactorial risk assessment for patients with a history of falls each year. The assessment should include a focused medical history, physical examination, functional assessment, and environmental assessment to evaluate patients’ balance, gait, mobility, vision, medications, and home environment. Once this baseline information is obtained, providers can address identified risk factors with comprehensive treatment and management plans.3Older adults who have previously fallen are also likely to have a fear of falling again. Social workers and psychologists can assist these patients in working through this fear to continue staying active in the community and at home.Family members, friends, and caregivers can also assist in maintaining fall risk precautions for patients in the community and to keep them engaged in activities to avoid isolation and counteract fear of falling.3

If a patient is being evaluated directly following a fall, the interprofessional team will need to perform a thorough assessment to identify any sustained injuries, including frequent vital signs, pain assessment, and neurological evaluation. Slurred speech or any change in cognitive status will warrant a referral to a neurologist to rule out intracranial bleeding and other complications. Patient’s gait and functional status should also be evaluated for changes that may indicate injury and must be addressed by the team.2

Interprofessional contacts for this topic:

Primary care providers

Acute care providers

Registered nurses

Pharmacists

Registered dietitians

Social workers

Psychologists

Physical therapists

Occupational therapists

Home health aides

Neurologists

Link to the following evidence-based protocols:

Assessing cognition

Falls

Frailty

Function

Medication

Pain

Urinary incontinence

References

1Kelsey, J.L., Procter-Gray, E., Hannan, M.T., & Li, W. (2012). Heterogeneity of falls among older adults: Implications for public health prevention. American Journal of Public Health, 102(11), 2149-2156.

2Gray-Miceli, D., & Quigley, P. A. (2012). Fall prevention: Assessment, diagnoses, and intervention strategies. In M. Boltz, E. Capezuti, T. Fulmer, & D. Zwicker (Eds.), Evidence-based geriatric nursing protocols for best practice (4th ed., pp. 268-297). New York, NY: Springer Publishing Company.

3Moyer, V.A. (2012). Prevention of falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 157(3), 197-204.