Fall prevention primer for the primary care practitioner: Review, updates and practical application
Abstract
ABSTRACT:
One of three older adults age 65+ fall each year, and every 20 minutes an older adult dies due to injuries sustained during a fall. Yet, most patients do not report falls to their physician. Primary care practitioners (PCPs) are well positioned to screen for fall risk and add proactive referral patterns to both well-selected practitioners and evidence-based fall prevention (EBFP) programs designed to help older patients stay healthy, active, and independent.
The purposes of this review are to summarize the data related to the impact of falls; review efficient and reliable screening tools that identify individuals at high fall risk; describe appropriate referrals that facilitate a match between individual specific risk factors and interventions; and, highlight evidence-based fall prevention (EBFP) programs available to significantly decrease fall risk with outstanding return on investment.
Simple administrative changes in a PCP’s practice accompanied by appropriate referrals will result in proactive fall prevention including lower rates of falls and fall injuries and fewer hospitalizations and/or hospital readmissions. Fall risk screening can be built into practice to seamlessly add services without impacting practitioner productivity. Additionally, reporting fall risk screening and prevention activities in the Physician Quality Reporting System will positively impact practice Medicare reimbursement rates.
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AGS. (2016, August 11). AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons. Retrieved from Screening and Assessment: http://www.americangeriatrics.org/index.php?url=health_care_professionals/clinical_practice/clinical_guidelines_recommendations/prevention_of_falls_summary_of_recommendations
AHRQ. (2016, August 17). AHRQ: National Guideline Clearinghouse. Retrieved from Fall prevention. In: Evidence-based geriatric nursing protocols for best practice: https://www.guideline.gov/summaries/summary/43933
American Association of Retired Persons. (n.d.). AARP Home Fit Guide. Retrieved from AARP: http://assets.aarp.org/www.aarp.org_/articles/families/HousingOptions/200590_HomeFit_rev011108.pdf
Anam Zia, 1. S. (2016). The consumption of two or more fall risk-increasing drugs. Geriatr Gerontol Int 2016, 1-8.
Bakker, R. (2005, 10 1). GEM Environmental Assessment. Retrieved from Cornell University - Gerontological Environment Modifications: http://www.environmentalgeriatrics.com/pdf/enviro_assessment.pdf
Barrett MM, D. E. (2013). Reduced vision selectively impairs spatial updating in fall-prone older adults. Multisens Res, 26 (102): 69-94.
Boutin T, K. M. (2012). Vision in the global evaluation of older individuals hospitalized following a fall. J Am Med Dir Assoc, 13(2): 187.e15-9.
Bulloch MN, O. J. (2014). Instruments for evaluating medication use and prescribing in older adults. J Am Pharm Assoc (2003)., 530-7.
CDC. (2015, September 21). Hip Fractures Among Older Adults. Retrieved from Home and Recreational Safety: http://www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html
CDC. (2015, August 16). Tai Chi Moving for Better Balance Guide for Implementation. Retrieved from Fall Prevention Activity for Seniors: http://www.taichimovingforbetterbalance.org/
CDC. (2016, August 10). Home and Recreational Safety: Important Facts about Falls. Retrieved from CDC: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
CDC. (2016, July 26). Make older adult fall prevention part of your clinical practice pdf. Retrieved from CDC's STEADI website: http://search.cdc.gov/search?utf8=%E2%9C%93&affiliate=cdc-main&query=falls+every
CDC. (2016, August 12). STEADI. Retrieved from STEADI Maaterials for Health Care Providers: http://www.cdc.gov/steadi/materials.html
CDC. (2016, August 12). STEADI. Retrieved from STEADI Materials for Health Care Providers: Tests: http://www.cdc.gov/steadi/materials.html
CDC. (2016, August 12). STEADI. Retrieved from Instructional Videos for Health Care Providers: http://www.cdc.gov/steadi/videos.html
CDC. (2016, August 10). STEADI - Older Adult Fall Prevention. Retrieved from STEADI: http://www.cdc.gov/steadi/index.html
Chaiwanichsiri D, J. S. (2009). Foot disorders and falls in older persons. Gerontology, 55(3): 296-302.
Chien MH, G. H. (2014). Nutritional status and falls in community-dwelling older people: a longitudinal study of a population-based random sample. PLoS One, 9(3): e91044.
Chowdhury PP1, M. T. (2016). Surveillance for Certain Health Behaviors, Chronic Diseases, and Conditions, Access to Health Care, and Use of Preventive Health Services Among States and Selected Local Areas. MMWR Surveill Summ., Apr 29;65(4):1-142. doi: 10.15585/mmwr.ss6504a1.
Cockayne S, A. J. (2014). The REFORM study protocol: a cohort randomised controlled trial of a mutlifaceted podiatry intervention for the prevention of falls in older people. BMJ Open, 4(12): e006977.
Comans T, B. S. (2009). A break-even analysis of a community rehabilitation falls prevention service. Aust N Z J Public Health, 33(3): 240-45.
Crews JE, C. C. (2016). Falls Among Persons Aged > 65 Years With and Without Severe Vision Impairment - United States, 2014. MMWR Morb Mortal Wkly Rep, 65(17): 433-7.
Crews, Chiu-Fung, Stevens, & Saaddine. (2016, august 16). Falls Among Persons Aged ≥65 Years With and Without Severe Vision Impairment — United States, 2014. Retrieved from CDC MMWR: http://www.cdc.gov/mmwr/volumes/65/wr/mm6517a2.htm?s_cid=mm6517a2_e
Criter RE, H. J. (2016). Audiology patient fall statistics and risk factors compared to non-audiology patients. Int J Audiol, 22: 1-7.
Cumming RG, T. M. (1999). Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. J Am Geriatr Soc. , 1397-402.
Dhital A, P. T. (2010). Visual loss and falls: a review. Eye, 24(9): 1437-46.
Ding L1, Y. F. (2016). Muscle weakness is related to slip-initiated falls among community-dwelling older adults. J Biomech, 238-43.
Ducic I, S. K. (2004). Relationship between loss of pedal sensitivity, balance, and falls in patients with peripheral neuropathy. Ann Plast Surg, 52(6): 535-40.
Elliott. (2014). The Glenn A. Fry award lecture 2013: blurred vision, spectacle correction, and falls in older adults. Optom Vis Sci., 593-601.
Fonad E, R. W. (2015). Associations between falls and general health, nutrition, dental health and medication use in Swedish home-dwelling people aged 75 years and over. Health Soc Care Community, 23(6): 594-604.
Geldman F, C. H. (2008). Falls and the physical environment: a review and a new multifactorial falls-risk conceptual framework. Can J Occup Ther, 75(2): 82-95.
Gerson LW, C. J. (2005). Home modifications to prevent falls by older ED patients. Am J Emerg Med, 23(3): 295-8.
Gillespie LD, R. M. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, Sep 12(9): CD007146.
Gillespie LD1, R. M. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev., 1-420.
Harvey LA, M. R. (2014). Determinants of uptake of home modifications and exercise to prevent falls in community-dwelling older people. Aust N Z J Public Health, 38(6): 585-90.
Haynes M1, L. P. (2015). A matter of balance: older adults taking control of falls by building confidence. Front Public Health., Apr 27;2:274. .
Health Quality Ontario. (2008). Prevention of falls and fall-related injuries in community-dwelling seniors: an evidence-based analysis. Ont Health Technol Assess Ser, 8(2): 1-78.
Heinrich S, R. K. (2013). Cost-effectiveness of a multifactorial fall prevention program in nursing homes. Osteoporos Int, 24(4): 1215-23.
Hirose T, H. J. (2013). Accumulation of geriatric conditions is associated with poor nutritional status in dependent older people living in the community and in nursing homes. Geriatrics & Gerontology Int, 14(1): .
Hita-Contreras F, M.-A. A.-D.-L. (2015). Osteosarcopenic obesity and fall prevention strategies. Maturitas, 80(2): 126-32.
Hong T, M. P. (2014). Visual impariment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountain Eye Study. Invest Ophthalmol Vis Sci, 55(11): 7589-93.
Isenring E, B. J. (2013). Malnutrition and falls risk in community-dwelling older adults. J Nutr Health Aging, 17(3): 277-9.
J, C. (2015). Emerging therapeutic concepts for muscle and bone preservation/building. Bone, 80: 150-6.
Jiam NT, L. C. (2016). Hearing loss and falls: A systematic review and meta-analysis. Laryngoscope, doi: 10.1002/lary.25927.
Kamei T, K. F. (2015). Effectiveness of a home hazard modification program for reducing falls in urban community-dwelling older adults: A randomized controlled trial. Jpn J Nurs Sci, 12(3): 184-97.
Kamil RJ, B. J. (2016). Association of Hearing Impairment With Incident Frailty and Falls in Older Adults. J Aging Health, 28(4); 644-60.
Karlsson MK, V. T. (2013). Prevention of falls inthe elderly: a review. Scand J Public Health, 41(5): 442-54.
Keall MD, P. M.-C. (2015). Home modifications to reduce injuries from falls in the home injury prevention intervention (HIPI) study: a cluster-randomised controlled trial. Lancet, 385(9964): 231-8.
Kelsey JL, B. S.-G. (2010). Indoor and outdoor falls in older adults are different: the maintenance of balance, independent living, intellect, and Zest in the Elderly of Boston Study. J Am Geriatr Soc, 58(11): 2135-41.
Leveille SG, K. D. (2008). The MOBILIZE Boston Study: design and methods of a prospective cohort study of novel risk factors for falls in an older population. BMC Geriatr, 8:16. doi: 10.1186/147-2318-8-16.
Li, F. (2013). Tai Ji Quan exercise for people with Parkinson's Disease and other neurodegenerative movement disorders. International Journal of Integrative Medicine.
Lin FR, F. L. (2012). Hearing Loss and Falls Among Older Adults in the United States. Arch Intern Med, 172(4): 369-71.
Lord SR, S. S. (2010). Vision and falls in older people: risk factors and intervention strategies. Clin Geriatr Med, 26(4): 569-81.
Madigan M, R. N. (2014). Obesity as a Factor Contributing to Falls in Older Adults. Curr Obes Rep, 3(3): 348-54.
Mahler M, S. A. (2012). Appetite and falls: Old age and lived experience. Int J Qual Stud Health Well-being, 7.doi: 10.3402/qhw.v7i0.11540.
MaineHealth. (2016, August 16 ). A MOB Lay Leader Model Master Trainer Sites by State. Retrieved from Where is A MOB offered?: http://www.mainehealth.org/mh_body.cfm?id=5195
MaineHealth. (2016, August 16). Partnership for Healthy Aging. Retrieved from What is A Matter of Balance?: http://www.mainehealth.org/mob
Maki BE, C. K. (2008). Preventing falls in older adults: new interventions to promote more effective change-in-support balance reactions. J Electromyogr Kinesiol, 18(2): 243-54.
Menant JC, S. J. (2008). Optimizing footwear for older people at risk for falls. J Rehabil Res Develop, 45(8): 1167-82.
Menant JC, W. A. (2016). Depressive Symptoms and Orthostatic Hypotension Are Risk Factors for Unexplained Falls in Community-Living Older People. J Am Geriatr Soc., 1073-8.
Menz HB, L. S. (2001). The contribution of foot problems to mobility impairment and falls in community-dwelling older people. J Am Geriatr Soc, 49(12): 1651-6.
Menz HB, M. M. (2006). Foot and ankle risk factors for falls in older people: a prospective study. J Gerontol A Biol Scie Med Sci, 61(8); 866-70.
Menz HB, M. M. (2006). Footwear characteristics and risk of indoor and outdoor falls in older people. Gerontology, 52(3): 174-80.
Miller TR, D. J. (2011). Assessing costs and potential returns of evidence-based programs for seniors. Eval Health Prof, 34(2): 201-25.
Milos V1, B. Å. (2014). Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatric.
Mithal A, B. J.-H. (2013). Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int, 24(5): 1555-66.
Mott DA, M. B. (2016). Impact of a medication therapy management intervention targeting medications associated with falling: Results of a pilot study. J Am Pharm Assoc (2003), 22-8.
MS. (2016, August 17). Free From Falls. Retrieved from National Multiple Sclerosis Society: http://www.nationalmssociety.org/Chapters/CAL/Calendar/Programs/Free-From-Falls
Muir SW1, B. K. (2010 Fall). Modifiable Risk Factors Identify People Who Transition from Non-fallers to Fallers in Community-Dwelling Older Adults: A Prospective Study. Physiother Can., 358-67.
Najafi B, d. B. (2013). The role of podiatry in the prevention of falls in older people: a JAPMA special issue. J Am Podiatr Med Asso, 103(6): 452-6.
NCOA. (2016, August 16). Program Planning. Retrieved from National Council on Aging NCOA: https://www.ncoa.org/center-for-healthy-aging/basics-of-evidence-based-programs/offering-evidence-based-programs/program-planning/
NCOA, N. C. (2016, August 10). Fall Prevention Facts. Retrieved from NCOA: https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/
Ng TP, F. L. (2015). Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: a Randomized Controlled Trial. AM J Med, 128(11): 1225-36.e1.
Page AT, P. K.-B. (2016). Deprescribing in older people. Maturitas., 115-34.
Pelletier AL, R.-R. L. (2016). Vision Loss in Older Adults. Am Fam Physician., 219-26.
Pighills AC, T. D. (2011). Environmental assessment and modification to prevent falls in older people. J Am Geriatr Soc, 59)1): 26-33.
Pineles SL, R. M. (2015). Risk of musculoskeletal injuries, fractures, and falls in medicare beneficiaries with disorders of binocular vision. JAMA Ophthalmol, 133(1): 60-5.
Reed-Jones RJ, S. G.-I. (2013). Vision and falls: a multidisciplinary review of the contributions of visual impairment to falls among older adults. Maturitas, 75(1); 22-8.
Renfro M, F. S. (2011 ). Multifactorial screening for fall risk in community-dwelling older adults in the primary care office: development of the fall risk assessment & screening tool. J Geriatr Phys Ther., 174-83.
Renfro, M. B. (2016). Fall Risk Among Older Adult High-Risk Populations: a Review of Current Screening and Assessment Tools. Current Geriatrics Report, 160-171.
Rojas-Fernandez C1, 2. D. (2015). Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term care and retirement home residents in Ontario, Canada. BMC Res Notes.
Rubenstein. (2006). Falls in older people: epidemiology, risk factors. Age and Ageing , 35-S2; 37-41.
Salonen L, K. S. (2012). Eye Diseases and Impaired Vision as Possible Risk Factors for Recurrent Falls in the Aged: A Systemic Review. Curr Gerontol Geriatr Res, doi:10.1155/2012/271481.
Sherrington C, T. A. (2011). Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull., 22(3-4):78-83.
Shumway-Cook A, B. M. (1997). Predicting the Probability for Falls in Community-Dwelling Older Adults. Physical Therapy Volume 77 Number 8, 812-819.
Soo-Kyung Bok, T. H. (2013). The effects of changes of ankle strength and range of motion according to aging on balance. Annals of Rehabilitation Medicine.
Spink MJ, F. M. (2011). Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. BMC Geriatr, 11:51.
Stenholm, H. K. (2016). Smoking, physical inactivity and obesity as predictors of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study.
Int J Epidemiol., Aug 2. pii: dyw126. [Epub ahead of print].
Stubbs B1, P. S. (2014). The avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study. Pain Med, 1861-71.
Suominen MH, P. T.-S.-O. (2015). Nutritional Guidance Improves Nutrient Intake and Ouality of LIfe, and May Prevent Falls in Aged Persons with Alzheimer Disease Living with a Spouse (NuAS Trial). J Nutr Health Aging, 19(9): 901-7.
Svantesson U, B. B. (2014). Influences on modern multifactorial falls prevention interventions and fear of falling in non-frail older adults: a literature review. J Clin Med Res, 6(5): 314-20.
Timar B, T. R. (2016). The Impact of Diabetic Neuropathy on Balancd and on the Risk of Falls in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. PLoS One, 11(4): e0154654.
Torres MJ, F. C.-G. (2015). Poor nutritional status is associated with a higher risk of falling and fracture in elderly people living at home in France: the Three-city cohort study. Osteoporos Int, 26(8): 2157-64.
Tsai AC, L. M. (2014). Mini Nutritional Assessment and short-form Mini Nutritional Assessment can predict the future risk of falling in older adults - results of a national cohort study. Clin Nutr, 33(5): 844-9.
Turner S, A. G. (2011). Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev, Feb 16(2): CD003600.
UNC. (2016, August 16). Falls and Otago Resources. Retrieved from Carolina GeriatricEducation Center (CGEC): http://www.med.unc.edu/aging/cgec/exercise-program
Verghese J1, W. C. (2016). Modifiable Risk Factors for New-Onset Slow Gait in Older Adults. J Am Med Dir Assoc., 421-5.
WHO, W. H. (2016, August 10). WHO Falls fact sheet N 344 October 2012. Retrieved from Falls: http://www.who.int/mediacentre/factsheets/fs344/en/
WIHA. (2016, August 16). Falls Prevention with Stepping On. Retrieved from Wisconsin Institute for Health Aging: https://wihealthyaging.org/stepping-on
Wood JM, L. P. (2011). Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration. Invest Ophthalmol Vis Sci, 52(8): 5088-92.
Yalla SV, C. R. (2014). An immediate effect of custom-made ankle foot orthoses on postural stability in older adults. Clin Biomech , 29(10): 1081-8.
Yip JL, K. A. (2014). Visual acuity, self-reported vision and falls in the EPIC-Norfolk Eye study. Br J Opthalmol , 98(3): 377-82.
DOI: http://dx.doi.org/10.18103/imr.v2i8.165
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