As the population of the United States grows older, the need for healthcare interventions aimed at aging adults is on the rise. As we know, older patients are at higher risk of fall and that falls can lead to disablement and death. It's not always the fall that's deadly but the resulting sequelae patient's experience from spending time in the hospital - growing weaker and increasingly immobile. Every 20 minutes, an older adult dies from a fall in the US (CDC).
As an SPT, I wanted to create a reference guide for any PT/SPT/PTA/SPTA who may be interested in creating a community assessment. I believe it's vitally important to create awareness for programs that already exist to prevent falls and improve patient lives. This screening is short and proven to be effective.
At the University of Miami, in conjunction with the Miller School of Medicine's Department of Community Service (DOCS) PT students volunteer to perform Fall Risk Assessments at various UM Health Fairs across South Florida. We talk with and screen patients, work with other future health care providers, and give back to the community. Not only are we proud to serve our local community, establishing collaborative partnerships between disciplines is essential in the medical field and working together is a vital aspect of giving quality care.
By utilizing the CDC's STEADI resources and age-normative values, we know that this screening is reliable and valid. I would encourage you to take a look at all of the awesome materials for both patient's and health care providers on this site.
The overarching purpose of the fall risk assessment is to identify patients who are low, moderate and high risk of fall; identify modifiable risk factors in patient's home and community, and offer effective interventions.
We begin with these recommended questions:
1. Have you fallen in the past year?
2. Do you feel unsteady when standing or walking?
3. Do you worry about falling?
You may to choose to include more questions regarding medications, patient's understanding of fall risk, vision, sensation, etc... If you have suggestions for more questions you believe would help identify patient's at risk of fall, I'd love to read them. Comment below, tweet me @SPTKlee or email me kayleevd@gmail.com
The CDC recommends if a patient says "yes" to any of the three screening questions, they are at an increased risk of fall. Using our clinical judgement and understanding of the FRA, we proceed with the three screening tools: The Timed Up and Go, the 4-Stage Balance Test and the 30 Second Chair stand test. Here are the CDC's materials to the three tests, and the normative age scores. The wonderful part of this screening, along with being relatively quick and safe, is the simplicity. In order to conduct the screening, the necessary materials are a chair, cone, gait belt, tape measure and stop watch.
After assessing our patient's based on the age-norm scores, we are able to provide them information on risk factors that contribute to falls, and some modifications: such as removing carpets, caging pets, lighting up the floor at night, and being aware of clutter. More materials for your patients can be found here! In addition, we can provide them a recommendation to pursue physical therapy for a full evaluation or suggest other complementary therapy options, such as tai chi and yoga.
At the Health Fairs, our patients always appreciate the opportunity to run through the functional outcome measures and learn what their scores mean for their health. They're thankful for the education, resources and the positive message we send to them about physical therapy. Being a GA for the DOCS Health Fairs has been a great opportunity to see how a screening so simple can make a big impact in the community. I'm looking forward to utilizing these resources and introducing them to my clinical sites and communities, to continue to spread the STEADI initiative and help identify fall-risks and further prevent falls!
If you have any questions, suggestions or otherwise - reach out on twitter @SPTKlee, or email me kayleevd@gmail.com.