Falls

Victoria Trulove

Background

Screen for falls in the past year at annual visits; History of fall is a strong risk factor for future falls; If yes to fall, ask about frequency, injuries, assistive device use, feeling unsteady (can use CDC STEADI questions)

  • CDC STEADI Questions: 1. Feels unsteady when standing or walking? 2. Have worries about falling? 3. Have fallen in the past year?
  • If yes to any of these questions, proceed with assessing modifiable risk factors and fall history: Resource Algorithm for Fall Risk Screening, Assessment, and Intervention
  • Physical Exam: If potentially unstable injuries (new spine fracture or lower extremity fracture), clarify weightbearing status with surgical teams; If no potentially unstable injuries, assess patient’s mobility
  • The Timed “Up and Go” Test: have the patient rise from sitting in a chair, walk 10 feet forward, turn around, walk back to chair, and sit down; ≥12 seconds indicates increased risk for falls
  • Med Rec: Antipsychotics, antidepressants, anticholinergics, anxiolytics, sedatives/hypnotics, anti-hypertensives, antiarrhythmics, steroids, statins all can increase risk of falls

Management

Assess syncopal vs. medical condition vs. situational (environmental); Rule out other causes: Cardiac, Neurologic, Infectious; Assess intrinsic risk factors; Check Vitamin D levels; if <30, supplement until level >30; Consider A1c, B12, folate, TSH; Assess for vision or hearing loss, dementia, neuropathy; Consult Inpatient PT/OT for formal assessment; Assess extrinsic risk factors; Fall hazards in the home (rugs, small pets); Recommend non-skid shoes with a backing (sneaker), gripping socks; Refer for HH PT/OT for home safety evaluation at discharge; Exercise is key in future fall prevention; Refer to exercise program at VUMC: Dayani Center “Ambulatory Referral to Medical Fitness” outpatient order

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