Question
What are the fall risk factors?
Answer
Fall risk factors include many areas that may be either modifiable or nonmodifiable. Thirty-three percent of older adults fall according to those that have been reported to the emergency room staff or to a physician, primarily, though, to the emergency department. There is a much higher rate of falls among older adults that cannot be counted because so many people fall and never report their falls. Looking at these fall risk factors, it is very important in your practice to ask your patients whether they have any of these fall risk factors, as well as, asking how many times have they fallen or almost fallen over the past year.
Nonmodifiable fall risk factors include an age, particularly those over 80 years of age. Those that are 75 years and older incur the most injuries. Being white and being female, you cannot change those risk factors. Having a history of prior falls also puts you at a higher risk for future falls. Having certain chronic diseases such as stroke, Parkinson's disease, or dementia may cause a person to fall as well as having a permanent sensory loss with your vision, vestibular system, or somatosensory system, especially in the feet and legs. This is often linked to diabetes for those who have peripheral neuropathy and have no idea where their feet are when walking.
Modifiable fall risks are those that you really need to focus in on. The ones that I have just reviewed with you, the nonmodifiable, you need to also pay particular attention. Yes my client is over 80. She is Caucasian, she is female. She has a history of falls. Yes she has one of these chronic conditions. That is telling you this person is at a higher risk and you need to be providing some type of fall prevention/intervention with her.
Those that are modifiable are also very important to recognize. A person may have muscle weakness, balance problems, gait problems, mobility deficits, or syncope (dizziness). Orthostatic hypotension can be problematic. When a person changes positions, particularly after lying down all night, sits up or stands up too quickly, maybe to go to the bathroom in the middle of the night or in the morning, the blood pools down to their feet and the person becomes lightheaded. They may fall from passing out. Another modifiable fall risk is taking more than four prescribed medications. It is very important that your patients have a pharmacist review their medications whenever they have a change. Please recommend to your older clients to use one pharmacy only and not to use multiple pharmacies because it is very challenging for a pharmacist to compare one medication to the other if they are not aware of all of the medications your patients or clients are taking at one time. Psychotropic medications have a very high risk for falls and should be looked at to see if they may be reduced or gradually stopped. Decreased health, frailty, and incontinence, all of these can potentially be modifiable. For incontinence, the person could be put on a bowel and bladder schedule.
Additional modifiable fall risk factors may include the environment. For OT practitioners, you have a very important role in all of these areas that are listed here in this column: performing home assessments in home, around the home, and then in the community area where that person typically travels. ADL and IADL performance deficits are another area of concern. Does that person need some type of therapy to become stronger or some adaptations to make their homes safer? Do they need adaptive equipment, or durable medical equipment, which now is referred to also as assistive technology, to help them increase their performance skills in a safer way? They may have visual impairments or need glare reduced for macular degeneration. They may need a referral to an optometrist, opthalmologist or an OT for these visual impairments.
Many of the people that we see in our fall risk assessment clinic do fine with their walking, but cannot do anything else. As soon as you ask that person to carry a grocery sack or to talk to someone, to turn their head and not look where they are going, that person loses her balance, becomes more unsteady. These potential areas, that have been identified by the American Geriatric Society and British Geriatric Society Clinical Practice Guidelines of 2010, are very important for you as OT practitioners to follow through with in regards to working with your older clients.
In addition to the above mentioned impairments, they may be coming to see you for cognitive deficits, complications from medications, or complications even from anesthesia from their surgery. These too can put the person at a higher risk for falling. Depression and anxiety are also independent fall risk factors. Someone who is depressed and is on antidepressants will be at a higher risk for falls. This is the same for those with anxiety. Some of the medications that address these two psychological problems can cause a person, due to side effects from the medication, to be at a higher risk for fall. Fear of falling is another risk factor which is the topic for today, but I did want to go over the fall risk factors and general information on falls first.
Fear of falling is a fall risk factor and fear of falling all by itself can cause a person to fall, whether he or she has fallen or not. One of the most important ramifications of fear of falling for OT practitioners is to realize that these people are the ones that want to sit in your clinic, do not want to stand, do not want to move, want to stay stationary, and they tend to restrict their activities because they are afraid if they stand up they are going to fall, break a hip, or be injured.
