Falls

Falls

Background

  • Screen annually: Ask if elderly pts had falls in the past year
    • History of fall is a strong risk factor for future falls
    • Recommended History Screening Tool:  CDC STEADI Algorithm
  • Physical Exam Screening Tools:
    • If potentially unstable injuries (new spine fracture or lower extremity fracture): push ortho to clear the patient for mobility
    • If no potentially unstable injuries, attempt to get the patient out of bed
      • If lying down, have them lift each leg off the bed
      • If they can do this, ask them to sit up on side of bed
      • If they can do this, ask them to stand
      • If they can do this without assistance, then observe them walk
    • The Timed “up and Go” Test (TUG) tool for fall risk
      • Have the patient rise from sitting in a chair, walk 10 feet forward, turn around, walk back to chair, and sit down
      • Patients who require > 10 seconds are at increased risk for falls
  • Med Rec:
    • Antipsychotics, antidepressants, anticholinergics, anxiolytics, sedatives/hypnotics, anti-hypertensives, antiarrhythmics, steroids, statins all can increase risk of falls

 

Management

  • Rule out other causes: Cardiac, Neurologic, Infectious
  • Check Vitamin D levels (goal > 30)
    • Supplement (800-1000 IU daily) if at increased fall risk
  • Assess visual acuity (e.g. expedite cataract surgery)
  • Hearing assessment (audiology screen)
  • Consult Inpatient PT/OT 
  • Recommend non-skid shoes with a backing (sneaker)
  • Home health PT or OT for home safety evaluation at discharge
    • Modify extrinsic risk factors for falls: removal of fall hazards, placement of hand rails
  • Referral to Exercise programs: At VUMC = Dayani Center “Ambulatory Referral to Medical Fitness” outpatient order