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No Falls KY

Physician with Patient

This section is intended to provide information for medical practitioners, nursing staff, rehabilitation professionals, and emergency responders on the most effective way to identify and manage those at risk for falls.

It provides evidence-based content, access to recent literature on assessment tools and patient/client tailored interventions.

 

1. History of Falls

  • Have you had any falls within the past year?
    • If so, how many?
    • Were you injured from your fall?
      • If so, did you seek medical attention?
    • If you haven't had any falls, have you had any stumbles within the past year?

2. Home Hazards

  • Have you stumbled on anything inside or outside your home?
    • Do you have things that will help you in your home like handrails in your bathroom?
    • Do you have things that may get in the way like poor lighting, throw rugs, little pets, or something else that might cause you to stumble in your home?
    • Do you have outside challenges like stairs into the home, unlevel surfaces, inclined driveways, or clutter in the yard?

3. Strength and Balance

  • Do you feel unsteady walking indoors?
  • Do you feel unsteady walking outdoors?
  • Do you use an assistive device to walk indoors or outdoors? (eg cane, walker)
  • Do you have difficulty going from sit to stand?
  • Do you feel dizzy as if the room is spinning or moving or light-headed on a regular basis?

4. Polypharmacy

  • Do you take >4 medications daily or any of the following?
    • Antidepressants
    • Antianxiety or tranquilizers
    • Narcotic pain medicine
    • Cardiovascular medications

5. Vision

  • Do you have trouble seeing even with glasses?

 

 

Address the underlying risk factor(s) in order to provide tailored patient/client-specific interventions.

Odd ratios and relative risk from:
Tinetti M, Kumar C.The patient who falls "it's always a tradeoff". JAMA.2010;303(3):258-266.

Increase in Risk as a Result of
the Presence of a Risk Factor

(Relative risk numbers represent multiple studies.)
Risk Factor Relative Risk (RR)
History of previous falls 1.9-6.6
Polypharmacy
(>4 medications daily)
1.1-2.4
Age >80 1.1-1.3
Multiple co-morbidities no data
Reduced Sensation no data
Decreased Muscle Strength 2.2-2.6
Vision defects 1.5-2.3
Home/Environmental Hazards no data
Gait abnormalities/Balance impairments 1.2-2.2
Cognitive/memory problems 2.8
Urinary Incontinence no data
Symptoms of dizziness no data
Postural hypotension
  Systolic: >20mmhg
  Diastolic:>10mmhg
2.0
Abnormal heart rate and rhythm no data
Female 2.1-3.9
Receiving IV therapy and/or oxygen no data
Post major medical procedure no data

 

The greater number of risk factors, the greater the risk of falling.

Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701-1707.

Relative risk is the risk of the outcome in one group compared with another group.

Example of relative risk: An individual with a history of falls would be 1.9-6.6 times more likely to fall than an individual without a history of falls.

Zhang J, Yu K. What's the relative risk? JAMA. 1998; 280(19): 1690-1691.

 

Address the underlying risk factor(s) in order to provide tailored patient/client-specific interventions.