Suggestions

Permission for Use

Falls and Hip Fractures

Methods and Assessments

Methods

The AGS panel on falls prevention (2001) suggests a screening algorithm to decide whether a person should have a fall evaluation:

If a person has had only one fall in the past year, then check for a gait or balance problem. This can be done by having a person stand from a chair without using their arms, walk, and return, such as the Get Up and Go Test. If such a problem exists, then do a fall evaluation.

If a person has had more than one fall in the past year, or if the patient presents to a medical facility after a fall, then do a fall evaluation.

If a person has had no falls the past year, then no fall evaluation is necessary.

A comprehensive falls assessment determines underlying sensory, motor, cognitive, medical, and psychological impairments contributing to functional disabilities. The resultant customized exercise plan results in improved survival, reduced hospital and nursing home stays, and improved functional status.

Identifying the causes of a fall is critical to preventing future falls. A person who has had several falls often has several problems which interact or are comprised of accumulated deficits which together produce instability. Sixty percent of falls result from multiple interacting factors (Campbell AJ, 2006).

Consequently, multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programs are effective in reducing the incidence of falls (Gillespie LD, 2003).

Assessments

A fall assessment includes:

• history of fall circumstances
• medications
• medical problems
• vision
• gait and balance
• lower extremity joint function
• neurological
• cardiovascular

(AGS panel, 2001)

Assessment instruments for balance and strength training might include performance-oriented tests such as:

• Functional Reach (Duncan PW, 1990)
• Berg Balance Scale (Berg KO, 1992)
• Tinetti Mobility Assessment Tool (Tinetti ME, 1986)
• Fear of Falling Test (Tinetti ME, 1994)
• Short Physical Performance Battery (Guralnik JM, 1994)
• Dynamic Gait Index (Shumway-Cook A, 1995)

equilibrium tests such as:

• Postural Stress Test (Wolfson LI, 1986)
• Romberg
• Clinical Test of Sensory Integration and Balance (Cohen H, 1993)

neuropsychological measures such as:

• Health Status Inventory
• Geriatric Depression Scale (Yesavage JA, 1983)
• Falls Efficacy Scale (Tinetti ME, 1990)

environmental checklists such as:

• For the home: Check for Safety
• For clinical settings: Preventing Falls in Acute Care