Falls are the leading cause of injury death for Americans 65 years and older.
Every 20 minutes, an older adult dies from a fall in the US, and many more are injured, costing $50 billion a year. Approximately a third of older adults who live at home, and half of those living in nursing homes, fall at least once a year.
Only 37 percent of elderly patients are asked about falls in the primary care setting.
Most falls are preventable, and many common causes can easily be corrected. The Centers for Disease Control and Prevention (CDC) and the American Geriatric Society recommend a yearly fall assessment screening for all adults 65 years of age and older, but for most, this is NOT done.
Seniors are prone to underreporting falls, usually out of denial, fear of losing their independent living status, or because of memory and recall difficulty.
Fall Risk Assessments should be part of regular check-ups for our seniors and performed every six months.
Anyone who falls outside of sports activity should undergo a gait and balance assessment. Those who have had multiple falls within a year should be evaluated more thoroughly to determine their fall risks and identify and mitigate them. Falls are rarely due to a single cause or risk factor and are often the accumulated effect of impairments in multiple domains.
1. Perform a Fall Risk Assessment to Identify Risk Factors
Our Fall Prevention Program is based on the CDC’s STEADI program.
VPT’s Fall Prevention Program is based on the CDC’s STEADI program. A questionnaire to identify risk factors, including medications, home hazards, visual impairment, cognition, feet/footwear issues, Vitamin D deficiency, and comorbidities, is reviewed with our trained therapists.
Our therapists then perform an extensive assessment, including range of motion and strength of the lower extremities and specific balance testing. Multiple studies have shown an association between walking speed and survival, so many of our screening tests for falls involved timed movement. (*Extreme caution is taken by our clinicians when testing patient’s remotely. Patients with moderate to high fall risk must have someone assisting them during our screening.)
Individuals with a “low fall risk” are provided with educational materials on fall prevention and an Otago exercise program and are advised to have a yearly follow-up. Those individuals with “moderate” and“high fall risk” are recommended for further evaluation to determine the root cause of the balance deficit. This includes a comprehensive vestibular assessment, gait analysis, strength, range of motion, neurological screen, and specific balance tests, including Sit to Stand, Single Leg Stance, and Timed Up and Go. Those with a “high fall risk” require physical assistance to complete the assessment.
- Five Times Sit to Stand (5X STS): This test assesses strength. Have the patient start seated in an armless chair with a firm seat, ask him or her to stand up and sit down five times as quickly as possible, and record the time required to complete the five repetitions.
- Single Leg Stance (SLS): This test assesses balance. Have the patient stand on one leg with arms crossed. Time how long the patient can remain in this position without touching the suspended foot to the ground, moving the hands away from the chest, or displacing the weight-bearing foot.
- Time Up and Go (TUG): This test assesses gait. Have the patient start in a seated position, rise to a stand, walk three meters and return to a seated position in the chair, and record the time required to complete the exercise.
*Patients who take more than 10 seconds to do the 5X STS and TUG tests and those who can balance for less than 10 seconds during the SLS probably require further scrutiny.
The underlying physical condition determines the individualized treatment plan, which may include vestibular, neurological, strength, and/or specific balance exercises. Each exercise program is provided with a video demonstration. The focus of the treatment plan is to educate and empower to remove any risks, improve any deficits and reduce their overall risk of a fall. Follow-up appointments are based on individual patients’ needs.
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