7 The CDC STEADI initiative encourages physicians to screen for fall risk by asking these questions and about fear of falling, or by administering the Stay Independent self–risk assessment brochure. Recently discharged from the hospital (within one month)Īll persons older than 65 years should be asked annually about whether they have fallen, the number of falls they have had and if they caused injury, and whether they have difficulty with walking or balance. History of cerebrovascular accident/transient ischemic attack Parkinson disease and other movement disorders Medication use (see Table 3 risk is higher when four or more medications are used simultaneously) Withdrawal or minimization of psychoactive and other medicationsĪdaptation or modification of the home environment for those who have fallen or have visual impairmentĭual chamber cardiac pacing should be considered in patients with carotid sinus hypersensitivity who experience unexplained recurrent falls. Vitamin D 3 supplementation of at least 800 IU daily
The following components should be included in multifactorial interventions for falls in older persons:Įxercise, particularly balance, strength, and gait training Nursing home residents at risk of falls should receive a multifactorial risk assessment and intervention tailored to their needs that are administered by a multidisciplinary team. Older persons at risk of falls who are hospitalized in an acute setting or for an extended time in a subacute setting should receive a multifactorial risk assessment and intervention tailored to their needs. Fall prevention is reimbursed as part of the Medicare Annual Wellness Visit.Ĭommunity-dwelling older persons at low to moderate risk of falls should participate in an exercise program or physical therapy and take vitamin D supplements.Ĭommunity-dwelling older persons at high risk of falls should receive a multifactorial risk assessment and intervention tailored to their needs. These interventions effectively decrease falls in the community, hospital, and nursing home settings. Multifactorial interventions should include exercise, particularly balance, strength, and gait training vitamin D supplementation with or without calcium management of medications, especially psychoactive medications home environment modification and management of postural hypotension, vision problems, foot problems, and footwear. The algorithm suggests assessment and multifactorial intervention for those who have had two or more falls or one fall-related injury. The Centers for Disease Control and Prevention developed an algorithm to aid in the implementation of the American Geriatrics Society/British Geriatrics Society guideline. Preventive Services Task Force and American Academy of Family Physicians do not recommend routine multifactorial intervention to prevent falls in all community-dwelling older adults, they state that it may be appropriate in individual cases. Preventive Services Task Force and American Academy of Family Physicians recommend exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling older adults who are at increased risk of falls. The American Geriatrics Society and British Geriatrics Society recommend that all adults older than 65 years be screened annually for a history of falls or balance impairment.
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