CONTINUING PROFESSIONAL DEVELOPMENT
ANFClinical Updates Identification and management of Identification falls-relatedand riskmanagement factors of falls-related risk factors 1 iFolio hour ANF iFOLIO CLINICAL UPDATE:
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Read this article and complete the quiz to earn 1 iFolio hour Effective falls prevention strategies rely on the clinician’s ability to assess an individual, identify risk factors, and implement solutions to reduce the chance of falling.1,2 It is essential that all clinicians are aware of falls-related risk factors and prepared with solutions to help manage them. A wide range of solutions are required as not every option will be appropriate or realistic for all patients. Person-centred plans should be multifactorial, fully resourced, and achievable in order to promote ongoing patient safety and reduce the risk of a fall.1-3
WHAT ARE FALLS-RELATED RISK FACTORS? Falls-related risk factors are potential reasons or causes for a fall.4 Modifiable risk factors are those that are amenable to intervention. Even if a risk factor cannot be completely eliminated, strategies can be used to minimise the risk of a fall and prevent injury associated with a fall. There are three types of falls-related risk factors and each has its own set of risk factors matched with interventions that may be useful to help prevent a fall:4 • Environmental • Physical function and health • Psychological function
ENVIRONMENTAL RISK FACTORS Environmental hazards are responsible for up to one third of falls in older adults.5 They include:1,2,4 • Absence of bed and hand rails • Chairs, lounges, showers, and bathtubs that are difficult to get in to and out of • High bed heights • Inaccessible light switches • Inadequate lighting • Long distances to reach the toilet or access meals
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• Pets • Poorly maintained floor covering • Presence of trip hazards, such as loose rugs, cords, floor clutter, or obstacles • Slippery surfaces • Unfamiliar environments At home, the bathroom and stairs are most likely to be associated with injuries from falls.5 This is often because these areas require older adults to turn and transfer frequently. They also are more likely to have structural features that increase the risk of falls, such as uneven stairs, slippery floors, and lack of transfer assist aids.5 Environmental hazards can be assessed using a home safety screening tool, such as the Home Falls and Accidents Screening Tool (Home FAST).1,2,5 Once environmental hazards have been identified, they can be removed or managed. Unfortunately, research to understand the impact of managing or removing environmental hazards on the rates of falls has had conflicting results. This may be because there is no standard definition of environmental hazards for falls and no consistent approach to assessing these hazards in the community. Falls prevention experts are calling for a more consistent approach to the assessment and management of environmental hazards in the future.5
PHYSICAL FUNCTION AND HEALTH RISK FACTORS Physical function and health risk factors for falls include:1-4 Balance and mobility limitations (including limited physical activity and history of falls) • Continence issues • Dizziness and vertigo • Feet and footwear • Impaired vision • Medications • Syncope
Of all falls in older people, 50 to 70% occur when the individual is mobile.2 There are a variety of screening tools that can be used to assess balance, mobility, gait, and strength. Exercise may be beneficial for patients with low levels of physical activity, impaired mobility, and gait.6,7 While independent, general exercise may not make a significant difference, strength and mobility training programs, including Tai Chi, are likely beneficial and costeffective for individuals at risk.6,7 The identification of physical function and health related risk factors often suggests the need for referral to other health professionals.1,2 For example, any patient with ongoing concerns about their physical function should be reviewed by a medical practitioner.1,2 The underlying causes of conditions, such as loss of consciousness, syncope, black outs, or seizures need to be investigated and treated.1 Other health professionals that may be involved include a physiotherapist, occupational therapist, podiatrist, or continence nurse.1,2 However, there is limited evidence to support some of these referrals. For example, visual assessments are not beneficial as a single intervention for preventing falls, but may be useful as part of a multifactorial falls prevention plan. A referral to a continence nurse, in isolation of other interventions, may not be effective.8 There are two ways that medication use may increase the risk of a fall. The first is through polypharmacy, or the use of multiple medications that increase the risk of a fall.1,2 The second is from the use of individual medications that increase the risk of a fall.1,2 Psychotropic drugs, including benzodiazepines, antidepressants, and antipsychotics are most commonly associated with falls.1,2 However, medications that affect heart rate or blood pressure may also increase the risk of a fall.5 The most common intervention for risk factors related to medications is a medication review.1,2 To date, medication
