How to Help Older Patients Reduce Fall Risk
By Rebecca (Becky) Turpin, MA, UWHC Adult Injury Prevention Coordinator
Falls are the leading cause of injury-related death in adults over 65 and are the leading cause of admission to the UW Health Trauma Center. The July 2013 issue of “Updates in Clinical Care” discussed falls in older patients and how to screen for risk. This article explains how to treat patients based on identified risk levels.
In July 2014, Annual Fall Risk Screening using the Centers for Disease Control and Prevention (CDC) STEADI toolkit was rolled out in primary care for all of our patients over 65. The falls screening allows you to determine your patient’s risk for falls (low, medium or high risk) based on the results of the Falls Risk Questionnaire, their history of falls and screening test results. We are fortunate at UW Health, and in Wisconsin, to have access to many resources to help our older patients manage their risk. Below is a summary to help you navigate these options based on your patient’s level of risk.
High risk for falls
For our patients at highest risk for falls, referral to one of our two Geriatric Falls and Mobility Clinics may be in order. Patients are seen by a geriatrician, physical therapist and social worker to undergo a multifactorial assessment to identify their specific risk factors for falls. As you know, the more risk factors that can be reduced or eliminated, the lower the patient’s risk for falls will be. The providers communicate back with the primary care physician and also continue care after the initial appointment to help patients follow through with recommendations.
You can refer via HealthLink: Consult to Gerontology. Additionally, patients may self-refer. Right now there is immediate availability for appointments.
The two Geriatric Falls and Mobility Clinic locations are:
Medium risk for falls
Community-based fall prevention classes such as Stepping On are designed to help our older patients manage their own risk for falls. During a Stepping On workshop, patients will learn exercises to improve balance, ways to assess their homes for safety hazards, how medication may affect their risks and how to navigate their communities safely. UW Health has three nurses from the Learning Center trained to offer this seven-week, group-based class. Patients are eligible to participate if they have had a fall in the last year or have a fear of falling, live independently, and walk without the use of a walker or wheelchair indoors. Patients with dementia are not appropriate for this class. Stepping On has been shown to reduce falls by 31%.
You can refer patients to a UW Health Stepping on class by calling 608-890-5651 or emailing the MR# to firstname.lastname@example.org.
Stepping On classes are available all across Wisconsin. We know our patients are more likely to register for one of these workshops when their provider specifically recommends it and tells them it will help reduce their risk for a fall. Identifying a person in your clinic to help connect patients to these classes can help assure patients get the services they need.
Low risk for falls
Patients identified as low risk for falls should be congratulated and encouraged to maintain their strength and balance to remain independent. Starting or maintaining an exercise class will help keep their fall risk low. Many community classes are available that are specifically designed for the needs of our older community members. School and community recreation programs, YMCAs and senior centers are great places to find these classes.
There are a handful of ways we can help encourage any older adult to address their fall risk. It’s important to understand our older patients’ motivations to address this issue and to meet them where they are in their readiness to change. Based on their fall risk assessment and your understanding of their needs and motivations, referrals could be made for:
For more information
The UW Health Trauma Center is dedicated to injury prevention issues. You can contact Adult Injury Prevention Coordinator Rebecca Turpin with referral questions, or contact Gerontology at (608) 263-7740 for questions about its three geriatric consultation clinics: Geriatric Assessment Clinic (GAC), Memory Assessment Clinic, and Mobility and Falls Clinic.