As individuals age, the risk of falling becomes a significant concern. Falls are the leading cause of both fatal and nonfatal injuries among older adults, and are associated with substantial healthcare costs and resource use. According to the National Institute on aging, more than 1 in 3 people aged 65 years or older fall each year. In North Carolina, the cost of fall-related deaths in 2020 alone was estimated at $6.0 billion. With the right combination of awareness, lifestyle adjustment, and medical support, a patient’s risk of falling can be greatly reduced.
Falls: Screening for Future Fall Risk
Falls are considered one of the most common and significant health issues for people aged 65 years or older. Identifying at-risk patients and applying preventative measures is key to enhancing the safety, well-being, and independence of an aging population. Applying preventive measures for this vulnerable population has a profound impact on public health.
The CDC’s STEADI initiative includes three core elements: Screen, Assess, and Intervene, and offers resources for providers, patients and caregivers.
Family physicians play a pivotal role in screening for fall risks and recommending preventive strategies for at-risk patients. CMS quality programs target high-cost chronic conditions, preventive care, and patient safety. CMS included Screening for Future Fall Risk as a quality measure in the Medicare Shared Savings Program (MSSP). This measure is defined as:
A history of falls or problems with gait/balance are assessed for this quality measure. A specific screening tool is not required, however potential screening tools include the Morse Fall Scale and the timed Get-Up-And-Go test.
Tips & Best Practices to Close Care Gaps:
- Falls screening and evaluation of falls risk should be completed by clinicians with appropriate skills and experience
- Document falls screening and evaluation of falls risk in the medical record
- The setting for a falls screening is not restricted to an office setting
- Screening for falls risk can be completed during telehealth encounter
- The following meet the intent of the quality measure:
- Documentation of “no falls”
- Documentation of a history of falls during the measurement period
- A gait or balance test
Falls Prevention
- Ask patients if they have fallen, worry about falling, or feel unsteady
- Review medications, including over the counter medicines, to evaluate potential increase in falls risk
- Consider Vitamin D to improve bone, muscle, and nerve health
- Refer to Physical Therapy when appropriate for treatment of imbalance and deconditioning
- Recommend the best type of exercise for patient to improve strength and balance
- Recommend and refer for vision check yearly
- Assess patient’s feet each year and discuss proper footwear
- Provide information on how to make a home environment safe
- Refer patients to care coordination or a social worker if they need financial support to help prevent falls
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