KEY POINTS FOR PRACTICE
| • In patients 65 years and older or in those 50 to 64 years of age at increased risk of falls, a comprehensive fall-risk assessment is recommended rather than using fall-risk prediction tools alone. |
| • Comprehensive fall-risk assessment is recommended in patients with two or more falls in 1 year or in those with one fall if it was associated with frailty, required medical care, involved a loss of consciousness, or resulted in an inability to get up after the fall. |
| • A structured medication review is recommended in patients at increased risk of falls to identify medications, such as psychotropics, that may increase fall risk and may require weaning or dosing adjustment. |
| • Patient participation in a fall prevention exercise program is encouraged, especially in patients with a history of falls or gait or balance impairment. |
| From the AFP Editors |
Each year, approximately one-third of people 65 years and older and one-half of those 80 years and older have at least one fall. Hip fractures are one of the most severe outcomes of falls, with a 31% mortality rate at 1 year. The National Institute for Health and Care Excellence (NICE) published updated guidelines for prevention of falls in adults 65 years and older and those 50 to 64 years of age with a risk factor for falls such as diabetes, arthritis, dementia, Parkinson disease, a learning disability, or previous stroke.
IDENTIFYING FALL RISK
NICE recommends against using fall-risk prediction tools solely to estimate future risk of falling because of low-quality evidence, and it may be impractical in some settings. Risk assessment tools should be used as part of a comprehensive fall-risk evaluation. Although the Timed Up and Go test can help identify gait and balance problems, it does not reliably predict future falls. The evidence on the accuracy of individual risk-factor assessments is limited, and no single assessment is superior in predicting falls.
Community Settings
Comprehensive falls assessment and management should be offered to patients who have fallen in the past year if they meet the following criteria: living with frailty, had a fall requiring medical or surgical treatment, had a fall related to loss of consciousness, were unable to get up independently after a fall, or had two or more falls in 1 year. Gait and balance should be assessed in people who have fallen in the past year but do not require a comprehensive assessment. Those with a gait or balance impairment who have fallen in the past year should be offered a fall prevention exercise program, and a home hazard assessment should be considered. Guidance on physical activity can be provided to patients who have not fallen in the past year or have had a single fall without a gait or balance impairment.
Hospital and Residential Care
Patients in hospital or residential care settings should be offered comprehensive falls assessment and management. Those in residential care often have frailty, increasing the risk of falls.
Read the full article
Get immediate access, anytime, anywhere.
Choose a single article, issue, or full-access subscription.
Earn up to 14 CME credits per issue.
