Which Patients Have the Highest Fall Risk?

Which Patients Have the Highest Fall Risk?

Falls are a common and serious problem for many patients, especially older adults and those with chronic conditions. Falls can result in injuries, disabilities, reduced quality of life, and increased health care costs. Therefore, it is important to identify which patients have the highest fall risk and implement appropriate interventions to prevent falls.

According to the World Health Organization, the risk of falling increases with age, as well as with certain medical and environmental factors. Some of these factors are:

– History of falls: Patients who have fallen before are more likely to fall again, especially if they have not received adequate treatment or rehabilitation.
– Medications: Some medications can affect the balance, coordination, vision, or alertness of patients, making them more prone to falling. These include sedatives, antidepressants, antihypertensives, diuretics, and opioids.
– Cognitive impairment: Patients with dementia, delirium, or other cognitive disorders may have difficulty remembering, orienting, or following instructions, which can increase their fall risk. They may also wander or become agitated and try to get out of bed or chairs without assistance.
– Mobility impairment: Patients with muscle weakness, joint pain, arthritis, stroke, Parkinson’s disease, or other conditions that affect their mobility may have difficulty walking, standing, or transferring. They may also use assistive devices such as walkers, canes, or wheelchairs, which can pose additional challenges for fall prevention.
– Sensory impairment: Patients with vision loss, hearing loss, or peripheral neuropathy may have reduced awareness of their surroundings and potential hazards. They may also have difficulty perceiving depth, distance, or contrast.
– Environmental hazards: Some environmental factors that can contribute to falls are poor lighting, slippery floors, cluttered spaces, loose rugs or cords, uneven surfaces, stairs, or furniture that is too high or low.

To assess the fall risk of patients, health care providers can use various tools and scales that measure the presence and severity of these factors. Some examples are:

– The Morse Fall Scale: This is a simple and widely used tool that assigns points to six items: history of falls, secondary diagnosis, ambulatory aid, intravenous therapy/heparin lock, gait/transferring ability, and mental status. The total score ranges from 0 to 125 and indicates the level of fall risk (low, moderate, or high).
– The Hendrich II Fall Risk Model: This is a more comprehensive tool that includes eight items: confusion/disorientation/impulsivity, symptomatic depression, altered elimination (urinary frequency/incontinence/diarrhea), dizziness/vertigo,
male gender (due to higher incidence of falls), administration of antiepileptics (or changes in dosage), administration of benzodiazepines (or changes in dosage), and poor performance in the “Get-Up-and-Go” test (a simple test that measures the time and number of steps required to stand up from a chair,
walk three meters, turn around, walk back to the chair and sit down). The total score ranges from 0 to 16 and indicates the level of fall risk (low or high).
– The STRATIFY Tool: This is a tool that was developed specifically for hospital settings and includes five items: history of falls,
agitation (restlessness/anxiety/aggression), visual impairment (poor vision/blindness), need for toileting assistance (frequency/urgency/incontinence), and transfer/mobility assistance (difficulty walking/standing/transferring). The total score ranges from 0 to 5 and indicates the level of fall risk (low or high).

Once the fall risk of patients is determined, health care providers can implement individualized interventions to reduce the risk and prevent falls. Some examples are:

– Educating patients and their families about the causes and consequences of falls and how to prevent them.
– Reviewing and adjusting medications that may increase fall risk or cause adverse effects such as drowsiness or dizziness.
– Providing cognitive stimulation and orientation for patients with cognitive impairment and monitoring their behavior and mood.
– Enhancing mobility and strength through physical therapy and exercise programs.
– Providing sensory aids such as glasses or hearing aids for patients with sensory impairment and ensuring adequate lighting and contrast in their rooms.
– Modifying the environment by removing hazards such as loose rugs or cords,
installing grab bars or handrails in bathrooms and hallways,
lowering beds and chairs to appropriate heights,
providing nonslip footwear or socks,
and using alarms or sensors to alert staff when patients try to get out of bed or chairs without assistance.

Falls are a major threat to the health and well-being of many patients. By identifying which patients have the highest fall risk and implementing appropriate interventions,
health care providers can prevent falls and improve patient outcomes.

Bibliography

World Health Organization. Falls [Internet]. Geneva: World Health Organization; 2018 [cited 2023 Jan 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/falls

Morse JM, Morse RM, Tylko SJ. Development of a scale to identify the fall-prone patient. Can J Aging. 1989;8(4):366-77.

Hendrich AL, Bender PS, Nyhuis A. Validation of the Hendrich II Fall Risk Model: a large concurrent case/control study of hospitalized patients. Appl Nurs Res. 2003;16(1):9-21.

Oliver D, Britton M, Seed P, Martin FC, Hopper AH. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. BMJ. 1997;315(7115):1049-53.