“My community-dwelling older clients are telling me they have fallen or have stopped doing their activities because they are afraid they might fall.” HELP! Where do I start?
A great place to start is the Centers for Disease Control and Prevention’s (CDC) STEADI program. The STEADI program provides specifics in implementing the AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons recommendations for standardized assessments, professional education materials, and informative brochures for patients and families.
How Do I Assess the Risk of Falling?
There are many screenings or evaluations you can use to prevent future falls or a fear of falling in older adults.
Occupational therapy screenings and assessments include:
- Home assessments
- Functional assessments
- Fear of falling screenings
- Depression and anxiety screenings
- Cognition screenings
- Vision assessments
- STEADI recommended assessments and incorporation of OT assessments and screenings
|Check out fall prevention handouts and exercises available on MedBridge.|
Recently in our Falls Risk Assessment Clinic, I saw a 74-year-old lady with a history of falls and decreased activities.
For the occupational therapy portion of the multi-disciplinary falls risk screening, I administered several tests:
- Risk of fall and fear of falling. STEADI’s Fall Risk Checklist; Falls Efficacy Scale-International (fear of falling);
- Mental state. Lawton ADL, Geriatric Depression Scale, Short Form; Generalized Anxiety Disorder-7 (GAD-7); Mini-Mental State Exam.
- Vision. MARS for contrast sensitivity; Frisby Stereopsis (depth perception);
- Home safety. A home assessment checklist.
To address her identified risk of falls, I took the following steps:
- Home Assessment. I recommended a more in-depth occupational therapy home safety assessment.
- Medication. I discussed with the geriatrician and geriatric pharmacist her severe depression (13 out of 15 points) and anxiety scores (17 out of 21 points) in relation to her current medications and possible referral to psychiatrist. They recommended her anti-depressant medication to be adjusted and for her to return to her psychiatrist.
- Physical Therapy. I talked to a physical therapist about her complaint that her legs were so weak she could no longer stand to prepare meals, tend to her garden, walk to her mailbox, or get in/out of her shower. The physical therapist had performed the STEADI’s Timed Get Up and Go, 30-second stair stand, and 4-stage balance tests. Based on the results, he recommended a more comprehensive PT evaluation and treatment for core strengthening, balance, gait, and dual tasking activities.
This is just one example of how we can assess and manage fear of falling and fall risk. It is up to the occupational therapist to assess the various risk fall factors and help our clients achieve health, wellbeing, and participation in the life through occupation engagement.