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Doctor and Patient

CLINICAL PRACTICE GUIDELINES

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Algorithm for Fall Risk Screening, Assessment and Intervention

The Algorithm for Fall Risk Screening, Assessment and Intervention describes the systematic process of decision-making and intervention that should occur to address fall risk factors of concern with older adults who live in a community setting. This algorithm is based on the World guidelines for falls prevention and management for older adults in addition to the Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons and other evidence-based literature.

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For more information about each section of the algorithm, please click on its corresponding box or click on the following links:

NOTE: The Algorithm, it's accompanying Fall Risk Factor Checklist and other fall prevention resources will be updated on an ongoing basis as new research and best practice are available. 

Opportunistic Screening
 

Ask the patient the following 3 key questions:
    1. Have you had any falls in the past year?
    2. Do you feel unsteady when standing or walking?
    3. Are you worried about falling? 

OR

The patient obtains a score of 4 or more
on their Staying Independent Checklist ? (optional)

YES
TO ANY

NO
TO ALL

Individualized Interventions for Patients at
LOW RISK

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  • Ensure the patient receives relevant fall prevention information and handouts (e.g. fact sheets).

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  • Reassess at least once yearly

AND

Encourage uptake and adherence to the Canadian 24-Hour Movement Guidelines for Adults 65 years and older

NO

FALL SEVERITY SCREENING

Injury requiring medical treatment?                          YES   NO
Recurrent falls (≥ 2 in the previous 12 months)?      YES   NO
Does the patient seem frail?                                     YES   NO
Lying on the floor/unable to get up (≥1 hour)?          YES   NO
Loss of consciousness/suspected syncope?            YES   NO

NO
TO ALL

FALL SEVERITY SCREENING

Is the gait speed noticeably slow?                 YES   NO

*Can also be formally assessed as:
               Gait Speed ≤ 0.8 m/s  or  TUG > 15s
                (see Mobility Screening Guidelines)

YES
TO ANY

YES

Individualized Interventions for Patients at
INTERMEDIATE RISK

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  • Ensure the patient receives relevant fall prevention information and handouts (e.g. fact sheets).

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  • Reassess at least once yearly

AND

Refer the patient to individual or group    
exercise-based fall prevention program if available (e.g. Zoomers in Balance)

Individualized Interventions for Patients at 
HIGH RISK

Consider developing a feasible individualized care plan that takes into consideration the priorities, beliefs, preferences, and resources of the older adult.

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  • Optimize the management of underlying acute and chronic medical issues. Complete a physical exam and routine labs (including B12, Vit D and TSH levels) 

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  • Complete a medication review to deprescribe fall-risk-increasing drugs. Consider a referral to a pharmacist.

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  • Check for orthostatic hypotension with lying and standing BP, and manage if present                                                          (systolic drop ≥ 20 mm Hg or diastolic drop ≥ 10 mm Hg)

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  • Assess and manage concerns about falling with validated tool (e.g. Staying Confident Checklist). Consider a referral for occupational therapy and/or cognitive behavioural therapy.

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  • Refer to an optometrist to assess and optimize vision.

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  • Screen for osteoporosis and treat if present.

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  • Refer for occupational therapy for home safety assessment and modifications (e.g. EMP, outpatient or private)​

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  • Ensure the patient receives relevant fall prevention information and handouts (e.g. fact sheets).

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  • Plan follow-up within 3 months to review the individualized care plan​

AND

Refer to physical therapist for gait aid assessment, and optimization of strength/balance (e.g., EMP, outpatient or private)

Based on the World guidelines for falls prevention and management for older adults: a global initiative, Age and Ageing, 2022 Sep 2;51(9):afac205 and the Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011; 59 (1): 148-157.

Resources

 

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