CLINICAL PRACTICE GUIDELINES
Fall Risk Screening
Key Recommendations
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All adults 65 years and older should be screened at least once a year to help identify and manage their fall risk factors.
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While screening tools have been used to predict a general level of risk for falling, they do not accurately predict which people will actually fall or give much information about what can be done to decrease the risk of falling.
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Fall risk screening identifies older adults at increased risk of falls who would likely benefit from a more in-depth evaluation.
Screening for fall risk
Patient scores ≥4 on the Staying Independent brochure
OR
Patient answers YES to any of the 3 key questions:
1. Fell in the past year?
-If YES ask, How many times? Were you injured?
2. Feels unsteady when standing or walking?
3. Worries about falling?
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Screening tools such as the Staying Independent Checklist provide the ability for seniors to self-assess their risk for falls.
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Keep in mind that validated screening tools can also be used as a means to encourage a discussion around falls since many older patients who have fallen do not bring it up at medical appointments.
Next Step:
If a patient score ≥ 4 on the Staying Independent brochure or if a patient answers YES to any of the key questions, proceed with Evaluating Gait, Strength and Balance.
OR
If a patient who reports no falls in the past year obtains a score < 4 on the Staying Independent brochure or if a patient answers NO to all key questions, provide individualized interventions for an older patient at LOW RISK for falls.
Resources
- Algorithm for Fall Risk Screening, Assessment and Intervention
- Developed by Trauma NB
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Developed by Trauma NB
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Staying Independent Self-screening Checklist
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Developed by Trauma NB
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