The Community Setting

• At each visit, ask patient about history of falls, frequency of falls, and gait or balance disturbances.
• For patients who report a fall or gait/balance impairment, follow up with further risk assessment.
  • Review medical history and medications
  • Physical examination
    • Cognitive evaluation, visual acuity, and functional assessment
    • Cardiovascular system, include heart rate and rhythm, postural hypotension
    • Neurological impairment
    • Muscular strength
  • History of falls
  • Feet and footwear
  • Environmental hazards/home safety evaluation
  • Get Up and Go test
    • Ask patient to rise from chair, walk 9 feet, turn around, walk back to chair and sit back down
    • Normal time is 14 seconds or less
    • Observe postural stability, gait, stride length, sway, and leg strength

• Exercise/PT targeting balance, gait, and strength (ideally three hours per week). Consider pre-operative PT referral for patients undergoing elective hip, knee, or ankle joint replacement surgery, for core and upper body strengthening.
• Medication modification, as appropriate (e.g., decreasing or stopping psychoactive medications)
• Vitamin D supplementation for patients deficient or a high fall risk (800-1000 international units cholecalciferol daily)
• Evaluation and modification of the home environment (most effective when directed by occupation therapist)
• Patient education - Utilize the CDC’s STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative which includes educational materials and tools to improve fall prevention (CDC, 2024b).

For patients with comorbidities, consider the following recommendations (Kiel, 2024b):

Nursing Care Facility or Hospital Setting

• Utilize standardized screening tools.
  • Morse Fall Scale
  • Hendrich II Fall Risk Model
  • Schmid Fall Risk Assessment Tool
  • Johns Hopkins Hospital Fall Risk Assessment Tool
  • St. Thomas’ Risk Assessment Tool (STRATIFY)

• Exercise/physical therapy
• Occupational therapy
• Medication modification (e.g., decreasing or stopping psychoactive medications, if appropriate)
• Call bell in reach
• Hearing aids or glasses in reach
• Hourly rounding to assess pain, positioning, toileting, and personal needs
• Early and frequent mobilization
• Nonslip footwear
• Elimination of barriers to transfer and ambulation
• Avoidance of restraints
• Use of bed alarm to signal to staff that patient has exited the bed unattended
• Bed in lowest position to the floor
• Vitamin D supplementation for patients deficient or a high fall risk (800-1000 international units cholecalciferol daily)
• Patient and family education