Falls¶

Thomas Horton

Background¶

Screen annually for falls in the past year
History of fall is a strong risk factor for future falls
Recommended History Screening Tool: CDC STEADI Algorithm
Physical Exam Screening Tools:
If potentially unstable injuries (new spine fracture or lower extremity fracture): Ask ortho to clear the patient for mobility
If no potentially unstable injuries, attempt to get the patient out of bed
- If lying down, have them lift each leg off the bed
- If they can do this, ask them to sit up on side of bed
- If they can do this, ask them to stand
- If they can do this without assistance, then observe them walk
The Timed “up and Go” Test (TUG) tool for fall risk
- Have the patient rise from sitting in a chair, walk 10 feet forward, turn around, walk back to chair, and sit down
- Patients who require > 10 seconds are at increased risk for falls
Med Rec:
- Antipsychotics, antidepressants, anticholinergics, anxiolytics, sedatives/hypnotics, anti-hypertensives, antiarrhythmics, steroids, statins all can increase risk of falls

Rule out other causes: Cardiac, Neurologic, Infectious
Check Vitamin D levels (goal > 30) and supplement (800-1000 IU daily) if at increased fall risk
Assess visual acuity (e.g. expedite cataract surgery)
Hearing assessment (audiology screen)
Consult Inpatient PT/OT and refer for HH PT/OT for home safety evaluation at discharge
Recommend non-skid shoes with a backing (sneaker)
Modify extrinsic risk factors for falls: removal of fall hazards, placement of handrails
Referral to Exercise programs: At VUMC = Dayani Center “Ambulatory Referral to Medical Fitness” outpatient order