Fall Prevention and Home Modification for Patients with Instability and Chronic Conditions

Introduction to Fall Prevention

The American Geriatrics Society recommends implementing a multifactorial home modification program, including gait training, environmental hazard reduction, medication review, and consideration of wheelchairs, to reduce falls and improve safety in patients with instability, fall history, chronic back pain, and assistive device dependence 1, 2, 3

Ambulatory assistive devices, such as canes and walkers, should be prescribed to improve gait, balance, and mobility safety in patients with instability or fall risk, as recommended by the American Heart Association and the American Stroke Association 4, 5
Wheelchairs should be prescribed for nonambulatory individuals or those with severely limited walking ability who cannot accomplish mobility-related activities of daily living, according to the American Heart Association and the American Stroke Association 4, 5, 6
Ankle-foot orthoses (AFOs) should be used for ankle instability or dorsiflexor weakness to improve gait and prevent falls, as recommended by the American Heart Association and the American Stroke Association 4

The American Geriatrics Society recommends installing grab bars in bathrooms near toilets and in showers/tubs to reduce fall risk 1, 2
Elevated toilet seats should be installed to reduce fall risk during transfers, as recommended by the American Heart Association and the American Stroke Association 5
Tub and shower chairs should be provided for bathing safety, according to the American Heart Association and the American Stroke Association 5

Patients with fall history should have comprehensive medication review with particular attention to psychotropic medications and polypharmacy, as recommended by the American Geriatrics Society 1, 2, 3
Reduction of medications is beneficial in patients taking four or more preparations, according to the American Geriatrics Society 2, 3

Older people with recurrent falls should be offered long-term exercise and balance training, as recommended by the American Geriatrics Society 3
Balance training is a critical component of effective fall prevention programs, according to the American Geriatrics Society 1
Gait training and advice on appropriate assistive device use should be provided, as recommended by the American Geriatrics Society 1, 2

Adaptive devices, such as long-handled sponges and hand-held showers, should be used for safety and function when other methods of performing tasks are unavailable, cannot be learned, or when patient safety is a concern, according to the American Heart Association and the American Stroke Association 4, 5

Assistive devices should not be prescribed in isolation without addressing other fall risk factors, as recommended by the American Geriatrics Society 2, 3
Motorized scooters should not be substituted for power wheelchairs in patients with instability, as scooters are less stable and cannot accommodate complex seating needs, according to Praxis Medical Insights 7

Patients require follow-up with primary care provider within one month of discharge, as recommended by the American Heart Association and the American Stroke Association 5
Those receiving rehabilitation services need follow-up with rehabilitation professionals 3-6 months after discharge, according to the American Heart Association and the American Stroke Association 5