Fall Prevention in Frail Elderly

Risk Stratification and Screening

• The American College of Physicians recommends annual screening for all adults ≥65 years using three key questions, with a focus on identifying individuals at risk for falls 1, 2
• The Timed Get-Up-and-Go test should be performed for any positive screen, with completion time >10 seconds indicating high fall risk and warranting intervention 1, 2, 3

Primary Interventions

• Exercise programs demonstrate the highest certainty of benefit, with a 23% reduction in fall rates and 15% reduction in number of fallers, and should include balance and functional exercises, gait training, strength training, and moderate-intensity aerobic activity 1, 2, 4
• Vitamin D supplementation with 800 IU daily is recommended for all frail elderly at fall risk, with greater benefit in vitamin D-deficient populations 1, 2, 5

Medication Management

• The American Geriatrics Society recommends systematically reviewing and reducing psychotropic medications, medications causing dizziness/sedation, and polypharmacy (≥4 medications) to minimize fall risk 3, 4, 2

Environmental and Assistive Interventions

• Home hazard modification reduces falls by 26% in high-risk individuals when combined with other interventions, and should address tripping hazards, inadequate lighting, bathroom safety, and stair safety 4, 5, 3

Implementation Algorithm

• For average-risk frail elderly, initiate exercise/physical therapy program with balance focus, start vitamin D 800 IU daily, review and optimize medications, and conduct annual reassessment 1, 2, 4, 5
• For high-risk frail elderly, comprehensive multifactorial assessment, exercise/physical therapy program, vitamin D 800 IU daily, targeted interventions, close case management, and frequent reassessment are recommended 5, 3, 4, 1