Fall Prevention Guidelines

Introduction to Fall Prevention

Fall prevention is crucial, especially in older adults, as it can reduce the risk of falling by approximately 17% with vitamin D supplementation 1
The American Academy of Family Physicians, American Geriatrics Society, and American College of Physicians recommend a comprehensive approach to fall prevention, including screening questions, balance and gait assessments, and medication review 2, 3, 4

The American Geriatrics Society recommends assessing the circumstances of the fall, including witness accounts, medical conditions, cognitive status, mental health, visual acuity, and musculoskeletal examination, to identify potential risk factors for falls 5, 6
The following risk factors for recurrent falls should be evaluated:
Risk Factor Relative Risk
Balance and mobility impairments 1.32
Medication-related factors 1.53
Psychological factors 1.35
Sensory and neuromuscular deficits 1.51
Cognitive impairment -
The American Diabetes Association recommends assessing for peripheral neuropathy, especially in patients with diabetes, to evaluate fall risk 8
Measuring orthostatic blood pressure and carotid sinus massage can help diagnose underlying conditions that contribute to falls, as recommended by the European Society of Cardiology 9

Risk Factor	Relative Risk
Balance and mobility impairments	1.32
Medication-related factors	1.53
Psychological factors	1.35
Sensory and neuromuscular deficits	1.51
Cognitive impairment	-

The Timed Up and Go (TUG) test can be used to assess functional ability, with normal results being less than 10 seconds, as recommended by the American College of Physicians 1
Cognitive Assessment using Mini-Mental State Examination or similar tool should be conducted, as recommended by the European Society of Cardiology 9
Gait and Balance Assessment using the "Get Up and Go" test or similar functional assessment should be performed, as suggested by the American College of Emergency Physicians 4
Laboratory tests, including complete blood count, electrolyte levels, renal function, blood glucose levels, and thyroid function, should be evaluated to detect underlying conditions that could contribute to falls in older adults, as recommended by the American College of Emergency Physicians and the American Geriatrics Society 4, 6

Home safety assessment and modifications, such as removing tripping hazards, installing handrails and grab bars, improving lighting, and ensuring even floor surfaces, are necessary to prevent falls, as recommended by the American College of Emergency Physicians and the British Medical Journal 4, 10
Implementing a structured exercise program focusing on balance and functional training, resistance/strength training, flexibility exercises, and gait training is recommended, with a frequency of 3 sessions per week for 12 months, and 50-60 minutes of exercise daily, including aerobic exercise performed in 10-20 minute sessions, 3-7 days per week, at an intensity of 12-14 on the Borg scale (55-70% of heart rate reserve) 7, 5, 11
A daily dosage of 800 IU of vitamin D is recommended for those at increased fall risk, as suggested by the American College of Physicians 1
Tai Chi is a promising balance exercise that may be considered as part of a falls prevention program, although further evaluation is needed 5

For patients with diabetes, assessing for peripheral neuropathy and vision problems is essential to prevent falls 6
For patients with urinary incontinence, evaluating and treating the condition can help reduce the risk of falls 6
For stroke patients, implementation of a specific falls prevention plan and skills training for safe transfers and mobility is necessary, as recommended by the International Journal of Stroke, and for patients with osteoporosis risk, consideration of bone health assessment and appropriate treatment is essential 12
Patients who are frail should be referred to specialist care of the elderly team, and a physical therapist or physical activity expert should be included in the care team, as recommended by the American Medical Association and the International Journal of Stroke 13, 11, 12

Reassessment of fall risk at all transition points and whenever there is a change in health status is necessary, as recommended by the International Journal of Stroke, and expedited outpatient follow-up, including home safety assessments, is essential to prevent subsequent falls 4, 12
Frailty status should be reassessed every 1-2 years for those who are frail or pre-frail, and functional status and quality of life should be monitored for improvement, as recommended by the American Geriatrics Society and the International Journal of Stroke 14, 5
Staff education programs should be implemented to educate healthcare providers on fall prevention strategies, and regular reassessment every 1-2 years for frail/pre-frail patients should be conducted to monitor fall risk and adjust interventions as needed, as recommended by the American Geriatrics Society and the International Journal of Stroke 5, 14
Benefits from the intervention are typically seen by 12 months 1