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Comprehensive Assessment

Working with Patients & Clients to Prevent Falls
doctor and patientThe most effective way to prevent falls is to address the factors that put your client at risk. Clinicians, pharmacists, social service providers, community centers and other organizations can each take action to prevent falls.

Key interventions for preventing falls are: physical activity, medication review and modification, finding and fixing fall hazards, and vision screening and correction. Your patient may be eligible for home care services that can help address some of these areas of falls prevention.

 

Promote Physical Activity for All Older Adults
  • Encourage patients and clients to get regular exercise. Refer to the Physical Activity section, which includes links to BeFitNYC for free and low cost classes for seniors. Tai Chi is especially helpful.


  • Lead an exercise class at your organization or community center or recommend exercises older adults can do at home using these comprehensive guides.
  • Exercise recommendations should be tailored to a patient’s fitness level to ensure safety. Refer to the Screening and Assessment web page for tools to assess patient mobility and balance. Physical or occupational therapy, mobility training or vision rehabilitation may
    be required.


  • Even if a patient has not fallen, under Medicare and Medicaid, doctors can prescribe assistive devices and refer patients for physical or occupational therapy if medically necessary. Physical or occupational therapists can ensure proper fitting and orientation to devices and tailor appropriate exercise programs.

 

Review and Modify Medications
  • Read about medications linked to falls (PDF)


  • Periodically review all medications with patients using the Brown Bag method. Remember to ask patients about over-the-counter medicines, alcohol, and herbal, supplement and vitamin use. Encourage patients and clients to use a medication list (Español, 中文)


  • Ask patients about side effects and potential interactions.


  • Withdraw unnecessary medications and, if possible, modify dosages of psychoactive and other classes of medications known to increase falls risk in older adults.


  • Encourage patients to use a single pharmacist. Older adults often see several health care providers that may prescribe other medications. The pharmacist can alert prescribing physicians of possible interactions with other prescribed medications.


  • Consider Vitamin D supplements of at least 800 IU/day for people with suspected vitamin D deficiency or who are otherwise at increased risk for falls.


  • See the Medication Adherence Action Kit for tools and resources.


  • Refer patients to the Managing Your Medicines section of this site for information and resources to take medications safely and as directed.


 

Screen For and Correct Vision Problems
  • Perform basic visual screening. Ask patients if they are having any trouble with their daily activities because of their eyesight. Test the patient’s ability to read regular print (wearing their prescribed reading glasses if applicable).


  • Refer patients to an ophthalmologist for an annual dilated eye exam and visual field test.


  • Encourage patients and clients to:
    • wear glasses only as prescribed
    • get new prescriptions filled as quickly as possible
    • allow time to adjust to changes from light to dark
    • wear sunglasses

 

Assess, Discuss, Treat or Refer for the Following

 

Remove Home Hazards
  • Share the Check for Safety Other languages: [ Español ][ 中文 ] home fall prevention checklist with patients and clients. Many home hazards, such as poor lighting and clutter, are easy to fix.
    • Occupational therapists are qualified to conduct comprehensive home safety assessments and recommend modifications.


    • Vision rehabilitation therapists and orientation and mobility specialists conduct safety assessments and recommend modifications specific to vision loss such as lighting, reducing glare, using high contrast, placement of furniture, etc.


  • Grab Bars in the bathtub or shower are a widely recommended home safety modification.
    • NYC building owners must install grab bars in disabled adults’ bathtubs upon request but do not need to pay for them.

 

Resources:

 

Last Updated: February 21, 2012