Prevention of Future Falls
We don’t always think of prevention – a key component of primary care – as an Emergency Department responsibility. There are some components of falls prevention, which are certainly within the ability of the ED to complete:
- Ask about prior falls and document frequency and situation – an avoidable pattern may evolve
- If frequent falls, suggest an assessment in a Falls Prevention Clinic (family doctor may not be aware – new problems are often uncovered in the ED)
- If this is the first fall, assess balance and gait as part of your physical exam; perhaps suggesting a cane or a walker now will prevent an ED return tomorrow
- Use your knowledge of fall risk factors to make suggestions:
- Check orthostatic vitals
- Check for carotid hypersensitivity
- Check lower extremity strength
- Suggest medication changes (decrease benzos, sedatives, minimize anti-hypertensives, decrease alcohol use)
- Make suggestions about avoiding falls: “sit on the bed for a minute before standing” “always use your walker” “sit when voiding”
- Promote activity to improve gait and motor strength
- Refer for Home assessment by a community OT/PT
Discussion: Prevention of Future Falls
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good
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Great information and reminders!
great topic
nothing to add
great info
Great info
orthostatic vitals are a good tool as they could drastically change
good info
best username EVER!
great info!
gtk
good information on specific geriatric risk factors
Great information
A patient with a history of falls should be probably referred to some sort of community health program that would a home visiting nurse or a community paramedic. several test and observations can be done while at home to determine what is the best course for this patient. I find a Time Up and Go Test is a very good test to do with a patient if they are able to stand and are not a fall risk.
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Try to prevent falls.
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great review
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neat
good info
good info
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ask the ED manager to train staff in the proper history and functional asessment of the elderly in er
manager may be able to assist
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I work in the UK in the NHS. here, a patient leaving hospital or going home from ED will likely be referred to a community rehab team like mine. We will follow up with the things mentioned on this page.
One of the balance checks we use is the Berg balance test which gives a validated score that also prompts which balance exercises to target. We often see the score go up significantly over the weeks.
A tricky area is walking aids – people easily become adapted to them and even addicted to them especially after having a fall and being fearful of another. We find that providing an aid when not really necessary reduces balance ability and therefore increases the risk of falls in the long term. This has to be ‘balanced’ with the short-term risk of another fall without an aid.
A community-visiting therapist would hopefully train a person away from a walking aid over time.
Great contribution
Great comments. Thanks for the tips.
It’s good to prevent falls.
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Checking for carotid hypersensitivity was not an eval I had ever done for a pt. Will start
alright
something to bear in mind
good advice
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need better fall prevention dc planning
resources concerns
prevention is a better way to ensure our elderly are safe. Educate family and friends of the elderly
Great suggestions. Appropriate discharges from ED with adequate supports and follow up in place prevent ED return visits.
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check gait
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good interventions
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Educación sobre estilos de vida para el anciano,eliminar barreras arquitectónicas uso de espejuelos y buena iluminación en la vivienda
prevention is important especially with a history of falls
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Tai Chi!
Tai Chi is a n effective alternative to falls prevention clinics with long waiting lists
good information
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useful info
good recs
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assess home….clutter, rugs, use of ladders, climbing, some people forget they don’t have the abilities they had when they were young
great suggestions
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Great points for prevention.
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this is good advice. often in the busy ER we forget our role in prevention of the next incident
I like all of the above advise and think fall prevention needs to be included with every pt since memories fail and pt status change. Repeating this info could have a pt recognise a need they may have at a given time if they are familiar with the info and not taking it all in as new along with their presenting problem.
Checking for carotid hypersensitivity is something that is admittedly new to me so I’d very much would be interested to hear the insight of others on the application, value, and risks of it. I appreciate the significance of auscultating for carotid bruits first but are there any other cardiac risks of doing it as an assessment aid?
good learning
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Outpatient referral, OT and/or PT interview before discharge.
Remove scatter mats
Remove all mats at home. Add bar rails in bathroom and perhaps assistance from homecare with medications and bathing. Involve family in taking patient out for shopping and visits.
I like to ask the patient “What would you do differently to help prevent a similar fall from happening again?” I also discuss eyes/ears and types of slippers patients use e.g. improper footwear, use of bifocals and malfuncitoning hearing aides are a bad recipe for falls risk
Thank you
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geriatric referral
will keep this in mind as I get old
good ideas
all this will help
Important to have a multidisciplinary approach to falls prevention in the ED.
hay que educar a los pacientes adultos mayores para enfrentarse a esta nueva etapa de la vida
excellent ideas for my emergency department
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timber
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Making sure CCAC is able to organize pt/ot in the home setting
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Referral for Geriatric assessment clinic will be
Outpatient referrals as needed.. Ex physiotherapy, better balance programs, regular vision, hearing eye exams, good footwear environmental changes like handrails etc
always good to have an OT PT consult prior to dc with any concerns
I always encourage patients to accept a CCAC OT home visit for falls prevention
Evidence would suggest that measurement of Orthostatic V.S.’s is essential an exercise in random number generation. It is the presence or absence of symptoms with change in position that matters.
True. However documenting that the beta-blocked diuresed older person drops her pressure AND get symptoms when she stands up will almost certainly trigger a re-assessment of her medication — or simply advice to sit before standing.
the assesment of the elderly in the ER should include a functional, medication and social supports questionnaire as a matter of routine
referral to outpatient rehab services and geriatric clinics for further asessment will be optimal
er staff who are comfortable in getting a medical functional and drug history are better at dealing with the geriatric patients
ask the ED manager to train staff in the proper history and functional asessment of the elderly in er