How do you assess fall risk in an outpatient setting?

From the Guidelines

Fall risk assessment in an outpatient setting should include a multifaceted approach combining standardized tools, physical examination, and medication review, with a focus on the Timed Up and Go (TUG) test, as recommended by the USPSTF 1. To assess fall risk, begin with validated screening tools like the TUG test, where times exceeding 12 seconds indicate increased fall risk.

• The TUG test is performed by observing the time it takes a person to rise from an armchair, walk 3 meters (10 feet), turn, walk back, and sit down again, with the average healthy adult older than 60 years able to perform this task in less than 10 seconds 1.
• Assess balance using the Berg Balance Scale or Single Leg Stance test.
• Review the patient's medication list for high-risk medications including benzodiazepines, antipsychotics, antidepressants, antihypertensives, and sedatives, as these can cause orthostatic hypotension, dizziness, or impaired coordination.
• Evaluate vision, hearing, and footwear appropriateness, as sensory deficits significantly contribute to falls.
• Document fall history by asking about previous falls within the past year, circumstances surrounding those falls, and any resulting injuries.
• Check orthostatic vital signs by measuring blood pressure and heart rate while the patient is lying down, then after standing for 1 and 3 minutes, with a drop of ≥20 mmHg systolic or ≥10 mmHg diastolic indicating orthostatic hypotension.
• Assess home safety by discussing potential hazards like loose rugs, poor lighting, or lack of grab bars. This comprehensive approach allows for targeted interventions to reduce fall risk, including physical therapy referrals, medication adjustments, home modifications, or assistive device recommendations, as supported by the USPSTF recommendations 1.

From the Research

Assessing Fall Risk in Outpatient Settings

To assess fall risk in outpatient settings, several methods and tools can be utilized. The following are some of the key approaches and factors to consider:

• Physiological Profile Approach: This approach, as described in 2, involves a series of simple tests of vision, peripheral sensation, muscle force, reaction time, and postural sway. The Physiological Profile Assessment (PPA) provides valid and reliable measurements for assessing falls risk.
• Falls and Injuries Risk Assessment Clinic: The experience of a falls and injuries risk assessment clinic, as outlined in 3, highlights the importance of a multidisciplinary approach involving specialist medical assessment and physiotherapy assessment and treatment.
• Fall Risk Assessment Tools: Various fall risk assessment tools can be used in outpatient settings, including the Timed Up and Go Test, Functional Gait Assessment, and Berg Balance Scale, as recommended in 4.
• Patient Characteristics and Medications: Certain patient characteristics, such as history of falls, needing assistive devices, confusion, and dizziness, as well as medications like hydantoin, benzodiazepine anticonvulsants, and haloperidol, can increase the risk of falls, as identified in 5.
• Comprehensive Fall Reduction Programs: Developing comprehensive fall reduction programs, as described in 6, can help identify and address fall risk factors in outpatient settings.

Key Factors to Consider

When assessing fall risk in outpatient settings, the following factors should be considered:

• Patient's medical history and current health status
• Medications and potential side effects
• Mobility and balance issues
• Cognitive function and mental status
• Environmental factors, such as home safety and accessibility
• Patient's ability to perform daily activities and manage their condition

Assessment Tools and Strategies

The following assessment tools and strategies can be used to assess fall risk in outpatient settings:

• Physiological Profile Assessment (PPA)
• Timed Up and Go Test
• Functional Gait Assessment
• Berg Balance Scale
• Medication review and management
• Home safety assessment and modification
• Patient education and counseling on fall prevention strategies