What is the initial assessment and treatment for injuries from falls?

Initial Assessment and Treatment for Injuries from Falls

The initial assessment for fall injuries should include screening for fall risk factors, evaluating the severity of injuries, and implementing a multifactorial intervention approach to prevent future falls and reduce complications.1

Initial Assessment

• Fall History Assessment: Determine circumstances of the fall, including location, activity during fall, and whether there was loss of consciousness or warning symptoms 2
• Injury Evaluation: Assess for fractures, soft tissue injuries, head trauma, and other injuries that may require immediate medical attention 2, 3
• Risk Factor Screening: Evaluate modifiable risk factors including:
  • Medication review (especially psychoactive medications) 1
  • Gait and balance assessment 1
  • Visual acuity testing 1
  • Postural hypotension evaluation 1
  • Home environment hazards 4

Immediate Treatment Approach

• Injury Management:

  • Stabilize fractures and provide appropriate pain management 2
  • Address wounds and soft tissue injuries 2
  • Evaluate for head injuries and neurological complications 3
  • Consider hospitalization for severe injuries (approximately 800,000 fall-related hospitalizations occur annually among older adults) 3

• Functional Assessment:

  • Evaluate impact on mobility and activities of daily living 2
  • Address psychological consequences such as fear of falling 2

Prevention of Future Falls

• Exercise Intervention:

  • Implement balance, strength, and gait training exercises 1
  • Physical therapy referral for patients with significant mobility impairment 1

• Medication Management:

  • Review and modify medications associated with fall risk 1
  • Consider withdrawal of psychotropic medications when possible 4

• Nutritional Support:

  • Vitamin D and calcium supplementation, particularly for institutionalized elderly 4, 1

• Environmental Modification:

  • Professional assessment and modification of home hazards 4, 1
  • Consider assistive devices as appropriate 2

Special Considerations

• High-Risk Populations:

  • Adults aged ≥85 years have the highest rates of fatal falls 5
  • Institutionalized elderly may benefit from specific interventions like hip protectors 4

• Follow-up Care:

  • Regular reassessment of fall risk 2
  • Ongoing monitoring of intervention effectiveness 1
  • Annual fall risk screening for all adults over 65 years 1

Clinical Pitfalls to Avoid

• Underestimating Impact: Falls are the leading cause of injury among adults ≥65 years, resulting in approximately 3 million emergency department visits and 32,000 deaths annually 5
• Inadequate Assessment: Failure to conduct comprehensive fall risk assessment may miss modifiable factors 2
• Single-Intervention Approach: Using only one intervention strategy rather than a multifactorial approach reduces effectiveness 1
• Overlooking Psychological Impact: Fear of falling can lead to activity restriction and functional decline 2