What strategies can be implemented to reduce costs and improve outcomes from fall injuries in patients, particularly the elderly or those with a history of falls?

Strategies to Reduce Costs and Improve Outcomes from Fall Injuries

Multicomponent exercise programs combining balance and strength training are the most effective intervention for preventing falls and related injuries in older adults, reducing falls by 23% compared to non-exercise controls. 1

Risk Assessment and Screening

• Screen all older adults for fall risk by asking about falls in the past year, concerns about falling, or assessing gait speed (less than 0.8-1 m/s indicates high risk) 1
• Implement systematic clinical assessments to identify modifiable risk factors in high-risk individuals 1
• Major modifiable risk factors to assess include:
  • Gait and balance disorders 1
  • Orthostatic hypotension 1
  • Sensory impairment 1
  • Medications that increase fall risk 1
  • Environmental hazards 1

Evidence-Based Interventions

Exercise Programs

• Prescribe regular multicomponent exercise focusing on:
  • Balance training 1, 2
  • Strength training, particularly for lower extremities 1, 2
  • Functional exercises to improve leg strength 1
• Exercise interventions reduce falls from 850 to 655 falls per 1000 patient-years (rate ratio 0.77) 1

Multifactorial Interventions

• For high-risk individuals, implement multifactorial interventions that systematically assess and address multiple risk factors 1
• These interventions reduce falls from 2317 to 1784 falls per 1000 patient-years (rate ratio 0.77) 1
• Effective components include:
  • Exercise programs 1, 2
  • Medication review and deprescribing when appropriate 1, 3
  • Vision assessment and correction 1
  • Home hazard assessment and modification 1, 2

Targeted Medical Interventions

• Refer for cataract surgery when indicated, which reduces fall risk (risk ratio 0.68) 1
• Consider multicomponent podiatry interventions (risk ratio 0.77) 1
• Assess vitamin D status in those at risk for deficiency and supplement as needed 3

Environmental Modifications

• Implement home hazard assessment and modification, especially for high-risk individuals (risk ratio 0.74) 1, 4
• Occupational therapy home assessments effectively reduce fall risk and fall rate among older people 4
• Recommend anti-slip shoe devices for icy conditions 2
• Consider assistive devices such as canes and walkers for appropriate candidates 2
• Hip protectors for nursing home residents and other high-risk individuals 2

Implementation Framework

1. Identify high-risk individuals through systematic screening 1, 5
2. Conduct comprehensive fall risk assessment for those at high risk 5
3. Develop individualized fall prevention programs addressing specific identified risks 5
4. Prioritize multicomponent exercise for most patients 1, 2
5. Add targeted interventions based on specific risk factors 1, 3
6. Reassess fall risk periodically to ensure ongoing prevention 5

Clinical Pearls and Pitfalls

• Exercise programs alone are effective for average-risk populations, while multifactorial interventions should be reserved for high-risk individuals 1
• Home hazard reduction is more effective when combined with other fall prevention approaches such as exercise programs 2, 3
• Medication review is most effective as part of multifactorial interventions rather than as a standalone intervention 1
• More than 25% of older adults fall each year, making this a critical prevention target 1