Fall Assessment & Prevention

Fall Risk Assessment and Management

More than 25% of seniors fall each year, but less than half ever tell their doctor. Falling once doubles your risk of falling again and one out of every 5 falls causes a serious injury such as broken bones or a head injury. Over 95% of hip fractures are caused by falling, and falls are the most common cause of traumatic brain injuries (cdc.gov.) 

The dangers around falling go far beyond “the fall” itself and exist both in the years preceding “the fall” as well as the sequelae of events afterward. Looking at afterward, if you do suffer a serious injury such as a fracture, this will likely require a prolonged hospital stay and potentially surgery.

Following a prolonged hospital stay, you will typically be weaker than before (due to bed rest, stress, and any side effects of surgery), which only increases your fall risk and makes it significantly more challenging to return to your previous quality of life. This is why it’s important to take action to prevent “the fall” from occurring in the first place. 

Regarding the years preceding any serious fall, you will likely start to notice that you aren’t quite as active as you used to be. Typically, patients will note that they walk slower than they used to, they have a harder time going up and downstairs, rising and lowering from/into a chair, and “take things a little slower” than before because they don’t feel quite as steady. These should be raising alarm bells that your risk of falling is increasing. Ideally, this is when you want to be evaluated by a physical therapist to know what your risk of falling is. This is when it is easiest to address the balance deficits and muscle weakness that so often contributes to falling. 

Let me say it again: Falls are to be taken seriously!

If there is a take-home point to this piece, it’s the following:

Falls are to be taken seriously, oftentimes they are an indicator that one is on their way to increased disability and even mortality if certain steps are not taken to decrease their risk of falling. If you are falling or feel like you are walking slower than you used to, struggling to get out of a chair, or feeling off-balance, contact Chapman Physical Therapy to schedule your evaluation so we can get you stronger, balanced & independent.

Testing someone’s fall risk:

Numerous evidence-based tests aim to assess an individuals’ fall risk. Typically, it’s good to perform several different tests because different tests look at different “aspects” of balance and disability. This portion is for understanding the testing process, and it is not for someone to perform them on their own. Do not perform these without the supervision of a physical therapist or another qualified medical provider.

Timed up & go Test: 

Sit in an armchair and time how long it takes to stand up, walk 10 feet, turn around and sit back down. If this test takes >12 seconds to perform, this older adult is likely at risk for falling. 

Short Physical Performance Battery (SPPB): 

The SPPB is 3 tests together (each has a maximum score of 4) for a cumulative maximum score of 12 points. The first test is a balance test, followed by a gait speed test, followed by a lower extremity strength test. The SPPB is commonly used to predict future risk of nursing home admission as well as mortality. Those scoring <10 on this scale have a notably increased risk of mobility disability in the future compared to those who score as 12 (odds ratio 3.38.) The lower your score is, the more predictive this measure is of falling (Lauretani 2018). 

6 Minute Walk Test:

It’s really all in the name. The 6-minute walk test measures your endurance and walking capacity, testing how far you can walk in the allotted time. Set a timer for 6 minutes and walk as far as you can in that time frame. Believe it or not, the distance you can cover in this time is thoroughly predictive of your level of future independence if you’re falling below your age-matched norms.

The Frail Scale: 

The Frail Scale, which stands for Fatigue/Resistance/Aerobic/Illness/Loss of weight, is a scale intended to identify those in a state of increased vulnerability to physical or psychological stressors. If you score a 1-2, you are classified as “pre-frail.”

The FRAIL scale is scored 0-5. A score of 1-2 indicates you are classified as “pre-frail.” Those classified as “pre-frail” have a 1.7X higher risk of mortality in the next 9 years, and the risk is as high as 4x for those classified as frail (score of 4-5). Furthermore, those who were pre-frail but had no difficulty with activities of daily living were more likely to have difficulties at their 9 years follow-up. Physical therapy can help improve your strength and balance, improving your metrics on these tests – but more importantly, improving your quality of life and independence. 

How the scale works:

Fatigue: How much of the time during the past 4 weeks did you feel tired?

-All the time, most of the time, some of the time, a little of the time, or none of the time?

-An answer of all or most of the time = 1 point. Any other answer = 0 points.

Resistance: By yourself and not using aids, do you have difficulty walking up to 10 steps without resting?

-Yes = 1 point

-No = 0 points

Ambulation: By yourself and not using aids, do you have any difficulty walking several hundred yards?

-Yes = 1 point

-No = 0 points

Illnesses: Did a doctor ever tell you that you have…..

Hypertension / diabetes / cancer (not including skin) / chronic lung disease / heart attack / CHF / angina / asthma / arthritis / stroke / kidney disease.

-0-4 illness is scored 0, and 5-11 illnesses are counted as 1 point. 

Loss of weight:

Question 1: How much do you weigh with your clothes on but without shoes?

Question 2: One year ago, how much did you weigh with your clothes but without shoes?

Percent change of >5 is scored a 1, and <5 is scored a 0. 

These are just some of the tests that go into assessing someone’s falls risk. They look at strength, balance, endurance, walking, and the patient’s perspectives of themselves to help the physical therapist understand the underlying issues and create a comprehensive plan of care that helps the patient achieve their goals. 

Now, the most important part….what can YOU do about the risk of falling?

If you believe you are at risk of falling, you should contact Chapman Physical Therapy to schedule a full evaluation. However, if you are just worried about trying to prevent yourself from becoming a fall risk in the future and want to work on improving your baseline, there are some home interventions you can put into action today.

Strengthen your lower body:

The lower body (core, hips, legs, and feet) are responsible for keeping us upright and well-balanced. Performing squats from a chair, practicing getting down to the floor safely and back up, initiating a core strengthening routine, lunges, and other lower body workouts are going to help you prevent muscle loss as you age. 

Work on your balance….safely! 

Balance is a skill, and you need to practice it! To do this safely, you can stand between two large chairs (so you can place your hands on them as necessary) and practice standing with your feet together or even in a tandem position, depending on how good your balance is. Again, if you feel your balance isn’t 100%, you should be evaluated by a medical professional before trying this at home. 

Get rid of the throw rugs!

Throw rugs are, while quite nice, actually a serious contributor to falls within the home as it can be easy to catch your foot on them while not paying attention. Pass them off to your kids; they’ll be delighted!

If you are on medications

Check with your doctor to see if they can affect your balance. If you are on multiple medications, check with your doctor to see if any drug interactions between your medications can contribute to dizziness or falling.

Eat well and rest.

Take care of your body and yourself. It’s important to make sure you’re not losing weight, as this (among many other issues) will decrease your strength and contribute to increasing your fall risk. 

Supplementation

Numerous studies have shown that supplementing with Vitamin D and Calcium (about 500IU each, 2x/daily) effectively reduces falls in the elderly. Check with your doctor to ensure there is no issue with you starting supplementation with Vitamin D and Calcium before you begin.

Conclusion:

Physical therapy is not a tool, an intervention, or a fix to wrap this all up. It is an individualized and specific plan of care that charts a path from where you are today to where you want to be in the future. It’s doctoral-level care that consists of a blend of exercise, hands-on care, education, guidance, and support for your needs.