Last updated December 18, 2021

Management of Falls in Community-Dwelling Older Adults

Recommendations

Screening

Physical therapists should routinely ask older adult patients if they have fallen in the previous 12 months.
Screening should include:
  1. History and context of falls over the previous 12 months
  2. At least one question about the patient's percept.ion of difficulty with balance or walking
(C)
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2. For each patient who reports a fall or falls or reports difficulty with balance or walking, the physical therapist should screen by observing for gait or balance impairment. A screening is positive when either of the following conditions is found:
  1. The patient reports multiple falls regardless of balance and gait impairments
  2. The patient reports one fall, and a balance or gait impairment is observed
(C)
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Assessment

Physical therapists should provide an individualized assessment within the scope ol physical therapist practice that contributes to a multifactorial assessment of falls and fall risk. Additional potential risk factors may need to be addressed by the appropriate provider as indicated (CGS Grade A: Strong recommendation based on Level II evidence). This assessment should include:
  1. Medication review with emphasis on polypharmacy and psychoactive drugs
  2. Medical history with emphasis on new or unmanaged risk factors:
    1. osteoporosis
    2. depression
    3. cardiac disease, including signs or symptoms of cardioinhibitory carotid sinus hypersensitivity
  3. Body functions and structure, activity and participation, environmental factors, and personal factors:
    1. strength
    2. balance
    3. gait
    4. activities of daily living
    5. footwear
    6. environmental hazards
    7. cognition
    8. neurological function
    9. cardiac function, including postural hypotension
    10. vision
    11. urinary incontinence
(A)
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Interventions

Physical therapists must provide individualized interventions that address all positive risk factors within the scope of physical therapist practice. (A)
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  1. Strength training that is individually prescribed, monitored, and adjusted.
(A)
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Balance training that is individually prescribed, monitored, and adjusted. (A)
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Gait training.  (A)
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Correction of environmental hazards. (A)
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Correction of footwear or structural impairments of the feet. (B)
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Components of the intervention should include:
 

Recommendation Grading

Overview

Title

Management of Falls in Community-Dwelling Older Adults

Authoring Organization

Publication Month/Year

June 1, 2015

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Provide recommendations to physical therapists to help improve outcomes in the identification and management of fall risk in community-dwelling older adults.

Target Patient Population

Community-dwelling older adults

Inclusion Criteria

Female, Male, Older adult

Health Care Settings

Emergency care, Hospice, Long term care, Outpatient

Intended Users

Physical therapist, occupational therapist

Scope

Rehabilitation, Management

Diseases/Conditions (MeSH)

D000058 - Accidental Falls

Keywords

fall prevention, geriatric falls, fall risk

Source Citation

Keith G. Avin, Timothy A. Hanke, Neva Kirk-Sanchez, Christine M. McDonough, Tiffany E. Shubert, Jason Hardage, Greg Hartley, Management of Falls in Community-Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association, Physical Therapy, Volume 95, Issue 6, 1 June 2015, Pages 815–834, https://doi.org/10.2522/ptj.20140415