7 Tips for Fall Prevention (in older adults at risk)

Based on a conversation with and information provided by Lindsey Yourman, M.D. 

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Listen to the related podcast.

icon of a person getting blood pressure taken with text that reads: A new study showed that orthostats are still predictive of falls if you test the standing blood pressure immediately after the person stands

Orthostats: A new study showed that orthostats are still predictive of falls if you test the standing blood pressure immediately after the person stands (as opposed to waiting 3 minutes). 

Juraschek SP, Daya N, Rawlings AM, et al. Association of History of Dizziness and Long-term Adverse Outcomes With Early vs Later Orthostatic Hypotension Assessment Times in Middle-aged Adults. JAMA Intern Med. 2017;177(9):1316-1323. doi:10.1001/jamainternmed.2017.2937

icon of two footprints with text that reads: Ask patient to semi-tandem stand, if they can't do it > 10 seconds, = increased fall risk

Gait and balance:

Ask patient to semi-tandem stand, if they can't do it > 10 seconds, = increased fall risk.

 

 

Icon of bifocal glasses with text that reads: bifocal glasses, the ones with the horizontal lines across the lens, are a fall risk on stairs or outside on uneven surfaces

Vision: Bifocal glasses, the ones with the horizontal line across the lens, are a fall risk on stairs or outside on uneven surfaces. Consider recommending the patient see their ophthalmologist to inquire about single distance lenses or take their glasses off when going up or downstairs.

Johnson L, Buckley JG, Scally AJ, Elliott DB. Multifocal spectacles increase variability in toe clearance and risk of tripping in the elderly. Invest Ophthalmol Vis Sci. 2007;48(4):1466-1471. doi:10.1167/iovs.06-0586

Icon of a calendar with text that reads: Check for Delerium: Ultra-Brief 2 (UB-2) is a 2 question test (wHAT IS THE DAY OF THE WEEK AND ASK THE PATIENT TO SAY THE MONTHS BACKWARD)

Cognition: Ultra-Brief 2 (UB-2) is a 2 question test (What is the day of the week and ask the patient to say the months backward) with 86% sensitivity and 69% specificity for delirium that has been evaluated in the GED.  Evaluate and treat delirium if possible. Delirium prevention (mobility assistance, medication review, paying attention to whether a patient can hear or see) also helps prevent falls.

Fick DM, Inouye SK, Guess J, et al. Preliminary Development of an Ultrabrief Two-Item Bedside Test for Delirium. J Hosp Med. 2015;10(10):645-650. doi:10.1002/jhm.2418

icon of a shoe with text that reads: look to see if the person has good treat on the bottom of their shoes

Functional Status: Look to see if the person has good tread on the bottom of their shoes;  if not, recommend new shoes if they can afford it.

Prevent Falls With Proper Shoes for Seniors. Sweating Seniors. August 2018. https://www.sweatingseniors.com/active-seniors/prevent-falls-with-proper-shoes-for-seniors/. Accessed May 22, 2019.

Icon of a medication container and pills with text that reads: Check AGS Beers Criteria for potentially inappropriate medication

Medications: Check the patient's medications against the American Geriatric Society Beers Criteria for potentially inappropriate medication use in older adults

A website deprescribing.org gives useful tips for how to decrease or discontinue meds including benzos; might have some useful materials for discharge instructions (that a nurse or pharmacist could go through with patient).

Icon of a set of stairs with text that reads: Share CDC fall safety checklist that a patient can do on their own at home

Home Hazards: Provide the CDC fall safety checklist that a patient can do on their own at home

Other CDC Resources: https://www.cdc.gov/steadi/

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