The Fear of Falling - Fall Risk Assessment

By Leslie Leite
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It's quite common for older adults to experience falls or to limit their activities because they are afraid of falling, but we shouldn't just accept falling as a normal part of aging, according to Jane Painter-Patton, Ed.D, a professor at East Carolina University's College of Allied Health Sciences in the Occupational Therapy Department.

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In her presentation Wednesday at the Kindred 2015 Clinical Impact Symposium, Painter-Patton gave tips to clinicians and encouraged them to work as a team with other specialists as they deal with the complex issues relating to falls in older adults.

Despite addressing large audiences, both Painter-Patton's presentation and the reaction panel discussion that followed felt very much like advice one clinician might give to a colleague, one-on-one. The participants weren't just speaking at the audience or discussing abstracts, they were speaking directly to every clinician in the room, giving practical, actionable advice that could be implemented successfully in the real world.

fallriskcis4In emphasizing that falling is not a normal part of aging, Painter-Patton said there is always a reason for the fall and the goal should be to find out why it happened. It's also critical to focus on prevention by assessing each patient's risk of falling again.

Painter-Patton stressed the need for an interdisciplinary approach to the problem because there are multiple factors that increase the risk of falling - from loss of strength and balance or gait deficits to the challenges of polypharmacy and environment.

She also made a special point of exploring the fear of falling in depth. She defined the issue as a "lasting concern about falling that can lead an individual to avoid activities that he/she remains capable of performing."

fallriskcis5When the fear of falling holds sway for a prolonged time it can lead to a debilitating cycle, she said. The individual stops being active, which leads to physical weakness. As the individual does less, he or she often experiences social isolation, anxiety and depression.

The question the healthcare provider needs to ask is whether the person is wisely avoiding unsafe activities or if she or he is missing out on favorite activities because of fear, Painter-Patton said.  

It can seem overwhelming to take into account all factors that can go into a fall assessment, but the good news is that, no matter what setting or which medical professional is seeing the patient, there are guidelines, tools and other resources that can help uncover the contributing factors.

fallriskcis6Painter-Patton praised Kindred's interdisciplinary approach - especially the way care is provided across the continuum - which she said makes it easier to perform a multi-factorial fall risk assessment.

She recommended several resources and tools, but suggested starting with the Centers for Disease Control's STEADI website . STEADI, which stands for Stopping Elderly Accidents, Deaths & Injuries, offers numerous resources, including a flow chart that can be used to determine the next steps based on an individual's responses. Painter-Patton also highlighted specific assessment tools and tests, providing practical information on their strengths and best uses, and noting for which settings they were most appropriate.

fallriskcis7Painter-Patton's work as an educator extends beyond the classroom. She is certified as a Tai Chi for Arthritis Instructor and is a Master Trainer for both A Matter of Balance and AOTA's Fieldwork Educator Certification program. She also serves on councils dedicated to preventing falls and injuries and has nearly 40 years of experience working with older adults.

Although it sounds as if she would be easily qualified to assess and treat any patient who is at risk of falling or has a fear of falling, she began her Symposium presentation by illustrating the limitations that individual healthcare providers face in addressing the complicated problem.

fallriskcis8She asked clinicians to hold out one hand, slightly cupped. "This is what you can do for your patient," she said. "And it's only 50 percent of what the patient needs."

The other hand, she explained, represents the group of healthcare providers and others who will need to help with both the assessment and care for each patient. On the medical side, this includes a primary care physician, dentist, nurse, pharmacist, geriatrician, psychologist and therapists. Other non-medical staff, and those who work in community agencies and recreational centers, also can play a role in assessment and care.

fallriskcis9Her presentation was the perfect lead-in to the reaction panel session that followed, which involved experts from different disciplines and different settings. Moderated by Mary Van de Kamp, the panel included Painter-Patton; Leslie Allison, PT, PhD; Jennifer Ellis, PT, DPT, MS; Thomas Lally, MD; and Matt Sivret, PT, CLT.

Each panel member offered information on additional resources designed not only to assess the risk of falling, but to help integrate the processes into each setting.

Dr. Lally agreed with Painter-Patton that fall assessment and prevention is a complex, challenging issue. He said his facility has a mantra for when to re-evaluate the risk of falls: Change in beds, change in meds, change in peds. He also emphasized that communication among providers and others who interact with patients is critical. Without sharing information, you're simply working in a void, he said.

fallriskcis10Each year the Kindred Clinical Impact Symposium focuses on a topic to enhance clinical practice in the post-acute continuum and to maintain Kindred as a leader in clinical excellence. This seventh symposium focuses on effective care management and, specifically, fall prevention and medication management across the continuum. At this week's symposium, held in Louisville, Kentucky, national speakers discuss these topics broadly, while internal speakers bring it home to Kindred attendees from across the country.