FALL PREVENTION PRIMER FOR THE PRIMARY CARE PRACTIONER:

2016 ◽  
Vol 2 (8) ◽  
Author(s):  
Mindy Oxman Renfro, PhD, DPT, CPH, PT ◽  
Joyce Maring, EdD, DPT, PT ◽  
Donna Bainbridge, EdD, PT, AT-Ret
Keyword(s):  
Primary Care ◽  
Fall Prevention ◽  
Fall Risk ◽  
Hospital Readmissions ◽  
Screening Tools ◽  
Evidence Based ◽  
Risk Screening ◽  
Quality Reporting ◽  
The Impact ◽  
Fall Risk Screening

<p><strong>ABSTRACT:</strong></p><p>One of three older adults age 65+ fall each year, and every 20 minutes an older adult dies due to injuries sustained during a fall.  Yet, most patients do not report falls to their physician.  Primary care practitioners (PCPs) are well positioned to screen for fall risk and add proactive referral patterns to both well-selected practitioners and evidence-based fall prevention (EBFP) programs designed to help older patients stay healthy, active, and independent.</p><p>The purposes of this review are to summarize the data related to the impact of falls; review efficient and reliable screening tools that identify individuals at high fall risk; describe appropriate referrals that facilitate a match between individual specific risk factors and interventions; and, highlight evidence-based fall prevention (EBFP) programs available to significantly decrease fall risk with outstanding return on investment.</p><p>Simple administrative changes in a PCP’s practice accompanied by appropriate referrals will result in proactive fall prevention including lower rates of falls and fall injuries and fewer hospitalizations and/or hospital readmissions. Fall risk screening can be built into practice to seamlessly add services without impacting practitioner productivity. Additionally, reporting fall risk screening and prevention activities in the Physician Quality Reporting System will positively impact practice Medicare reimbursement rates.</p>

scholarly journals Implementing a Clinically Based Fall Prevention Program

2017 ◽  
Vol 14 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Judy A. Stevens ◽  
Matthew Lee Smith ◽  
Erin M. Parker ◽  
Luohua Jiang ◽  
Frank D. Floyd
Keyword(s):  
Primary Care ◽  
Staff Training ◽  
Fall Prevention ◽  
Fall Risk ◽  
New York State ◽  
Primary Care Providers ◽  
York State Department ◽  
Care Providers ◽  
Risk Screening ◽  
Fall Risk Screening

Introduction. Among people aged 65 and older, falls are the leading cause of both fatal and nonfatal injuries. The burden of falls is expected to increase as the US population ages. The Centers for Disease Control and Prevention (CDC) developed the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to help primary care providers incorporate fall risk screening, assessment of patients’ modifiable risk factors, and implementation of evidence-based treatment strategies. Methods. In 2010, CDC funded the New York State Department of Health to implement STEADI in primary care sites in selected communities. The Medical Director of United Health Services championed integrating fall prevention into clinical practice and oversaw staff training. Components of STEADI were integrated into the health system’s electronic health record (EHR), and fall risk screening questions were added to the nursing staff’s patient intake forms. Results. In the first 12 months, 14 practices saw 10 702 patients aged 65 and older. Of these, 8457 patients (79.0%) were screened for fall risk and 1534 (18.1%) screened positive. About 52% of positive patients completed the Timed Up and Go gait and balance assessment. Screening declined to 49% in the second 12 months, with 21% of the patients screening positive. Conclusions. Fall prevention can be successfully integrated into primary care when it is supported by a clinical champion, coupled with timely staff training/retraining, incorporated into the EHR, and adapted to fit into the practice workflow.

scholarly journals Implementation of systematic fall risk screening in primary care: barriers and facilitators

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
W M A Meekes ◽  
C J Leemrijse ◽  
J C Korevaar ◽  
L A M van de Goor
Keyword(s):  
Primary Care ◽  
Older People ◽  
Fall Prevention ◽  
Fall Risk ◽  
Barriers And Facilitators ◽  
Risk Screening ◽  
Systematic Screening ◽  
Underlying Causes ◽  
Fall Risk Screening ◽  
Adequate Communication

Abstract Background Falls are a major problem among older people. Healthcare professionals are often unaware of the high fall risk of their patients because systematic screening does not take place. In the primary care setting systematic implementation of fall risk screening and referral to fall prevention interventions is lacking. This study aims to evaluate the implementation of a systematic and targeted fall risk screening among independently living frail older people in the primary care setting. Methods The implementation strategy used in this study consists of the provision of tools to screen for fall risk and identify the underlying causes, and services by physio- and exercise therapists who offer evidence-based interventions. The Theoretical Domains Framework of Huijg et al., (2014) is applied to identify barriers and facilitators of the implementation process. Online focus groups and informal interviews are conducted with the healthcare professionals involved. Preliminary results Participating GPs, practice nurses and district nurses acknowledged that fall prevention is part of their job, meaningful, and that they have the knowledge and skills to offer fall prevention. They also highlighted that the underlying causes of falls differ across patients, so personalized care is required. Experienced barriers are the complexity of diagnosing and treating high fall risk adequately versus lack of time, limited reimbursement, and patient's shame or limited motivation. Experienced facilitators are a good professional network, collaboration between GP practices and homecare providers, a motivated practice nurse, and adequate communication and support within the GP practice. Conclusions Identifying main barriers and facilitators offers opportunities for improving systematic fall prevention for older people. Hence, fall prevention can become more structurally available, reducing a major threat for the quality of life of older people living independently. Key messages Primary care professionals acknowledged systematic screening and fall prevention as meaningful and part of their job. Main facilitators are a good network of professionals, a motivated practice nurse, and adequate communication and support within the GP practice.

scholarly journals Implementation and Evaluation of a Fall Risk Screening Strategy Among Frail Older Adults for the Primary Care Setting: A Study Protocol

2020 ◽  
Vol Volume 15 ◽  
pp. 1625-1636
Author(s):  
WMA Meekes ◽  
Chantal Leemrijse ◽  
JC Korevaar ◽  
JMAE Henquet ◽  
M Nieuwenhuis ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Study Protocol ◽  
Fall Risk ◽  
Care Setting ◽  
Primary Care Setting ◽  
Screening Strategy ◽  
Risk Screening ◽  
Frail Older Adults ◽  
Fall Risk Screening

The validity of three fall risk screening tools in an acute geriatric inpatient population

2016 ◽  
Vol 35 (3) ◽  
pp. 167-173 ◽  
Author(s):  
Mark Dominic Latt ◽  
K Florence Loh ◽  
Ludi Ge ◽  
Annie Hepworth
Keyword(s):  
Fall Risk ◽  
Screening Tools ◽  
Risk Screening ◽  
Inpatient Population ◽  
Fall Risk Screening

Four-item fall risk screening tool for subacute and residential aged care: The first step in fall prevention

2009 ◽  
Vol 28 (3) ◽  
pp. 139-143 ◽  
Author(s):  
Caroline Stapleton ◽  
Peter Hough ◽  
Leonie Oldmeadow ◽  
Karen Bull ◽  
Keith Hill ◽  
...  
Keyword(s):  
Fall Prevention ◽  
Fall Risk ◽  
Screening Tool ◽  
Aged Care ◽  
Residential Aged Care ◽  
Risk Screening ◽  
Fall Risk Screening

scholarly journals A Practical and Validated Fall Risk Screening Instrument: A Systematic Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 233-233
Author(s):  
Wytske Meekes ◽  
J C Korevaar ◽  
C J Leemrijse ◽  
L A M van de Goor
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Older People ◽  
Fall Risk ◽  
Care Setting ◽  
Primary Care Setting ◽  
Screening Instrument ◽  
Screening Instruments ◽  
Risk Screening ◽  
Fall Risk Screening

Abstract Early detection of a high fall risk is important to start fall preventive interventions in time and to reduce fall risk among older people. Several fall risk screening instruments are available, however it is unclear which instrument is validated and most suitable for the primary care setting. This systematic review aims to identify the most suitable fall risk screening instrument(s) for the primary care setting (i.e. requires limited time, no expensive equipment and no additional space) with good prognostic ability to assess high fall risk among independently living older people. An extensive search was conducted in the databases PubMed, EMBASE CINAHL, Cochrane and PsycINFO. Twenty-six out of 2277 articles published between January 2000 and February 2019 were included. Six fall risk screening instruments were identified; TUG test, Gait Speed test, BBS, POMA, FR test, Fall History. Most articles reported AUCs ranging from 0.5-0.7 for all instruments. Sensitivity and specificity varied substantially across studies (e.g. TUG, sens.: 10-83.3%, spec.:37-96.6%). The results showed that none of the included screening instruments had sufficient (AUC&gt;0.7) predictive performance (Šimundić, 2009). As suitability for the primary care setting prevails for now, Fall History appears to be the most suitable screening instrument. Compared to the other instruments, Fall History requires the least amount of time, no expensive equipment, no training, and no space (adjustments). Patient’s fall history together with a health care professional’s clinical judgment, might be a promising screening strategy for the primary care setting to identify high fall risk among older people.

scholarly journals Physical Therapists as Partners for Community Fall Risk Screenings and Referrals to Community Programs

2021 ◽  
Vol 9 ◽  
Author(s):  
Jennifer L. Vincenzo ◽  
Colleen Hergott ◽  
Lori Schrodt ◽  
Subashan Perera ◽  
Jennifer Tripken ◽  
...  
Keyword(s):  
United States ◽  
Fall Prevention ◽  
Fall Risk ◽  
Physical Therapists ◽  
Community Organizations ◽  
The United States ◽  
Evidence Based ◽  
Community Based ◽  
Pro Bono ◽  
Fall Risk Screening

Objectives: Physical therapists (PTs) are integral team members in fall prevention in clinical settings; however, few studies have investigated PTs' engagement in pro-bono community-based falls prevention. Therefore, we aimed to describe the characteristics of PTs and physical therapist assistants (PTAs) in the United States who conduct community-based fall screenings, the reach of screenings, their knowledge and utilization of the Centers for Disease Control and Prevention's fall-risk screening toolkit (STEADI, Stopping Elderly Accidents, Deaths, and Injuries), and therapists' knowledge and referrals to evidence-based programs (EBPs) and community resources.Methods: A cross-sectional survey distributed to a convenience sample of PTs/PTAs in the United States through news-blasts, and social media.Results: Four hundred and forty-four therapists who worked with older adults completed the survey. Approximately 40% of the respondents (n = 180) conduct screenings, most frequently annually. People who screen tend to be PTs with &gt;20 years of experience, work in outpatient/wellness or academia, and be involved in the least amount of direct patient care. The majority (n = 344, 77.5%) of survey respondents were somewhat to very familiar with the STEADI, and ~84% (n = 114) of respondents who were very familiar with the STEADI (n = 136) use the toolkit to conduct community-based, pro-bono fall risk screenings. Twenty-six percent (n = 14) out of the 53 PTAs who responded to the survey conduct falls screenings in the community. Of the PTs/PTAs who conduct community-based fall screenings (n = 180), ~ 75% (n = 136) are aware of and refer older adults to EBPs. Over half also refer to Silver Sneakers and/or senior centers.Discussion: PTs and PTAs are key partners in evidence-based multifactorial fall prevention in the community. Data helps inform community organizations that most PTs who engage in community-based fall risk screening utilize the STEADI toolkit and refer to community-based programs. Community organizations seeking PT partners to engage in fall risk screenings and promote referrals to local resources or EBPs will likely have the most success collaborating with local physical therapy education programs or physical therapy clinic managers.

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