Fall Prevention Interventions
When thinking about preventing falls in geriatric people, the American Geriatrics Society has given us some guidelines to help us understand how to assess that and prevent that and help in those cases. Basically, the guidelines go as follows.
You sit down with the elderly person and the first thing you ask is, “Have you had any falls in the past year.” Over the past 12 months, you want to know if they’ve had any falls and, if so, how many. Then, based on their answer, you use the following scale to determine what actions, if any, you ought to take. Remember, the whole goal of this is to keep them from falling and injuring themselves more severely.
The assessment is part of that process of helping them out. You sit down across from the person, you’re talking with them, and you ask them, “Have you had any falls in the past year?” and they answer, “No. I haven’t fallen at all in the past 12 months.”
The American Geriatrics Society assessment here says, basically, if there are no falls in the past year, no intervention is necessary. You wish them well and send them on their way. Now, let’s say they come back and say, “Well, I’ve fallen once in the past year.”
If there’s been at least one fall, you want to go ahead and assess their gait and their balance. You’re going to ask them to walk for you. Watch how their balance is and what their gait is like as they walk. You might use the Get Up and Go test, which is getting them from a seated position to a standing position without using their arms in order to lever themselves up.
They stand up, they walk across the room, and then they walk back. You can use Get Up and Go test to assess their gait and balance. As you’re watching them get up and go and come back, if they’re steady, no further assessment is necessary. However, as you watch them in this test and you watch their gait you, watch their balance.
If they’re unsteady, then assess further to perhaps determine the cause of the unsteadiness. What’s going on? If there’s been one fall, quick assessment of their gait and balance. If they’re steady, no further assessment. If they show some unsteadiness, then you need to assess further to try to determine the cause.
Now, if you asked them, “Have you fallen any in the last year?” and they say, “Multiple times,” and they list a high number here, then full assessment is necessary at this point. There is obviously something going on here. All people slip, lose their balance, trip occasionally.
It happens. You don’t have to be old. At any age it can happen. If there is an elderly person who has fallen multiple times, then in order to protect their health and help them, a full assessment is necessary. Under that full assessment, you want to take their full health history, check their vision, their neurological status, their muscle strength, their joint function, their mental status, their reflexes, their cardiovascular status, both heart rate and rhythm, their blood pressure, their postural pulse.
After all of that, you may still need to refer them to a specialist for help. All of this, of course to ensure their safety and help them. Someone falling multiple times, who is of advanced age, in the past 12 months has need of help in some of these areas.
Basically, these guidelines are given to us by the American Geriatrics Society. You ask the person, “Have you had any falls in the past year.?” No falls, no intervention. One fall, basic assessment of the Get Up and Go gait and balance test. If they’re steady, nothing else further.
If unsteady, try to determine what’s going on. Then, of course, if they’ve listed multiple falls, you must go and do a full assessment, get all this information, and perhaps even refer them to a specialist.