Safe Communities

Ways Professionals Can Reduce Falls

Interventions

Reducing falls among older adults requires completing a comprehensive falls risk assessment and identifying the risk factors that may put an individual at risk of falling. Following the identification of risk factors, a health care professional can recommend intervention strategies and actions that address each risk factor and the unique situation of the older adult.

Multifactorial assessments and interventions, tailored to each individual, are the most effective in reducing fall rates. As a single intervention, exercises that include gait and balance as well as lower body strengthening have also been proven to reduce falls in older adults

Learn about the evidence-based health promotion interventions that have been proven to produce a desired outcome in participants.

Here are intervention strategies organized by risk factor:

Risk factor	Intervention strategy
Muscle weakness	Evaluate and assess. Refer as needed to physical therapy and/or occupational therapy for assessment and treatment. Treatment may include an exercise program that includes gait, balance, and lower body strengthening exercises.
Gait, balance or both	Evaluate and assess. Refer as needed to physical therapy, occupational therapy, home care, and/or medical equipment suppliers. Treatment may include an exercise program that includes gait, balance, and lower body strengthening exercises. Recommend professionally delivered home safety evaluation to reduce environmental hazards and identify home modifications to maximize safety.Encourage older adult to have cane, walker or gait device fitted properly to ensure correct form.
Medications	Review prescribed and over-the-counter medications. Evaluate for proper dose, route, compliance, interactions and side effects that may increase the older adult’s risk of falling. Taper medications to the lowest effective dose. Reduce the total number of medications when possible. Educate the older adult about their medications, possible side effects, and when those side effects should be reported. Encourage older adult to bring list of all prescribed and over-the-counter medications to each visit and to keep list current.
Potural hypotension	Evaluate and assess. Review medications. Encourage good hydration habits. Educate older adult on how to rise slowly from a seated or supine position.
Hazards inside and outside the home	Educate older adult about environmental hazards. Recommend professionally delivered home safety evaluation to reduce environmental hazards and identify home modifications to maximize safety.
Cardiovascular disorder	Evaluate and cardiovascular assessment. Treat medical condition as needed.
Foot problems or Inappropriate footwear	Recommend self-examination of the feet and regular foot care. Educate older adult about foot problems and proper footwear. Suggest supportive shoes with non-slip soles and wide low heels.
Cognitive impairment	Evaluate and assess to determine whether or not there is cognitive impairment. Recommend home health care services if needed.
Visual impairment	Visual acuity testing. Recommend visit to eye doctor to test vision and make sure eye glasses prescription is up-to-date. Eye doctor may also test for conditions of the eye that may impair vision.
Limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs)	Evaluate and assess to determine whether or not functional impairment exists. Recommend visit to physical therapy for evaluation of gait and possible need for assistive devices. Recommend home health care services.
Fear of falling	Screen older adults perceptions of their abilities to perform their ADLs and IADLs, as well as their fear of falling. Encourage older adult to be physically active.
Osteoporosis	Screen and treat as indicated.

Vitamin D Supplementation

Studies have shown that Vitamin D supplementation may decrease older adults’ risk of falling, including those older adults who do not suffer from Vitamin D deficiency. A meta-analysis by Bischoff-Ferrari and colleagues found that Vitamin D supplementation reduced the risk of falls by 22% (compared to patients receiving placebo or calcium supplement) among older patients. Broe and colleagues found that higher dose (800 international units) Vitamin D supplementation decreased nursing home residents’ risk of falling by more than 70%. Lower doses of Vitamin D supplementation did not have as large of an impact. Typically an 8oz glass of milk provides 100 IU of Vitamin D.

This information suggests that Vitamin D supplementation may be an efficacious component in fall prevention. Supplementation should occur in the context of a multifactorial risk factor reduction strategy.

The information provided on this page is adapted from the following sources: 2, 9, 10

Fall risk evaluation and interventions for older adults may be reimbursable.