Talking With Your Patients About Falls POCKET GUIDE • Help patients understand their own unique fall risk. Preventing Falls • Educate patients on their modifiable Key Facts About Falls risk factors and corresponding fall • One in four older adults age in Older Patients prevention strategies. 65+ falls every year. • Emphasize that can help • Falls are the leading cause of them remain independent. injury deaths for older adults. • Discuss with patients which strategies • Many patients who have fallen do they might be willing to do. not bring it up at medical appointments, so providers need to ask. • Work with patients and caregivers to develop a plan for fall prevention. Each year, ask your older patients: • Have you fallen in the past year? • Do you feel unsteady when standing or walking? STEADI Resources for Your Patients • Do you worry about ? Available patient-friendly brochures: For more patient and provider resources, • Stay Independent visit www.cdc.gov/steadi. • Postural Hypotension:

What it is & How to Manage it Centers for Control and Prevention • Check for Safety National Center for Injury Prevention and Control Stopping Elderly Accidents, • What YOU Can Do to Prevent Falls Deaths & Injuries 2019 STEADI Algorithm for Fall Risk Screening, Assessment, and Intervention among Community-Dwelling Adults 65 years and older

START 1 SCREEN for fall risk yearly, or any time SCREENED 2 ASSESS patient’s modifiable risk factors 3 INTERVENE to reduce identified risk factors using effective strategies. HERE patient presents with an acute fall. AT RISK and fall history. Reduce identified fall risk • Discuss patient and provider health goals Available Fall Risk Screening Tools: Common ways to assess fall risk factors are listed below: • Develop an individualized patient care plan (see below) Below are common interventions used to reduce fall risk: • Stay Independent: a 12-question tool • Refer for physical therapy [at risk if score 4] Evaluate gait, strength, Common assessments: • 30-Second Chair Stand ≥ Poor gait, strength, • Refer to evidence-based exercise or fall prevention & balance • Timed Up & Go • 4-Stage Balance Test & balance observed - Important: If score < 4, ask if patient fell in the past year program (e.g., Tai Chi) (If YES  patient is at risk) Identify medications that (e.g., Beers Criteria) Medication(s) likely • Optimize medications by stopping, switching, or increase fall risk to increase fall risk reducing dosage of medications that increase fall risk • Three key questions for patients [at risk if YES to any question] - Feels unsteady when standing or walking? Ask about potential (e.g., throw rugs, slippery tub floor) Home hazards likely • Refer to occupational therapist to evaluate home safety - Worries about falling? home hazards - Has fallen in past year? » If YES ask, “How many times?” “Were you injured?” • Stop, switch, or reduce the dose of medications that increase fall risk Measure orthostatic Orthostatic • Educate about importance of exercises (e.g., foot pumps) (Lying and standing positions) hypotension blood pressure observed • Establish appropriate blood pressure goal • Encourage adequate hydration • Consider compression stockings • Refer to ophthalmologist/optometrist • Stop, switch, or reduce the dose of medication Check visual acuity Common assessment tool: Visual affecting vision (e.g., anticholinergics) SCREENED PREVENT future risk by recommending • Snellen eye test impairment observed • Consider benefits of cataract surgery NOT AT RISK effective prevention strategies. • Provide education on depth perception and single vs. multifocal lenses • Educate patient on fall prevention • Provide education on shoe fit, traction, Feet/footwear • Assess intake Assess feet/footwear insoles, and heel height issues identified • Refer to podiatrist - If deficient, recommend daily vitamin D supplement • Refer to community exercise or fall prevention program Assess vitamin D intake Vitamin D deficiency • Recommend daily vitamin D supplement observed or likely • Reassess yearly, or any time patient presents with an acute fall Identify comorbidities (e.g., depression, ) Comorbidities • Optimize treatment of conditions identified documented • Be mindful of medications that increase fall risk

FOLLOW UP with Discuss ways to improve patient receptiveness patient in 30-90 days. to the care plan and address barrier(s)