A client recently had a fall in a parking lot that led to a hospital admission and subsequent post-acute care for a fractured shoulder and pelvis. While his functional recovery has been excellent, a little historical “processing” prior to that event may have been all that was needed to prevent his fall from happening at all.

Taking the time to explain what a fall is and then asking your older client to share if they have fallen in the past 12 months can be a powerful start to falls risk reduction intervention in the home. If any fall has taken place, find out more about the circumstances of that fall, such as:

• The time of day of the fall
• The location of the fall
• What activity the client was doing at the time of fall
• Possible contributing factors to the fall, such as environmental factors (clutter, wet or uneven surfaces, footwear, etc.), not using assistive devices, distractions, rushing, the impact of others (people or pets), etc.

My client is in his eighth decade, and had experienced two other falls prior to the one in the parking lot. His first fall was about two months earlier – on an escalator (he was lucky to have been able to hang on to the rail and come back to standing during his ride down). A second fall occurred a few weeks later in his home. He landed on an ottoman that broke the fall and supported him. So what was up? After debriefing, we discovered that prior to each fall, he had either bent down or put his head down and was light-headed when moving his head back up. The same culprit was responsible for each of these posturally related hypotensive incidents – his medication regime. During his hospital stay, his medication was adjusted to eliminate that side effect.

If a fall has taken place in the past year, research indicates that there is a higher risk to fall again. Knowing this, any positive falls’ history offers an opportunity to open a dialogue with the client, demonstrate understanding, and create a better care plan that addresses needs and reduces the risk of a fall

The new Geriatric Falls Prevention Toolkit on the CHAMP web site offers home care clinicians helpful tools that highlight proven risk reduction efforts.  Falls are a health concern for everyone – especially those age 65 and older – but assessment, education and intervention coupled with tips for adherence can minimize the likelihood of history repeating itself!

Eileen Bach, PT, MEd, DPT, COS-C
Director of Rehab Quality Assurance and Education Services
Visiting Nurse Service of New York