Effective Date: June 30, 2021 Show
ScopeThis guideline addresses the identification and management of older adults aged ≥ 65 years living in the community with risk factors for falls, and is intended for primary care practitioners. The guideline facilitates individualized assessment and provides a framework and tools to manage risk factors for falls and fall-related injuries. Hospital, facility-based care settings and acute fall management are outside the scope of this guideline, although some of the principles in this guideline may be useful in those settings. TOP Key Recommendations
TOP EpidemiologyIncidence of Falls and Fall-Related Injuries Among British Columbians Aged ≥ 65 Years
Burden of Falls and Fall-Related Injuries Among British Columbians Aged ≥ 65 Years
Prevention of Falls and Fall-Related Injuries Among Older Adults Aged ≥ 65 years
TOP Risk FactorsFalling is an indicator of a complex system failure requiring multifactorial assessment and intervention.13 These can be categorized into four dimensions: biological, behavioural, environmental and socioeconomic factors (see Table 1). Medical conditions that cause gait and balance problems are reviewed in Appendix A: Medical Conditions Associated with Gait and Balance Disorders.17,18
Table 1. Risk Factors Associated with Falls and Fall-Related Injury18,22,29–40
Medical/Biological/Intrinsic Factors
Functional Changes
Behavioural Factors
Socioeconomic Factors
Environmental Factors
TOP Evaluating Patients for Fall RiskAnnually evaluate fall risk in patients ≥ 65 years using one of two evaluation tools (see text below and Figure 1).45,46 Reassess for fall risk if there is a significant change in the patient’s health: physical, cognitive, mental status, behavioural, mobility, medication changes, social network or environment.47–49 One of two evaluation tools can be used to assess patient fall risk (see Figure 1 below):501. Primary care practitioner asks 3 questions (could be done in one minute):
If the patient answers “yes” to any of the three questions above, carry out a multifactorial risk assessment and fall history. 2. Staying Independent Checklist (can be done in the waiting room): Ask the patient or their caregiver to complete the Staying Independent Checklist to identify major fall risk factors (see the Associated Document: Staying Independent Checklist) The Staying Independent Checklist can be made available in the office as a handout and distributed by other healthcare providers (e.g., nurse or medical office assistant [MOA]). Figure 1: Staying Independent ChecklistTOP Patient Evaluated as at Risk: Multifactorial Risk Assessment, Fall History and InterventionFalls History and Assessment of Modifiable Risk FactorsFor patients with multiple health concerns, consider using “rolling” assessments over multiple visits, targeting at least one area of concern at each visit. Interventions are recommended for patients based on their individualized multifactorial risk assessment (see Figure 2 below and Appendix B: Categories of Assessment for Patients Evaluated at Fall and Injury Risk (with suggested management)).The single most effective fall prevention intervention is participation in a safe exercise program designed to improve strength and balance.1–5 See Exercise Prescription and Programs below. All other fall prevention interventions are effective when completed in combination. Fall prevention quality improvement strategies proven to reduce falls include: education and reminders for patients and team changes, case management and staff education for clinicians.51 Figure 2: Categories of Assessment for Patients Evaluated at Fall and Injury Risk50See Appendix B for accompanyingdetailsandsuggestedmanagement.SeealsotheBC Guidelines.ca:FrailtyinOlder Adults–EarlyIdentificationandManagement TOP Follow-Up
Older adults may also wish to promote fall prevention when talking to their family and friends. TOP Patient Evaluated as Not at Risk of FallsConsider the opportunity to discuss the following to reduce future risk:
TOP Referral OptionsSee the Patient Handout: Referral Options Resource Guide for Patients and Caregivers Exercise Prescription and Programs
Best practice recommendations for falls prevention exercise: 14,47,52General considerations:
Type of exercise:
Frequency and duration:
Geriatric Medicine
Home and Community Care
Advance Care Planning
Vision Correction – Ophthalmologist and Optometrist
Diagnostic CodesICD-9 codes: E880-E88858 ICD-10 codes: W00-W019.959 TOP AppendicesAppendix A: Medical Conditions Associated with Gait and Balance Disorders (PDF, 88KB) Appendix B: Categories of Assessment for Patients Evaluated at Fall and Injury Risk (with suggested management) (PDF, 128KB) Appendix C: Medications Contributing to the Risk of Falling (PDF, 95KB) Appendix D:Conducting a Medication Review (PDF, 137KB) TOP Associated Documents
TOP Resources
A phone consultation line for physicians, nurse practitioners and medical residents. If the relevant specialty area is available through your local RACE line, please contact them first. Contact your local RACE line for the list of available specialty areas. If your local RACE line does not cover the relevant specialty service or there is no local RACE line in your area, or to access Provincial Services, please contact the Vancouver/Providence RACE line.
604-696-2131 (Vancouver) or 1-877-696-2131 (toll free) Available Monday to Friday, 8 am to 5 pm, excluding statutory holidays.
1-877-605-7223 (toll free)
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TOP References
TOP This draft guideline is based on scientific evidence current as of effective date. The draft guideline was developed by the Guidelines and Protocols Advisory Committee in collaboration with the BC Injury Research and Prevention Unit. For more information about how BC Guidelines are developed, refer to the GPAC Handbook available at BCGuidelines.ca: GPACHandbook. THE GUIDELINES AND PROTOCOLS ADVISORY COMMITTEE The principles of the Guidelines and Protocols Advisory Committee are to:
Contact Information: Guidelines and Protocols Advisory Committee Email: Website: www.BCGuidelines.ca Disclaimer The Clinical Practice Guidelines (the “Guidelines”) have been developed by the Guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The Guidelines are intended to give an understanding of a clinical problem, and outline one or more preferred approaches to the investigation and management of the problem. The Guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problem. We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional. TOP How can you reduce the risk of falls in the elderly?Steps to take to prevent falls. Stay physically active. ... . Try balance and strength training exercises. ... . Fall-proof your home. ... . Have your eyes and hearing tested. ... . Find out about the side effects of any medicines you take. ... . Get enough sleep. ... . Avoid or limit alcohol. ... . Stand up slowly.. Which of the following has been shown to be most effective for reducing falls in older adults?Exercise and physical therapy are recommended to prevent falls and injury from falls. Patients should receive a multifactorial risk assessment and intervention because it is the most consistently effective strategy to prevent falls.
What exercise program is most likely to reduce the risk of falls in older people who live in the community?The Otago exercise program was most effective at reducing falls for people over the age of 80 years, but people who were younger still found some benefit.
What form of activity can reduce the risk of falling?Doing regular strength exercises and balance exercises can improve your strength and balance, and reduce your risk of having a fall. This can take the form of simple activities such as walking and dancing, or specialist training programmes.
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