Important Considerations In Fall Risk Assessment

Fall risk, for the elderly especially, can have a significant impact on one’s quality of life. For many of our older patients, there can be major consequences to consider. One out of five falls causes a serious injury such as broken bones or a head injury.¹ In our practice, we consider it our privilege and honor to keep our patients safe and avoid falls caused by imbalance and other issues. My personal algorithm with regard to fall prevention starts with understanding the factors that put a patient at risk for falling. 

Indeed, there are some common issues we can identify in our patients that may lead to falls. 

• Muscle weakness. Weak legs and feet make it harder for a patient to carry his or her own weight, and move over obstacles.

• Flexibility. When a patient is more rigid, it makes it more difficult for him or her to recover from stumbles or missteps. 

• Balance. Better balance keeps the patient upright while walking on flat surfaces and uneven terrain.

• Gait. Walking with an untreated gait problem can be hazardous when considering the effect of abnormal biomechanics on the three aforementioned factors.

• Drastic changes in blood pressure. Labile blood pressure can cause headaches and vision changes that can make falls more likely. 

• Footwear. Shoe gear that does not fit properly, whether it is too big, too small or any other improper aspect of fit, can contribute to tripping, sliding, loss of balance and/or pain. 

• Foot deformities. Lower extremity deformities, if untreated in any way, can impact at minimum shoe gear, balance and flexibility.

• Loss of sensation. Those with neuropathy or a loss of protective sensation in their feet have a harder time navigating because they cannot accurately detect the ground underneath them. This has both mechanical and vestibular consequences. 

• Vision. Decreased vision prevents a patient from fully assessing potential hazards in his or her environment.

• Medications. Some medications have side effects such as dizziness, weakness or even dehydration. These symptoms can all lead to a higher risk of falls. 

• Physical hazards. Loose rugs, unkempt homes, carrying items that block one’s vision, uneven/slippery surfaces and stairs without railings all pose challenges to safety for our patients every day. 

In my experience, adding questions on the aforementioned topics as part of obtaining a patient history can help identify patients at risk for falls. As podiatrists, we have significant knowledge we can share with patients to educate them on fall risk and prevention. Some practices will even implement a flow sheet or questionnaire to expedite the process. Additionally, we can intervene with regard to shoe gear, inserts or orthotics, proper referrals and treatment of lower extremity issues. 

When we take these proactive steps to identify patients at high risk for falls, it is a win-win for our patients and our practice. 

Dr. Bonnin is in private practice with Family Foot and Ankle Specialists in Piscataway and Hillsborough, NJ. This blog was adapted with permission from the author and originally appeared at www.stopfootpainfast.com.

Reference

1. Centers for Disease Control and Prevention. Important facts about falls. Available at: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Accessed July 3, 2019.

Editor’s Note June 2023: The original reference link is no longer valid. One may find similar information here.