Assessing fall risk is a big part of assessing client mobility. Every year, approximately 30% of older persons living at home fall. In fact the Center for Disease Control says every year 1 in 3 older adults has a fall . Getting more information about where falls occur is vital. A practical mnemonic for reviewing the actual fall is as follows:
S ‑Symptoms experienced at the time of fall
P ‑Previous number of falls or near-falls
L ‑Location of falls
A ‑Activity engaged in or attempted at time of fall
T ‑Time (hour) of fall
T ‑Trauma (e.g., physical or psychological) associated with falls
Prevention of falls is of utmost importance because after a fall the fear of another fall can become a vicious cycle. Fear leads to inactivity that then results in decreased strength that then leads to increased risk of another fall.
Many falls by older persons occur in the bathroom, the most dangerous room in the house. Adaptations in the environment can decrease the risk. If your client is falling at night, ask about the use of sedating medications at bedtime. Or perhaps does the person fall because he or she ambulates slowly and needs to rush to answer the only phone in the home, which is located on the kitchen wall? Getting a portable telephone may decrease the risk of another fall. Was the person experiencing specific symptoms secondary to medical problems, for example, dizziness or postural hypotension? Reviewing these symptoms with the physician can result in treatment or change in medications that will reduce the risk of a repeat fall.
Changes in the environment, attention to adaptations, and medical evaluation will make it safer for a person with impaired mobility to get around the home. In addition, with the goal of improved mobility and balance, the care manager should think about the possibility of physical therapy for strength training, personal trainers who can come to the home or the assisted living facility to do light exercise, or even a membership at a local senior-friendly gym that offers tai chi classes, which are known to improve balance. In addition, for clients in nursing homes the care manager needs to advocate for needed therapies and medical evaluations to improve mobility and decrease falls.