Fall Risk Assessment

A fall risk assessment is a type of evaluation completed by healthcare professionals (e.g., nurses, physicians, advanced practice providers) to identify individuals at risk for falling. Falls are a leading cause of injuries, especially in older adults, and can significantly decrease the ability of an individual to care for themselves, as well as their overall quality of life. By assessing fall risk and addressing any modifiable fall risk factors, healthcare professionals can help reduce the risk of falls occurring.  

Fall risk factors can include individual risk factors, like cognitive impairment, balance deficits, or certain medical conditions like Parkinson disease; and environmental risk factors, like inadequate lighting or tripping hazards in the home, like rugs. Use of certain medications, like opioid analgesics (e.g., morphine) or antihypertensives (e.g., metoprolol), may also increase the risk of falls.  

A fall risk assessment is performed by a healthcare professional and usually includes a physical examination, medication review, environmental and functional assessment, mental state and cognitive assessment, and a review of one’s medical history for previous falls or use of ambulatory devices.  

Fall risk assessment tools or questionnaires are often used to help guide the physical exam process and provide the healthcare professional with risk factors to consider. In some instances, a medical questionnaire can be completed by the patient to help the healthcare professional gather information on fall risk. Common fall risk assessment tools can include the Timed Up and Go test, which assesses mobility by having someone walk, turn around, and walk back; and the Stopping Elderly Accidents, Deaths, and Injuries, or STEADI, tool which is a toolkit with information to help healthcare providers assess for falls, provide education, and recommend follow-ups. 

Another common type of fall risk assessment tool that can be used is the 30-second chair-stand test. This test helps to evaluate leg strength and endurance. In the chair-stand test, the individual is sitting in a chair with arms crossed over the chest with feet flat on the floor. Then, they will be asked to stand up and sit down repeatedly for 30 seconds to determine if they need to use their arms to successfully stand. If the individual has to use their arms to safely stand, this can indicate a risk of falls.

 The fall risk assessment results typically indicate that an individual has a low, moderate, or high risk of falling. Depending on the results of their fall risk assessment, the healthcare professional can implement different interventions to help prevent falls. For example, if an individual is at moderate risk of falling due to deficits in strength and balance, the healthcare professional may recommend exercising or even refer to physical therapy. For those at high risk of a fall due to orthostatic hypotension from medications, changes to the type or dose of medication may be recommended as well as educating the individual to change positions slowly and/or request assistance when getting out of a chair or bed. 

In an acute care setting, certain fall risk precautions can be implemented and include more frequent fall risk assessments; bed or chair alarms; visual cues for the healthcare team, like yellow socks to help identify those at high risk of falling; keeping the bed at the lowest position, with the wheels locked; using ambulation equipment, like gait belts; and providing fall risk prevention education to the individual and their family.