Reducing Falls

About this course

People of all age groups experience ground level falls, but in the older population, aged 65 or above, a fall can lead to a serious injury and long-term disability. Multiple factors can cause falls, and it is believed that a complex interaction between postural responses, musculoskeletal, neuromuscular, and cardiopulmonary systems, balance, sensory activity, and environmental factors increases susceptibility to falls. This course will provide a brief overview of the causes of falls, steps to assess risks for falls, and the mechanics of ambulation.

Learning objectives

• Define falls as described by the World Health Organization (WHO)
• Recognize risk factors for falls
• Understand the mechanics of ambulation
• Understand the components of a fall risk assessment
• Explain the proper use of crutches and walkers for improved mobility

Course outline

21 sections · finish in any order across devices

1. 1

   Introduction

   People of all age groups experience ground level falls, but in the older population, aged 65 or above, a fall can lead to a serious injury and long-term disability.1 According to the Center for Disease Control (CDC), 1 out of 4 elderly people fall each year, but only half of them seek medical attent

   4 min

2. 2

   According to the World Health Organization (WHO), a fall is described as “an event which results in a person coming to r

   According to the CDC, falls are most common among individuals aged 65 or above and are one of the leading causes of death in that age group.2,3 Falls can lead to serious injuries and are an economic burden on patients, hospitals, and society. In the United States, over the last 5 years, the rate of

   4 min

3. 3

   Causes for Falls

   Multiple factors can cause falls, and it is believed that a complex interaction between postural responses, musculoskeletal, neuromuscular, and cardiopulmonary systems, balance, sensory activity, and environmental factors increases susceptibility to falls.5 The multifactorial nature of falls makes i

   4 min

4. 4

   Age

   Age is a major fall risk factor in young children and older adults. Children under 2 years of age are at increased risk of falls because of their curious behavior, evolving developmental stages, and increasing independence to explore their surroundings.4 Insufficient parental supervision is the main

   4 min

5. 5

   Musculoskeletal Conditions

   Musculoskeletal conditions and pain are commonly associated with increased age.6 These conditions can lead to a reduced quality of life, impaired functionality and mobility, and persistent pain. Including physical activity in a daily routine is recommended.6 However, these conditions make it difficu

   4 min

6. 6

   Gait and Balance Disorders

   Gait and balance disorders are among the most common causes of falls in adults.6 Balance is maintained through complex interactions between the physiological and cognitive elements that enable an individual to respond rapidly and precisely. Both these elements are affected with age progression.6

   4 min

7. 7

   Cognitive and Emotional State

   Cognitive impairment is also a strong risk factor for falls, and one that is difficult to manage.6 Cognitive impairment or dementia increases fall prevalence. How? Cognitive disorders are associated with functional decline, which increases the risk of falls. If a cognitively impaired individual fall

   4 min

8. 8

   Vision

   Visual impairment is an important and overlooked risk factor for falls.6 Vision decline increases with age and is associated with a greater risk of falling. 6 Improving visual impairment can lead to a decreased risk; however, many studies support the contrary. For instance, a study concluded that th

   4 min

9. 9

   Pharmaceutical Agents

   The use of multiple medications or medications that affect the neurological system can lead to gait and balance changes that can increase the risk of falls.6 Common examples include hypnotics, sedatives, tranquilizers, muscle relaxants, and antidepressants.1,3,6 Healthcare professionals should quest

   4 min

10. 10

    Mechanics of Ambulation

    In medical terms, ambulation refers to the ability to walk independently, without the need for any assistance. It is often used to describe patients' goals after a major surgery or physical therapy. But before reaching these goals and walking freely, must work with healthcare professionals and use a

    4 min

11. 11

    Steps to Assess Fall Risk

    To implement effective interventions and preventive measures to reduce falls in older adults, the healthcare professional must first assess the patient and identify modifiable risk factors.10 The CDC recommends annual screening of older adults for fall risks. This should involve the patient’s histor

    4 min

12. 12

    History

    The healthcare professional should inquire about the patient’s history regarding falls and the associated circumstances, because the risk of repeated falls significantly increases if a patient has fallen previously within the year.6 The following is information that a healthcare professional may gat

    4 min

13. 13

    Physical Examination

    The following are the key components to assess fall risk in older adults:6

    4 min

14. 14

    Fall-Proof the Home

    Most falls occur at home, where someone is unaware of the potential risk factors. It is important to fall-proof the home to prevent future falls. A healthcare professional may suggest the following changes: 12

    4 min

15. 15

    Incorporate Exercise and Strength Training

    Staying physically active is important for increasing flexibility, strength, endurance, and balance.6 Older adults are usually recommended for physical activities and exercise to prevent age-related muscle mass and bone loss. Exercise should be introduced gradually, in a step-by-step manner, with gr

    4 min

16. 16

    Consult Physical and Occupational Therapists

    An individual can consult a physical therapist (PT) to detect deficits. A physical therapist conducts several assessment tests, such as Dynamic Gait Index and Four-Square Step Test to assess gait, strength, and balance deficits.10 A physical therapist can help design an exercise program based on the

    4 min

17. 17

    Reduce Medication Burden

    It is common practice that older adults are treated by multiple healthcare providers simultaneously with no coordination of care. This leads to polypharmacy and multiple side effects due to unforeseen drug-drug interactions, leading to dizziness, orthostatic hypotension, and sleepiness, all risk fac

    4 min

18. 18

    Crutches

    Crutches are used by individuals who cannot bear weight on one or both legs.13 They are used temporarily for recovery from serious injuries, or permanently in older adults with general leg weakness.13 There are two types of crutches; axillary crutches, which start at the axilla and extend to the gro

    4 min

19. 19

    Walkers

    Individuals with balance issues or general leg weakness often use walkers.13 Walkers have a steel frame with four legs and two hand grips. They are movable, lightweight, and easy to use. General considerations for walkers include:13

    4 min

20. 20

    Nursing Considerations

    It has been researched that patients that receive nursing interventions during hospital stays benefit from reduced fall risk regardless of age and length of stay. Thus, advanced nurse training is essential. The following are the general guidelines and nursing considerations for reducing falls: 3

    4 min

21. 21

    Conclusion

    Falls are a common reason older adults are frequently hospitalized or acquire life-long injuries. Although there is no sure way of preventing falls, individuals can improve their balance, posture, and bone structure by incorporating exercise and strength exercises to their daily routine.1

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• National Institute on Aging. Falls and Fractures in Older Adults: Causes and Prevention. National Institute on Aging. Published September 12, 2022. https://www.nia.nih.gov/health/falls-and-fractures-older-adults-causes-and-prevention
• Centers for Disease Control and Prevention. Facts about falls. www.cdc.gov. Published 2020. https://www.cdc.gov/falls/facts.html
• Wayne G. Risk for Falls – Nursing Diagnosis & Care Plan. Nurseslabs. Published 2022. https://nurseslabs.com/risk-for-falls/
• World Health Organization. Falls. World Health Organization. Published 2021. https://www.who.int/news-room/fact-sheets/detail/falls
• Lusardi MM, Fritz S, Middleton A, et al. Determining Risk of Falls in Community Dwelling Older Adults. Journal of Geriatric Physical Therapy. 2017;40(1):1-36. doi:https://doi.org/10.1519/jpt.0000000000000099
• Cuevas-Trisan, Ramon (2019). Balance Problems and Fall Risks in the Elderly. Clinics in Geriatric Medicine.2019;35(2):173–183.
• doi:10.1016/j.cger.2019.01.008
• American Bone Health. The Mechanics of Walking - American Bone Health. americanbonehealth.org. Published June 21, 2021. https://americanbonehealth.org/exercise/the-mechanics-of-walking/#:~:text=The%20mechanics%20of%20walking%20involves
• Jones O. Walking and Gaits - Stages - TeachMeAnatomy. Teachmeanatomy.info. Published 2012. https://teachmeanatomy.info/lower-limb/misc/walking-and-gaits/
• McKnight J. 4.3.2 Ambulation. ecampusontariopressbookspub. Accessed April 20, 2023. https://ecampusontario.pressbooks.pub/personalcareassistant/chapter/4-3-2-ambulation/
• Sun R, Paramathayalan VR, Ratnam R, Jain S, Morrow DG, Sosnoff JJ. 6 - Design and development of an automated fall risk assessment system for older adults. ScienceDirect. Published January 1, 2018. Accessed April 28, 2023. https://www.sciencedirect.com/science/article/abs/pii/B9780128112724000063
• Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and Management of Fall Risk in Primary Care Settings. Medical Clinics of North America. 2015;99(2):281-293. doi:https://doi.org/10.1016/j.mcna.2014.11.004
• Preventing Falls at Home: Room by Room. National Institute on Aging. Published September 12, 2022. https://www.nia.nih.gov/health/preventing-falls-home-room-room
• Assistive devices for ambulation: Clinical skills notes. osmosis.org. https://www.osmosis.org/learn/Assistive_devices_for_ambulation:_Clinical_skills_notes
• West GF, Rose T, Throop MD. Assessing nursing interventions to reduce patient falls. Nursing. 2018;48(8):59-60. doi:https://doi.org/10.1097/01.nurse.0000541404.79920.4e

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