SHIVANI JINDAL, MD, MPH, VICE CHAIR, COMMITTEE ON GERIATRIC MEDICINE, AND STUDENT MEMBERS HANNAH CARINGAL AND AVERY GLOVER
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Given the ongoing limits that the COVID-19 pandemic is placing on community activities and programs for older adults, many are continuing to spend more time in their home setting. While resources and opportunities for in-person office visits have been
limited, the well-being of older adults living at home must not be overlooked.
According to the CDC, each year about 25.9% of older adults in Massachusetts report falling,
and nationally, more than 3 million older adults are seen in emergency departments for fall-related injuries. Health care providers can help address both the prevention of falls and the fear of falling by providing tools to seniors and caregivers
and by implementing the following practices.
As clinician practices and hospitals rebound from delayed patient care due to COVID-19, fall risk screening should be included as standard practice for patients aged 65 or older. The Massachusetts Commission on Falls Prevention Phase 3 Report, released
in late 2020, recommends use of the CDC’s STEADI toolkit to conduct falls assessment screening with their older adult patients. The Commission’s suggestion for outreach to gerontologists
and primary care providers prompted the Committee on Geriatric Medicine to draw MMS members’ attention to the topic.
The CDC’s STEADI algorithm begins with three key questions to assess whether seniors are identified as high or low risk for falls: Do you feel unsteady when standing or walking?
Do you worry about falling? Have you fallen in the past year? Older adults who respond negatively to all three questions are assigned to a low-risk category; those who affirm any one question should receive a more thorough assessment including
strength and gait evaluation (sensitivity 78.9% and specificity 34.7%).
If an older adult is deemed “at-risk” upon screening, the CDC recommends that clinicians evaluate for an underlying medical cause, such as orthostatic hypotension or vertigo.
A thorough fall risk assessment includes a medication review for high-risk medications (e.g., anticholinergics, vasodilators, and neuroactive drugs), elicitation of associated symptoms, and identification of environmental factors. The physical
should include vision and foot examinations and an integrated musculoskeletal function assessment. A home safety evaluation with physical and occupational therapy should be considered. This can be done with an interprofessional approach depending
on the clinical practice structure.
Several strategies can be used to prevent falls. The CDC’s STEADI program has a brief checklist of hazards to address and recommendations to consider, including
keeping the home well lit and easy to navigate. The National Institute on Aging also recommends activities and exercises that improve
endurance, strength, flexibility, and balance. During the current pandemic, physicians can recommend home exercises or videos of senior-focused exercises and Tai Chi.
As our community-dwelling older adults continue to have limited opportunities for community activities due to the COVID-19 pandemic, we remind clinicians to review home safety and fall risk as part of standard care. Fall prevention and management are
important to preserve and improve the daily function of older adults.
