Fall Risk Assessment

Falls are common in adults 65 years of age and older. In the United States, about a third of older adults who live at home and about half of people living in nursing homes fall at least once a year. There are many factors that increase the risk of falling in older adults. They include:

• Mobility problems (e.g., trouble walking or standing up)
• Balance disorders
• Chronic (long-term) illnesses
• Impaired vision
• Taking certain medicines
• Foot problems and wearing unsafe shoes
• Mild cognitive impairment or certain types of dementia

Many falls cause at least some injury. These range from mild bruising to broken bones, head injuries, and even death. In fact, falls are a leading cause of death in older adults.

Other names: fall risk evaluation, fall risk screening, assessment, and intervention

What is it used for?

A fall risk assessment is used to find out if you have a low, moderate, or high risk of falling. If the assessment shows you are at an increased risk, your health care provider and/or caregiver may recommend strategies to prevent falls and reduce the chance of injury.

Why do I need a fall risk assessment?

The Centers for Disease Control and Prevention (CDC) and the American Geriatrics Society recommend yearly fall assessment screening for all adults 65 years of age and older. If the screening shows you are at risk, you may need an assessment. The assessment includes performing a series of tasks called fall assessment tools.

You also may need an assessment if you have certain symptoms. Falls often come without warning, but if you have any of the following symptoms, you may be at higher risk:

• Dizziness
• Irregular or rapid heartbeats (arrhythmia)
• Blood pressure that drops too much when you stand up

What happens during a fall risk assessment?

A fall risk assessment checks to see how likely it is that you will fall. It is mostly done for older adults. The assessment usually includes:

• An initial screening. This includes a series of questions about your overall health and if you've had previous falls or problems with balance, standing, and/or walking.
• A set of tasks known as fall assessment tools. These tools test your strength, balance, and gait (the way you walk).

Many providers use an approach developed by the CDC called STEADI (Stopping Elderly Accidents, Deaths, and Injuries). STEADI includes screening, assessing, and intervention. Interventions are recommendations that may reduce your risk of falling. STEADI includes three steps:

• Screening you for your risk of falling
• Assessing for your risk factors that can be improved to try to prevent falls (for example, balance problems, impaired vision)
• Intervening to reduce your risk of falling by using effective strategies (for example, providing education and resources)

During the screening, you may be asked several questions including:

• Have you fallen in the past year?
• Do you feel unsteady when standing or walking?
• Are you worried about falling?

During an assessment, your provider will test your strength, balance, and gait, using the following fall assessment tools:

• Timed Up-and-Go (Tug). This test checks your gait. You'll start in a chair, stand up, and then walk for about 10 feet at your regular pace. Then you'll sit down again. Your provider will check how long it takes you to do this. If it takes you 12 seconds or more, it may mean you are at higher risk for a fall.
• 30-Second Chair Stand Test. This test checks strength and balance. You'll sit in a chair with your arms crossed over your chest. When your provider says "go," you'll stand up and sit down again. You'll repeat this for 30 seconds. Your provider will count how many times you can do this. A lower number may mean you are at higher risk for a fall. The specific number that indicates a risk depends on your age.
• 4-Stage Balance Test. This test checks how well you can keep your balance. You'll stand in four different positions, holding each one for 10 seconds. The positions will get harder as you go.
  • Position 1: Stand with your feet side-by-side.
  • Position 2: Move one foot halfway forward, so the instep is touching the big toe of your other foot.
  • Position 3: Move one foot fully in front of the other, so the toes are touching the heel of your other foot.
  • Position 4: Stand on one foot.

  If you can't hold position 2 or position 3 for 10 seconds or you can't stand on one leg for 5 seconds, it may mean you are at higher risk for a fall.

  During the assessment, your provider may also:

  • Identify any medicines you take that could increase your risk of falling
  • Ask about possible safety hazards in your home, such as throw rugs you could trip on, a slippery tub floor, etc.
  • Measure your blood pressure when lying and standing
  • Do an eye test that checks your ability to see small details (the Snellen test)
  • Check your feet and footwear
  • Measure your vitamin D levels
  • Identify other conditions you may have that could affect your risk of falls such as depression and osteoporosis)
  • Do a cognitive test to check for problems with cognition thinking, learning, remembering, being aware of surroundings, and using judgment)

  There are many other fall assessment tools. If your provider recommends other assessments, he or she will let you know what to expect.

  Will I need to do anything to prepare for a fall risk assessment?

  You don't need any special preparations for a fall risk assessment.

  Are there any risks to a fall risk assessment?

  There is a small risk that you might fall while you are doing the assessment.

  What do the results mean?

  The results may show you have a low, moderate, or high risk of falling. They also may show which areas may be increasing your risk for falls (e.g., gait, strength, and/or balance). Based on your results, your provider may make recommendations to reduce your risk of falling. They may include:

  • Exercising to improve your strength and balance. You may be given instructions on specific exercises or be referred to a physical therapist.
  • Changing or reducing the dose of medicines that may be affecting your gait or balance. Some medicines have side effects that cause dizziness, drowsiness, or confusion.
  • Taking vitamin D to strengthen your bones.
  • Getting your vision checked by an eye doctor.
  • Switching to safer footwear to lower your risk of falling.
  • Getting a referral to a podiatrist (foot doctor) if you are having problems with balance or gait.
  • Getting rid of any safety hazards in your home. These may include poor lighting, loose rugs, and/or cords on the floor.
  • Treating any medical conditions that could increase your risk of falls.

  If you have questions about your results and/or recommendations, talk to your provider.

  References

  1. American Nurse Today [Internet]. HealthCom Media; c2023. Assessing your patients' risks for falling; 2015 Jul 13 [cited 2023 Aug 10]; [about 11 screens]. Available from: https://www.myamericannurse.com/assessing-patients-risk-falling/
  2. Casey CM, Parker EM, Winkler G, Liu X, Lambert GH, Eckstrom E. Lessons Learned From Implementing CDC's STEADI Falls Prevention Algorithm in Primary Care. Gerontologist [Internet]. 2016 Apr 29 [cited 2023 Aug 10]; 57(4): 787-796. Available from: https://academic.oup.com/gerontologist/article/57/4/787/2632096
  3. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; About STEADI; [reviewed 2023 Apr; cited 2023 Sep 5]; [about 2 screens]. Available from: https://www.cdc.gov/steadi/about/
  4. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Algorithm for Fall Screening, Assessment and Intervention; [cited 2023 Aug 10]; [about 2 screens]. Available from: https://www.cdc.gov/steadi/media/pdfs/STEADI-Algorithm-508.pdf
  5. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Assessment: The 4-Stage Balance Test; [cited 2023 Aug 10]; [about 2 screens]. Available from: https://www.cdc.gov/steadi/media/pdfs/STEADI-Assessment-4Stage-508.pdf
  6. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Assessment: 30-Second Chair Stand; [cited 2023 Aug 10]; [about 1 screens]. Available from: https://www.cdc.gov/steadi/media/pdfs/STEADI-Assessment-30Sec-508.pdf
  7. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Older Adult Fall Prevention; [reviewed 2023 Apr; cited 2023 Sep 5]; [about 2 screens]. Available from: https://www.cdc.gov/falls/index.html
  8. Cleveland Clinic: Health Library: Articles [Internet]. Cleveland (OH): Cleveland Clinic; c2023.Fall Risk Assessment; [reviewed 2022 June 23; cited 2023 Sept 5]; [about 3 screens]. Available from: https://my.clevelandclinic.org/health/articles/23330-fall-risk-assessment
  9. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998-2023. Evaluating patients for fall risk; 2018 Aug 21 [cited 2023 Aug 10]; [about 4 screens]. Available from: https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/evaluating-patients-for-fall-risk/mac-20436558
  10. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co., Inc.; c2023. Falls in Older Adults; [modified 2022 Sep; cited 2023 Aug 10]; [about 8 screens]. Available from: https://www.merckmanuals.com/home/older-people%E2%80%99s-health-issues/falls-in-older-adults/falls-in-older-adults
  11. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: cognition; [cited 2023 Sep 18]; [about 1 screen]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cognition
  12. Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Med Clin North Am [Internet]. 2015 Mar [cited 2023 Aug 10]; 99(2):281-93. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707663/

  Related Health Topics

  • Balance Problems
  • Dizziness and Vertigo
  • Drug Reactions
  • Falls
  • Fractures
  • Walking Problems