Fall‐Risk Assessment and Management in Clinical Practice: Views from Healthcare Providers
- 16 August 2004
- journal article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 52 (9), 1522-1526
- https://doi.org/10.1111/j.1532-5415.2004.52416.x
Abstract
To determine the extent to which healthcare providers reportedly address evidence-based fall risk factors in older patients after exposure to an educational intervention and to determine barriers reportedly encountered when these healthcare providers intervene with or refer older patients with identified fall-risk factors. Cross-sectional study using a structured interview. Geographic area of Connecticut where the Connecticut Collaboration for Fall Prevention (CCFP) has been implemented. Emergency department (ED) physicians, hospital-based discharge planners or care coordinators (nurses or social workers), home health agency nurses, and office-based primary care physicians (total n=33) after exposure to the CCFP implementation team. Self-reported practices (direct intervention or referral) and barriers when addressing seven evidence-based risk factors for falls: gait and transfer impairments, balance disturbances, multiple medications, postural hypotension, sensory and perceptive deficits, foot and footwear problems, and environmental hazards. Respondents were most likely to report directly intervening with or referring older patients for gait and transfer impairments (85%) and balance disturbances (82%) and least likely to do so when encountering foot or footwear problems (58%) and sensory or perceptive deficits (61%). ED physicians reported lowest rates of direct intervention or referral for foot or footwear problems (20%), home health agency nurses for sensory or perceptive deficits (50%), and office-based primary care physicians for foot or footwear problems (50%). Patient compliance was the most commonly reported barrier to successful direct intervention across several risk factors, whereas inadequate availability of other healthcare providers and lack of Medicare reimbursement were the most commonly reported barriers to successful patient referrals. After exposure to the CCFP implementation team, the majority of healthcare providers reported directly intervening or referring patients when addressing all risk factors, but results pinpointed specific healthcare provider groups with room for improvement in assessment and management of specific risk factors. Patient education appears to be a necessary adjunct to healthcare provider training, because patient compliance was a reported barrier to optimal intervention by healthcare providers.Keywords
This publication has 11 references indexed in Scilit:
- Fall and Injury Prevention in Residential Care—Effects in Residents with Higher and Lower Levels of CognitionJournal of the American Geriatrics Society, 2003
- Guideline for the Prevention of Falls in Older PersonsJournal of the American Geriatrics Society, 2001
- Prevention of falls in the elderly trial (PROFET): a randomised controlled trialThe Lancet, 1999
- Fall-related factors and risk of hip fracture: the EPIDOS prospective studyThe Lancet, 1996
- Risk Factors for Serious Injury During Falls by Older Persons in the CommunityJournal of the American Geriatrics Society, 1995
- A Multifactorial Intervention to Reduce the Risk of Falling among Elderly People Living in the CommunityThe New England Journal of Medicine, 1994
- Risk Factors for Falls in a Community-Based Prospective Study of People 70 Years and OlderJournal of Gerontology, 1989
- Risk Factors for Falls in a Community-Based Prospective Study of People 70 Years and OlderJournal of Gerontology, 1989
- Risk Factors for Recurrent Nonsyncopal FallsJAMA, 1989
- Risk Factors for Falls among Elderly Persons Living in the CommunityThe New England Journal of Medicine, 1988