Risk Factors

Awareness of risk factors for abuse can increase the chance of identification and early intervention. Although research is ongoing, several characteristics of both the victim and the

PREVENTION OF FALLS IN OLDER PERSONS LIVING IN THE COMMUNITY

Older person encounters health care provider [A]

Older person encounters health care provider [A]

>

t

Screen for fall(s) or risk of falling (See questions in sidebar) [B]

>

f

Sidebar: Screening for fall(s) questions

1. Two or more falls in prior 12 months?

2. Presents with acute fall?

3. Difficulty with walking or balance?

Answers positive to any of the screening questions? (See sidebar) [C]

Does the person report a single fall in the past 12 months? [D]

Does the person report a single fall in the past 12 months? [D]

4 ,

f

Evaluate gait and balance [E]

>

f

Are abnormalities in gait or unsteadiness identified?

Are abnormalities in gait or unsteadiness identified?

1. Obtain relevant medical history, physical examination, cognitive and functional assessment Determine multifactoral fall risk:

a. History of falls b. Medications c. Gait, balance, and mobility d. Visual acuity e. Other neurological impairments f. Muscle strength g. Heart rate and rhythm h. Postural hypotension i. Feet j. Environment [F]

Any indication for additional intervention?

Reassess periodically

Initiate multifactorial/multicomponent intervention to address identified risk(s) and prevent falls:

1. Minimize medications

2. Provide individually tailored exercise program

3. Treat vision impairment (including cataract)

4. Manage postural hypotension

5. Manage heart rate and rhythm abnormalities

6. Supplement vitamin D

7. Manage foot and footware problems

8. Modify the home environment

9. Provide education and information

Figure 4-3 Practice guideline for the prevention of falls in older persons.

(From American Geriatrics Society (AGS), British Geriatrics Society, and American Academy of Orthopedic Surgeons Panel on Falls Prevention: Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001;49:664-672.)

abuser should trigger further screening questions. Risk factors associated with the victim include shared living situations, history of dementia, and social isolation. Perpetrator risk factors include a history of mental illness (specifically depression), alcohol abuse, and financial dependency (Lachs and Pillemer, 2004).

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