Although falls are not an inevitable part of aging, it is well known that falls are the leading cause of both nonfatal injuries and injurious death among older adults. The consequences of a fall far exceed personal injury, affecting the patient, family members and society at large. With an estimated 1 in 3 adults 65 years of age and older experiencing a fall each year, it is clear that comprehensive fall prevention screening and patient education are of paramount importance when working with Florida’s ever-increasing senior population.
Too often, patients report to emergency rooms to be treated after experiencing a fall only to have their primary symptoms evaluated and treated while not being properly evaluated for the cause of the fall. Physical therapists are able to properly screen at-risk patients for their risk of falls, as well as educating their patients on ways to improve the safety of their home environment.
At the student run non-profit organization Department of Community Service (DOCS) program, patients are asked a series of questions to determine if a falls prevention screening is necessary. Screening questions include:
- Are you 60 years of age or older?
- Have you fallen to the ground at least once in the past year?
- Have you had several near falls in the past year?
- Are you currently taking 4 or more medications? Are you currently taking a psychotropic medication?
- Do you utilize any assistive device?
If a patient answers “yes” to at least one of these questions, the patient is referred to the physical therapy station to be screened.
Once at the physical therapy station, patients are screened for their risk of falls through utilization of the Center for Disease Control’s screening tool Stopping Elderly Accidents, Deaths, & Injuries (STEADI). The STEADI is based on an algorithm that was adapted from the American and British Geriatric Societies’ Clinical Practice Guidelines. Patients perform the Timed Up & Go (TUG) Test to assess their mobility, the 30-Second Chair Stand Test that assesses the patient’s leg strength and endurance, and the 4-Stage Balance Test to assess the patient’s balance. If an individual does not successfully complete any one of the three tests, they are deemed a fall risk and physical therapy intervention is recommended. Parameters established by the CDC were used to determine if a patient was successful in completing each of these tests. All patients screened are also provided with literature and education on how to improve their home environment to reduce their risk of falls, along with a flashlight to use in the absence of nightlights or while moving around in dark settings.
Aside from receiving a comprehensive screening and patient education, patients benefit from simply being told whether or not they were found to be at an increased risk of falls, and if so, where they can seek treatment that may reduce their risk of future falls, thus improving their quality of life. While physical therapists and students understand the value of appropriate physical therapy intervention for many fall risk patients, many patients do not. Patients may recognize that they have increased difficulty moving about that may be causing them to experience falls, or to constantly worry about falling, but they are unlikely to consider a visit to a physical therapist. Without being informed about how physical therapy can reduce their risk of falls, these patients are unlikely to receive the proper intervention until it is too late.
This lack of awareness was seen in a 67-year-old male patient screened at one of the DOCS health fairs. Decreased balance, lower extremity strength and endurance were all observed during the STEADI. After explaining to the patient that he was at an increased risk of falls based on his test results, and informing him which tests he was unable to perform properly, he was less than surprised, stating “I have noticed that I get tired much more quickly over the last couple of years. While working in the yard, I frequently find myself having to rest against a tree or against the fence. I’ve also noticed that I have to walk slower or I feel as though I am going to become unsteady and lose my balance, but I never understood why this was happening. I saw a medical doctor recently, and was told that I was totally healthy, so I just assumed that this was a normal part of getting older, and that there wasn’t anything I could do. It makes me feel much better to hear this from you, because nobody else has seemed to consider it to be an issue.”
After explaining that his symptoms are not an inevitable byproduct of aging, and telling him how he could benefit from a customized physical therapy intervention, his elation was almost tangible. The patient was relieved and extremely thankful that a medical professional was able to identify his impairments, and could provide him with a plan of action.
About the DOCS Program
In October of 2015, the Department of Physical Therapy at the University of Miami began to work alongside our colleagues in the University of Miami Miller School of Medicine through the student run non-profit organization Department of Community Service (DOCS) program. Founded in 2000, DOCS brought health screening and educational services to over 1,500 patients in the South Florida community within the past year with the help of more than 250 medical students and 50 physicians. This year, DOCS is expecting to serve at least 2,000 patients over the span of eight health fairs throughout the Miami-Dade, Monroe and Broward counties. DOCS provides health screenings for the most prevalent diseases that impact our community, including: hypertension, diabetes, dyslipidemia, vision loss, obesity and depression, as well as colon, breast, cervical and skin cancer. With the recent addition of the physical therapy program, individuals are now also being screened for their risk of falls.
The Department of Physical Therapy at the University of Miami has recently begun to treat underserved patients in the community in our student-run pro bono physical therapy clinic at the University of Miami Hospital. It is our hope that many of these patients who were identified to be at an increased risk of falls at the DOCS health fairs will be referred to our clinic to receive individualized physical therapy intervention to address their impairments.
Physical therapists and physical therapist assistants help with balance issues and fall prevention. Visit the APTA Move Forward section on fall prevention for more information.
By Paden Wallace, SPT
University of Miami Miller School of Medicine,
Department of Physical Therapy
Class of 2017
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In the Literature
Screening & Assessment
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