Evidence-Based Care Practices in Older Adults Who Have Fallen

Thesis (Master's)--University of Washington, 2014BACKGROUND: Falls in adults aged ≥65 years are the leading cause of injury-related deaths and nonfatal injuries. The American and British Geriatrics Societies (AGS/BGS) published an updated clinical practice guideline in 2010 to encourage performance of fall risk assessment and management in everyday practice. OBJECTIVE: To assess how current fall risk assessment and management practices align with the 2010 AGS/BGS guideline. DESIGN: A retrospective study. SETTING: Oregon Health and Science University (OHSU), a large academic medical center in Portland, Oregon. PARTICIPANTS: Study participants were outpatients of OHSU's Internal Medicine clinic, aged 65 to 95 years, who received medical care for a fall occurring between October 1, 2010 and March 31, 2012. MEASUREMENTS: Directed by the 2010 AGS/BGS guideline recommendations, healthcare provider performance of fall risk assessments and prescribed interventions was abstracted from medical records for a period of 12 months following the most recent fall. RESULTS: Five modifiable fall risk factors (postural hypotension, vision, feet/footwear, muscle strength, and gait/balance) were assessed, on average, 47% of the time. When a fall risk factor was identified as being present, healthcare providers recommended an evidence-based intervention, on average, 73% of the time. Two risk factors were addressed infrequently--prescription medications associated with high fall risk (17%) and home safety evaluation (24%). Use of a geriatric risk assessment template and geriatric specialty both strongly correlated with healthcare provider assessment of fall risk factors. CONCLUSION: Although the frequency of intervention is encouraging, assessment aimed at identifying the presence of modifiable fall risk factors remains modest overall. Opportunities exist for improving the quality of care of older adults at high risk of falls via increasing provider attention to identifying modifiable fall risk factors in these patients