By Kathryn Stambaugh
Geriatric Services Director
In early July, my mom fell. At age 81, it wasn’t her first fall, but this time she really hurt herself – a compression fracture in her spine. She had just gotten her toenails cut, and the nurse rubbed lotion on her feet (normally the best part!). Mom’s slippery feet moved inside her summer sandals, causing her to lose her balance and hit her rear end on the floor, hard.
The statistics about falls among older adults are jarring:
- More than one in four older people falls each year.
- Falling once doubles the chance of falling again.
- One in five falls causes a serious injury such as broken bones or head injury.
- Even minor falls without injury can be significant, as fear of falling can lead to reduced activity, which in turn can cause weakness (ironically increasing fall risk), isolation, and loneliness (as bad for health as smoking).
My mom was lucky in many ways. She didn’t hit her head. She didn’t bleed internally, which feels like a miracle because she takes an anticoagulant. Her attentive and capable husband took her to the ED, where she received excellent care. Her insurance covered a custom brace that takes pressure off the fracture to support healing.
Ten weeks later, Mom remains weak and off-balance. She uses a walker and seems more frail. Still, she stays positive, leaning into the can-do attitude and humor that served her well throughout her career as a medical social worker. She walks down the hall in her building for exercise, cherishes visits with friends and the occasional meal out, and jokes that she doesn’t want everyone to know she’s feeling better because “once they think you’re well, they stop bringing pies.”
There is a lot we can do in primary care to reduce fall risk, including:
- Ask patients if they have fallen or are afraid of falling. These evidence-based questions are prompted annually in Care Gaps for patients aged 65+. Use .FALLSCREENFOLLOWUP to identify next steps for a positive fall risk screen.
- If a patient reports a fall, get more information. What happened? Confirm a fall vs syncope. Check gait and balance using a tool such as the Timed Up and Go (available as a flowsheet in Epic and with the dotphrase .TUG).
- Share fall prevention resources with patients:
My Mobility Plan (Home Safety Checklist)
What You Can Do To Prevent Falls
- For recurrent falls or a gait disturbance, complete a multifactorial fall assessment or refer to LifeLong’s Geriatrics consult service by routing a telephone encounter with any relevant background and your specific consult questions to pool “P SA185 Geriatric Consult Over 60” or directly to Michael Goldrich, MD.