Fall-Risk Assessment and Management in Clinical Practice: Views from Healthcare Providers

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 52; no. 9; pp. 1522 - 1526
• Main Authors: Fortinsky, Richard H., Iannuzzi-Sucich, Michele, Baker, Dorothy I., Gottschalk, Margaret, King, Mary B., Brown, Cynthia J., Tinetti, Mary E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Inc 01.09.2004; Blackwell; Wiley Subscription Services, Inc
• Subjects: Accidental Falls - prevention & control; Accidental Falls - statistics & numerical data; Activities of Daily Living; Adult; Aged; Attitude of Health Personnel; Biological and medical sciences; Connecticut; Connecticut - epidemiology; Cross-Sectional Studies; Drug Therapy, Combination; Elderly people; Emergency Service, Hospital; fall prevention; Falls; Female; Gait; General aspects; Geriatric Assessment - methods; Health Personnel - education; Health Personnel - psychology; Health professionals; Home Care Agencies; Humans; Hypotension, Orthostatic - complications; Intervention; Male; Medical personnel; Medical research; Medical sciences; Medicare reimbursement; Middle Aged; Older people; patient compliance; Patient Discharge; Practice Patterns, Physicians' - statistics & numerical data; Prevention; Primary Health Care; Risk assessment; Risk Assessment - methods; Risk Factors; Risk management; Shoes; Surveys and Questionnaires; USA; Connecticut; USA, Connecticut; Human; Evaluation; Gerontology; Clinical management; Health; Practice; Fall; Risk management; Elderly; Care; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2004.52416.x

Objectives: 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. Design: Cross‐sectional study using a structured interview. Setting: Geographic area of Connecticut where the Connecticut Collaboration for Fall Prevention (CCFP) has been implemented. Participants: 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. Measurements: 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. Results: 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. Conclusion: 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.