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Functional Fall Risk Assessment for Senior Safety

Dr. Rein Tideiksaar - October 26, 2015 10:45 AM

According to a new report, falling continues to be a major problem and a leading cause of injury among elders.

•    Up to 35% of people aged 65 years and over fall each year (many suffer multiple falls).
•    Falls are responsible for up to 15% of all emergency room visits (sprains, dislocations, broken bones, head injuries, etc.).
•    Falls are a leading cause of hospital admissions in the 70+ age group (exceeding that of stroke, disease and dementia).
•    About 6 out of 10 falls take place in the home.

These are disturbing statistics. But what’s notable is that the majority of falls continue to occur at home. By taking a few preventive measures, such as improving lighting, installing bathroom grab bars, moving items to make them easier to reach, clearing floor and stairway clutter, etc., you’d think that many of these falls could be prevented. Such environmental modifications appear on literally hundreds of ‘home safety’ websites on the internet and make a lot of common sense.

So why haven’t these changes made a difference? One reason may be that for many elders with multiple, chronic health conditions, relying on environmental modifications by themselves haven’t really worked in avoiding falls in the home. Why?

•    Falls are due to a combination of internal (poor vision, memory, balance, muscle strength, etc.), external (environmental hazards, drug side effects, etc.), and situational (hurrying, not paying attention, living alone, etc.) factors.

•    For those ‘well-elderly’ (absence of disease; good balance/mobility), simple environmental modifications (along with a regular exercise program aimed at balance strengthening) are generally sufficient to avoid falling.

•    But for those ‘ill-elderly’ (presence of multiple chronic health conditions; poor balance/mobility) environmental modifications may be necessary, but are often not sufficient to prevent falls. For these elders, preventing falls in the home requires a more comprehensive approach. For these individuals, I favor a ‘functional approach’ to avoiding falls.

The Functional Approach

What is this?

A functional fall risk assessment consists of observing an elder in their home (and living environment) and watching them:

•    Walk over different floor surfaces (carpet, tile, etc.)
•    Walk up and down stairs/steps
•    Reach up and bend down for objects in closets/cupboards
•    Get in/out of bathtubs/showers
•    Get up from beds, toilet, chairs, etc.

What does this tell you?

•    The health of an elder’s balance and mobility with respect to their home environment, whether it is good or bad.
•    The presence of potential environmental fall hazards.

Why is this beneficial?

•    Information from a functional assessment allows specific recommendations to be made on how to avoid falls.
•    Elders (and their family caregivers) are more accepting of recommendations because they are targeted or specific to the elder’s fall risk factors and mobility needs.

Does it work?

Let me illustrate the functional approach with one of my patients:

•    MK is a 74 year-old woman who lives alone. She has severe arthritis of both hips, poor vision (cataracts), and mild depression (takes an antidepressant medication). She has a caring daughter who visits once a week.  
•    MK has suffered 3 falls. Two falls in the bathroom (one while getting into the tub and another getting up from the toilet); she experiences some mild dizziness during both these falls. The third fall occurred while going up the staircase (she lost her balance while carrying a basket of clothes); she was hurrying at the time in order to complete the task.
•    Her daughter is very worried about her mother’s falls and is considering moving her to assisted living facility, which MK doesn’t want.
•    The functional assessment reveled that MK’s balance was poor; especially when getting into her tub, up from the toilet, and going up the stairs. She didn’t have any bathroom grab bars or stairway handrails for balance support. Because of her poor eyesight, she tripped several times over a living room rug and clutter on the bedroom floor.

Based on her functional assessment, risk factors, and further evaluation, the following strategies were put in place:

•    Start a regular exercise program for balance, strength and flexibility.
•    Get eyes and vision checked.
•    Lower dose of her depression drug, which was causing dizziness.
•    Install bathroom grab bars (in the tub and by the toilet) to support her balance.
•    Install stairway handrails and extra lighting to support her balance when going up/down stairs.
•    Encourage MK to not hurry while walking stairs and to lighten her carrying load.
•    Clear all of MK’s walking areas of clutter and tripping hazards.
•    Give MK a personal emergency response system (PERS) to avoid ‘down time’ in the event of a fall (MK lives alone).

MK’s balance and mobility improved and she didn’t have any more falls. Her daughter was relived and stopped talking about moving her mother to an assisted living facility.

When it comes to falling, prevention is always better than treatment. Evaluating an elder’s function in the home is a good way to get started.  There are several health professionals (such as occupational and physical therapists, and geriatric care managers) who perform functional assessments of the home environment. These professionals work with the elder’s primary care doctor to design comprehensive recommendations that help reduce the risk of falling.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at

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