Guidelines for Managing Falls in the Elderly: From Screening to Holistic Care
Falling in the elderly is not a "normal" part of aging that should be overlooked. Proper risk classification and appropriate care can significantly reduce injury and mortality rates. Below is a summary of the Clinical Practice Guideline (CPG) for healthcare professionals and caregivers on managing this vulnerable group.
1. Protocol for Low-Risk Patients (Single Fall within 1 Year)
This protocol applies to patients aged 60+ with a history of only one fall in the past year and no severe injury.
The 5-Domain Assessment
History Taking: Determine if the fall was related to environmental factors (indoors vs. outdoors) or physical factors.
Visual Acuity (VA): Screen for vision impairments.
Balance Assessment: Use the 5-Time Sit-to-Stand Test or the Timed Up and Go (TUG) test.
Blood Pressure: Measure in both sitting and standing positions to check for Orthostatic Hypotension.
Medication Review: Assess the risk associated with current prescriptions (e.g., sedatives, antihypertensives).
Management & Care
Medication: Adjust dosages or switch medications to reduce fall risks.
Vision: If VA is worse than 20/70 in either eye, refer to an ophthalmologist.
Follow-up: Schedule a follow-up visit within 6–12 months.
Patient Education
Provide pamphlets or links to home exercise videos for balance and strength.
Recommend a diet rich in Calcium and Vitamin D.
Provide a checklist for Home Safety & Environmental Modification.
Additional Screening: Check for Osteoporosis and Vitamin D levels in at-risk individuals.
2. Protocol for High-Risk Patients
This applies to patients who have fallen more than once in a year, or had a single fall resulting in physical impact (injury, fracture, bruising, reduced mobility) or developed a fear of falling.
The 9-Domain Assessment (5 + 4)
Perform the initial 5 assessments from the Low-Risk protocol, plus these 4 additional domains:
Functional Status: Assess Activities of Daily Living (ADLs and IADLs).
Cognitive Function: Screen using MMSE or Mini-Cog.
Depression Screening: Check for signs of depressive disorders.
Nutritional Status: Screen for malnutrition or BMI < 19.
Management & Referral
Treat the Root Cause: Manage dementia, depression, or diagnose gait abnormalities.
Rehabilitation Medicine: Refer for physical therapy if there are gait or balance issues.
Ophthalmology: Refer if significant vision problems are found.
Nutrition: Consult a nutritionist if malnutrition is detected.
Follow-up: Schedule close monitoring and provide targeted prevention strategies based on findings.
3. Holistic & Social Management
Once screened by nurses or family physicians, the patient’s social context must be addressed:
Mental Health Issues
If depression or dementia is detected, the medical team must collaborate to create a comprehensive treatment plan.
Patients WITHOUT Caregivers (Social Issues)
If the patient cannot perform self-care and lacks a support system:
Social Worker Consultation: To identify potential family resources.
Community Coordination: Coordinate with community service centers for home assessments and aid.
Long-term Monitoring: Follow up with the center to evaluate the level of assistance required and facilitate access to services.
Patients WITH Caregivers
Family Meeting: The doctor should host a conference to explain causes and solutions, educating the caregiver at a practical, understandable level.
Rehabilitation: Prescribe physical therapy both at the hospital and as a continuous home program.
Environment: Modify the home environment to remove hazards and adjust the patient's risky behaviors.
Follow-up: If home care becomes difficult, consult a Home Visit Team and monitor the caregiver's wellbeing periodically.
Source: https://www.rama.mahidol.ac.th/fammed/th/article/patient/28jul2020-1242
