Inspired by The Joint Commission national safety goal of reducing falls, researchers at a home healthcare agency serving suburban Philadelphia evaluated a simple falls risk assessment tool (FRA). The FRA consists of 10 items: level of consciousness/mental status, history of falls (3 months), ambulation/elimination status, vision status, Timed Up and Go (TUG) test, gait and balance evaluation, orthostatic changes, medications, predisposing diseases, and equipment issues. The medication item lists fall-related medications and scores patients on frequency of use during the previous 7 days. The predisposing diseases category includes vertigo, CVA, Parkinson’s disease, loss of limb(s), seizures, arthritis, osteoporosis, and fractures. A retrospective chart review of 100 patients who fell and 25 patients who did not fall determined the validity of the FRA.
The FRA differentiated fallers from non-fallers; patients who fell had a higher FRA score than non-fallers, 14.61 versus 12.52, respectively (p = 0.035). Linear regression analysis distinguished the relative power of individual variables and confirmed that the multiple variable model was a stronger predictor of falls than any single variable. Notably, individual variables differed in predictive strength singly and within the model. A history of falling predicted falling singly and was the strongest component of the full model. Gait and balance, level of consciousness, and ambulation/elimination were predictive singly and contributed predictive power to the model. The TUG test and orthostatic changes were not predictive of falls singly but did contribute significantly to the model. The ranking of the importance of variables within the model demonstrated that history of falling followed in importance by level of consciousness, gait and balance, and ambulation/elimination were the most likely predictors of falling. The authors further note that although the Center for Medicare and Medicaid Services does not currently require the completion of a falls risk assessment in home healthcare practice, falls risk documentation and intervention may prevent life-altering injury, allows standardization of home healthcare practices, and represents best clinical practice.
James MB, Kimmons NJ, Schasberger B. Validating a multifactorial falls risk assessment. Home Healthcare Nurse. 2014;32(1):14-22.