Jacqueline Osborne PT, DPT
Board Certified Geriatric Clinical Specialist
We prepare for emergencies like hurricanes, but do we prepare our patients for the emergency created by an injurious fall? We have many screening tools, assessments and interventions to help direct and tailor a comprehensive fall prevention plan for our patients. However, often missing from that comprehensive plan is a fall preparedness strategy.
A fall preparedness strategy should have the following four components:
1. Prioritize Your Patient’s Risk Factors
An individual may have many fall risk factors. It can be helpful to classify which fall risk factors are modifiable with a comprehensive plan of care managed by a physical therapist. These factors include those which can be readily addressed, such as environmental hazards (removing a throw rug, putting a nightlight in a dimly lit hallway), as well as those which require a referral to a colleague (i.e. a referral to a pelvic health physical therapist to address incontinence, a referral to an optometrist to address vision changes, etc.). Check out the Stay Independent Brochure for a self-report checklist that may help you to prioritize your patient’s fall risk factors.
2. Determine Your Patient’s Floor Transfer Ability
Try a Floor Transfer Test to determine your patient’s level of assistance. This activity can serve as a task-analysis to help you identify impairments in body function and structure that hinders the patient's success at purposefully getting on and off the floor.
3. Determine Your Patient’s Self-Efficacy
Discuss your patient’s expectations regarding their ability to achieve a successful descent to and ascent from the floor.
4. Determine Your Patient’s Level of Engagement
Find out what your patient is willing to do. Perhaps a full floor transfer is too intimidating initially, but maybe your patient is willing to work up to this task. A floor transfer could be preceded by moving in and out of developmental positions (i.e. tall kneeling on a pillow while supporting the trunk on a large physio ball; using a walking stick to support deeper and deeper lunges from standing; moving from side-lying to quadruped on a large mat table; etc.).
Ultimately your patient’s Fall Readiness Plan should include:
Interventions that were chosen based on an assessment that was tailored to your patient’s needs
A prioritization plan for how each fall risk factor identified in your examination will be addressed and by whom;
A floor transfer plan;
Acknowledgement of the patient's self-efficacy and a plan to identify solutions to barriers; and
A determination of the patient's level of engagement to create accountability.