The Purpose and Benefits of a Falls Risk Assessment
The Purpose and Benefits of a Falls Risk Assessment
Falls can lead to injury and loss of confidence. For people living with disability, this can further affect your wellbeing, independence and quality of life. The team at Active Ability explain more about fall risk assessment, including tips for deciding whether you or your loved one could benefit from having one and how to arrange it.
Why might I need a fall risk assessment?
If you or someone you’re supporting is at heightened risk of having a fall, a health professional might advise a falls risk assessment. This not only helps to determine the level of falls risk, but also enables the development of a plan to reduce that risk.
Several factors can increase your risk for having a fall . If you or your loved one has one or more of these factors, it can be worthwhile arranging a falls risk assessment. These factors include:
Previous history of a fall
This is the strongest single predictor of having another fall, most likely because the reason for having the first fall still applies.
Some medications 2
Certain classes of medication, or combinations of medications, are known to increase the risk of falling. For example, psychotropics (medicines that affect psychological function) typically increase falls risk due to their effects on cognitive function, such as sedation, reduced balance and slower reaction times. This includes drugs used to manage mental health conditions, such as certain anti-anxiety medicines, antidepressants, antipsychotics, anticonvulsants, as well as narcotic pain medications.
Medications that work on the cardiovascular system can also impact falls risk due to their effects on heart rate and blood pressure. This is because maintaining an upright position requires adequate blood flow to your brain.
Furthermore, regularly taking five or more medications (which is known as polypharmacy) can also increase your falls risk.
Although the mechanisms are not fully understood, psychological factors are known to be associated with falling. Studies have shown that living alone, depression and fear of falling are all associated with falls risk. Anxiety and fear of falling can lead to taking shorter steps and focusing more internally than on the external environment, thereby increasing your risk of having a fall. Depressive symptoms have also been linked with falls risk.
The body systems involved in controlling your balance and movement are linked through high-level brain processes. Furthermore, purposeful movement requires higher order cognitive abilities such as planning and awareness of your environment. Therefore, issues affecting cognition can impact falls risk. For example, one study found a falls prevalence of 64% in individuals with non-Alzheimer’s dementia, compared to 25% in cognitively healthy individuals.
Clearly, physical characteristics play a vital part in maintaining an upright posture, moving around, and safely navigating your environment. They are therefore also linked with falls risk. Physical falls risk factors include 3 :
- limitations in mobility or activities of daily living
- impaired gait (walking) patterns
- balance problems
- vision impairment
- reduced muscle strength
- reduced reaction times.
Arthritis, foot problems and chronic pain are also associated with an increased falls risk.
Falls risk and disability
If you are living with a disability, you may be at increased risk for falling for several reasons. Firstly, several of the above risk factors may apply to you. For example, you may experience depression, be taking medications to manage your mood, and have difficulties with vision, balance and leg strength. Secondly, people with disability can experience age-related changes earlier in life, making a fall more likely.
Research is uncovering more about the link between falls and disability. For example, a 2019 study looked at falls incidence in 78 community-dwelling adults with intellectual disability (ID) over six months. They found participants experienced 296 falls in total, with 46.2% of them having one or more falls.
The authors note that people with ID fall at a younger age compared with those in the general population and have different falls risk factors. They advise health professionals to prioritise falls risk assessment and management for people with ID.
People with neurological disorders may also be at heightened risk of falls because these conditions are associated with several fall risk factors, including difficulties with balance, mobility, muscle strength, coordination, vision and cognitive function. Fall incidence has been reported as 2–4 times higher in people with neurological disorders than those of similar age without a neurological condition.
Some of the neurological disorders associated with an increased falls risk include:
- Parkinson’s disease
- Multiple sclerosis
- Motor neuron disease
- Peripheral neuropathy
- Muscular dystrophy
- Traumatic brain injury
- Vestibular disorders
- Cerebral palsy.
People with mental health conditions are also at risk of falling, with a 2014 study noting falls are the most reported patient-safety incident in mental health settings for older people. The authors explain falls risk is associated with altered mental status due to conditions such as dementia, depression, mania and anxiety, as well as treatments for mental health conditions.
This makes it especially important for people with ID, neurological conditions or mental health concerns to consider a fall risk assessment.
The benefits of having a falls risk assessment
Having a fall isn’t always serious, but falls can potentially lead to adverse consequences, such as:
- injuries, including fractures, head injuries, spinal injuries, and trauma to soft tissues and joints
- pain, bruising, wounds and haematomas
- bleeding on the brain
Even when falls don’t cause a physical injury, they can create a fear of falling. This can lead to a vicious cycle of reduced activity and decreased functional capacity.
Having a falls risk assessment can help to reduce your chances of having a fall. Even if you’ve already had one or more falls, it’s helpful to understand more about why they’ve been occurring. This can help you, your support team and your health professionals to create a plan for reducing your risk of having another fall.
It can also identify ways to improve your physical capacity and confidence, so you can have targeted therapy that helps you get back to doing things that matter to you.
What’s involved in a falls risk assessment?
A fall risk assessment is conducted by a health professional, such as a nurse, physiotherapist, occupational therapist or exercise physiologist. It involves using a falls risk assessment tool, which is a test specifically designed to examine factors that affect your risk for having a fall.
Numerous fall risk assessment tools are available, and your health professional will choose the test or tests most suitable for your situation. Some purely look at your physical function, while others include fall risk assessment questions. All fall risk screening tools provide an estimate of your risk. On timed tests, for example, taking longer to complete a task can indicate increased falls risk. Other tests have a scoring system that indicates your falls risk.
Examples of fall risk assessment tools include:
- Timed Up and Go Test – this test measures how long it takes you to rise from a chair, walk three metres at normal pace with your usual assistive device, turn around, walk back to the chair and sit down.
- Sit-to-Stand Test – this involves measuring how long it takes you to complete five sit-to-stands as quickly as possible from a standard height chair.
- Falls Risk Assessment Tool (FRAT) – this is a five-item screening test that includes questions about your falls history, medications, diagnosis, balance problems and ability to rise from a chair.
- Performance Oriented Mobility Assessment – this test grades your performance on nine balance and seven gait items, leading to a score that indicates whether you are at increased risk of falling.
At Active Ability, our skilled therapists take a thorough approach to fall risk assessment. Along with using falls risk assessment tools, they will look at your unique situation. This includes factors such as your supports and your home and community environments.
With these findings, your therapist will work with you to create a plan for achieving your goals, such as the ability to participate safely in home, work and community life.
How do I arrange a fall risk assessment?
If you think you or someone you’re supporting could benefit from having a falls risk assessment, the experienced team at Active Ability would love to help. If you’re already receiving NDIS therapy supports from us, simply talk to your therapist about arranging a falls risk assessment.
If your NDIS plan doesn’t currently include funding for therapeutic supports, contact our helpful team to discuss how we can help you to access them.
Active Ability’s mission is to support people living with disability to achieve optimal independence, health and quality of life, focusing on people who have a neurological condition, intellectual disability and/or mental health condition.
We come to your home, school, workplace or gym and don’t have waiting lists, so you can access therapy as soon as you need it.