MedEdPORTAL (Apr 2010)
Fall Risk Assessment Experience
Abstract
Abstract Falls are common in older adults and result in significant morbidity, including injury, pain, disability, and even death. Risk factors for falling have been identified, and interventions to improve these risk factors have been found to reduce fall rates by more than 30%. However, medical students are frequently not instructed on fall risk assessment (FRA) and management. The goal of this resource is to improve medical students' understanding of the impact of falls on the lives of older adults, fall risk factors, and evidence-based interventions to reduce fall risk by having students perform an FRA on an older adult patient. At Mount Sinai School of Medicine, the FRA occurs during the third-year Integrated Internal Medicine-Geriatrics Clerkship. Included in this resource is a Fall Risk Assessment Experience Student Guide providing background information about falls, fall risk factors, interventions to prevent falls, and patient education material. The guide directs the student to read a comprehensive fall assessment and management article, obtain relevant information from the patient's medical record, and conduct an FRA (including questions about fall risk factors, orthostatic vital signs, observed gait and balance, 3 Chair Rise and the Timed Up and Go tests) on a patient. Findings are then reviewed with the patient's doctor, and recommendations are offered to the patient. This hands-on student-directed approach activates learning, as the student plays a primary role in the patient's care by identifying risk factors, recommending treatment, and providing counseling. During the 2007–2008 academic year, our third-year students performed the FRA Experience with 19 of 27 (70%) eligible senior mentors. Falls were common even among this highly functional community-dwelling population as 79% of the mentors reported previous falls on the FRA Questionnaire. In spite of this, at the start of the assessment, 11 out of 19 patients (61%) did not think they were at risk of having another fall. Patients reported low rates of being asked about falls and of feeling they were at risk of falling. Of senior mentors, 36% said they were “almost never” asked about falls by their doctor, while only 29% noted that their physician “almost always” asked them about falls. The student-directed FRA module identified multiple fall risk factors, and students were able to make important recommendations to reduce their senior mentors' risk of future falls. All mentors had at least one risk factor for falling in addition to age. The mean number of fall risk reduction strategies recommended was 3.3 (range: 0–8). Of the older adults, 73% found the intervention to be helpful in recognizing their own fall risks. The assessment changed the mentors' perceptions of their own risk of having a fall from 39% thinking they were at risk to 50% thinking they were at risk afterwards; 53% said there were things that they were going to do differently after the assessment to reduce their risk of falling. These included being more careful, doing exercises, taking tai chi, taking their time when first getting up, and using a walker.
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