While often preventable, falls continue to be the leading cause of both fatal and nonfatal injuries in older adults. Per the Centers for Disease Control and Prevention, each year, a typical nursing home with 100 beds reports 100 to 200 falls, with even more falls going unreported. Between half and three-quarters of nursing home residents fall each year. That’s twice the rate of falls for older adults living in the community. Beyond that, about 1,800 people living in nursing homes die each year from falls. Those who survive their falls are often left to manage numerous serious injuries, including fractures, that can limit mobility and reduce quality of life. Even falls not resulting in injury can increase fear of falling, future fall risk, depression, and social isolation.

Fortunately, an estimated 20-30% of elderly falls in long-term care facilities are preventable, emphasizing the importance of standardized fall prevention assessments and strategies in long term care facilities. Assessing the resident’s risk is a crucial step in this process.

When considering the risk, using standardized assessment tools help care providers identify those at risk for falling and quantify specific risk areas.

Examples of Fall Risk Testing Tools

  • Allen Cognitive Screen: Also called the “leather lacing tool,” this test assesses functional cognition and implications for fall risk. During the screening, the resident is asked to stitch three increasingly difficult stitches through pre-punched holes in a piece of leather. Test evaluators then assess the resident’s results using the Allen Cognitive Levels and Modes of Performance.
  • The 30-Second Chair Stand Test: This test assesses leg strength and endurance by counting how many times within 30 seconds the resident can stand from a seated position without using their hands for support.  A low score is indicative of fall risk.
  • The 4-Stage Balance Test: This test assesses the ability to stay balanced while remaining stationary by measuring a resident’s ability to hold four progressively challenging balancing positions for at least ten seconds each. If a resident cannot hold the final stance for more than 10 seconds, they may be at a higher risk of falling.
  • Orthostatic Blood Pressure Test: The orthostatic blood pressure test seeks to identify orthostatic hypotension, a type of blood pressure that drops suddenly when an individual stands up. The test involves three consecutive blood pressure checks: one after the resident has been lying down for five minutes, a second test one minute after they stand up, and a third test after approximately three minutes of standing.
  • The Timed Up and Go (TUG) Test: The TUG test assesses how long it takes a resident to stand from a seated position and then walk ten feet while moving at their normal pace. If it takes them 12 seconds or more to complete this task, it may mean they are at higher risk for falls.

Every long-term care and healthcare facility should have a fall-reduction program and a committee in place made up of members from the interdisciplinary team within the facility. As part of the fall prevention program, integration of falls assessments that measure potential risks can guide care planning and preventative interventions.    Tests and measures of individual patient risks over time are one component of a successful program. In combination with other program components including, but not limited to strong general falls assessment skills, environmental safety analysis, person centered care plans, and falls response and investigation procedures, facilities can reduce the risk of falls and falls with major injury.

Contact Proactive for a review of your falls program, consultation on residents with frequent falls, and/or for falls prevention training.





Blog by Jessica Cairns, RN, RAC-CT, CMAC, Proactive Medical Review

Learn more about Jessica and the rest of the Proactive team.