Healthcare Providers’ Perceptions and Self-Reported Fall Prevention Practices: Findings from a Large New York Health System

Abstract

Among older adults, falls are the leading cause of injury-related deaths and emergency department visits, and the incidence of falls in the United States is rising as the number of older Americans increases. Research has shown that falls can be reduced by modifying fall-risk factors using multifactorial interventions implemented in clinical settings. However, the literature indicates that many providers feel that they do not know how to conduct fall-risk assessments or do not have adequate knowledge about fall prevention. To help healthcare providers incorporate older adult fall prevention (i.e., falls risk assessment and treatment) into their clinical practice, the Centers for Disease Control and Prevention’s (CDC) Injury Center has developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool kit. This study was conducted to identify the practice characteristics and providers’ beliefs, knowledge, and fall-related activities before they received training on how to use the STEADI tool kit. Data were collected as part of a larger State Fall Prevention Project funded by CDC’s Injury Center. Completed questionnaires were returned by 38 medical providers from 11 healthcare practices within a large New York health system. Healthcare providers ranked falls as the lowest priority of five conditions, after diabetes, cardiovascular disease, mental health, and musculoskeletal conditions. Less than 40% of the providers asked most or all of their older patients if they had fallen during the past 12 months. Less than a quarter referred their older patients to physical therapists for balance or gait training, and <20% referred older patients to community-based fall prevention programs. Less than 16% reported they conducted standardized functional assessments with their older patients at least once a year. These results suggest that implementing the STEADI tool kit in clinical settings could address knowledge gaps and provide the necessary tools to help providers incorporate fall-risk assessment and treatment into clinical practice.

Older adult fall prevention practices among primary care providers at accountable care organizations: A pilot study

“…Only 8% of respondents reported fall prevention practices based on guidelines from recognized organizations; lack of time, more pressing medical problems and lack of educational materials were the most frequently cited barriers to fall risk assessment [ 18 ]. Among 38 healthcare providers from 11 New York state practices, Smith et al found that less than 40% asked most or all their older adult patients if they had fallen in the last year; less than 20% referred their older patients to community-based fall prevention programs; and, less than 16% conducted standardized functional assessment with their older patients at least once a year [ 19 ]. Burns et al analyzed data on fall prevention recommendations to older adult patients among 1210 US primary care providers who participated in the 2014 DocStyles survey [ 20 ].…”

Medication use and falls: Applying Beers criteria to medication review in Parkinson’s disease

“…CDC has recognized a need to increase awareness among primary care physicians to conduct comprehensive medication review as part of the fall-risk assessment in the elderly. 34 This medication review should include an evaluation of number of medications and screening for PIMs, eliminating of potential therapeutic duplications, and screening for drug–drug interactions. 35 …”

Influences on general practitioner referral to allied health professionals for fall prevention in primary care

“…In one study, AHPs believed GPs did not view them as important contributors to patient care in fall prevention, and believed GPs were too busy to make or receive phone calls . Research in the United States found less than a quarter of doctors, nurses and specialty care providers referred older adults for gait or balance training and less than a fifth referred to community‐based programs . The reasons given for low referral include doctors not being aware of how other health professionals can contribute to fall prevention; not knowing how to refer; not knowing eligibility criteria for home safety assessments or community programs; and not having time to refer …”

“…7 Research in the United States found less than a quarter of doctors, nurses and specialty care providers referred older adults for gait or balance training and less than a fifth referred to communitybased programs. 8 The reasons given for low referral include doctors not being aware of how other health professionals can contribute to fall prevention 9 ; not knowing how to refer; not knowing eligibility criteria for home safety assessments or community programs; and not having time to refer. 10,11 The Integrated Solutions for Sustainable Fall Prevention (iSOLVE) project engaged with GPs and AHPs in metropolitan Sydney to embed integrated evidence-based processes for identifying and managing older people at risk of falls.…”