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Among Americans aged 65 and older, one in four falls each year. It’s a danger that increases with the natural aging process: growing older comes with changes to mobility, balance, visual acuity, muscle strength, and medication, all of which can increase the likelihood of falls. Seniors and their families should take falls seriously, and a Fall Risk Calculator can help.
Below, you’ll find a fall risk calculator based on the Morse Fall Scale. While it should not replace an in-person assessment, it can give seniors and their loved ones a better understanding of their condition and information they can take to their health care provider.
Please note that the information presented in our Fall Risk Calculatoris for supporting older adults and their families as they converse with each other and healthcare professionals. Our Calculator does not substitute a patient’s relationship with their healthcare provider and should not replace medical advice.
Fall-related incidents can have serious consequences, particularly for older adults and individuals with mobility impairments. Understanding the importance of a fall risk assessment and a fall risk calculator is essential in preventing such accidents. These tools enable healthcare professionals and caregivers to identify potential hazards, assess an individual’s vulnerability, and implement appropriate interventions, ultimately promoting a safer living environment and reducing the likelihood of life-altering injuries.
According to the CDC’s National Center for Injury Prevention and Control, almost half of fall-related deaths among those 65 and older involved a head injury. For less severe fall-related injuries like bone fractures and breaks, the treatment, recovery, and rehabilitation is still complicated for elderly individuals. Their age-related frailty and pre-existing medical conditions also negatively impact how seniors overcome fall-related injuries.
Hospitalization after a fall comes with risks, too. Because the recovery times are longer, seniors could experience lengthy hospital stays. When they recover from a fall, the seniors can still be incapable of caring for themselves. They could require admission to rehabilitation or long-term care facilities that can accommodate their new limitations. Even if a senior can move back home, it’s likely they’ll reduce their activity levels out of the fear they’ll have another incident; this can negatively impact their mental well-being.
For all these reasons, regular fall risk assessments are highly recommended for adults 65 and over – for instance, the American Geriatric Society recommends that they get a fall risk assessment every year. As an opening measurement, many in the healthcare field use a simple method called the Morse Fall Scale.
Widely used in both hospitals and long-term care facilities, the Morse Fall Scale predicts the risk of falling among seniors. It bases this likelihood on the patient’s fall history, gait, and other risk factors. By determining the risk among their elderly patients, health care teams can work to recommend and enact prevention measures.
Developed by Dr. Janice Morse, this simple yet effective assessment method allows healthcare professionals to quickly and accurately gauge a patient’s risk by examining six essential factors. With its ease of use and demonstrated accuracy, the Morse Fall Scale has become an integral component in patient care settings, playing a crucial role in fall prevention strategies and enhancing overall safety outcomes.
The Morse Fall Scale looks at six variables:
Health care facilities can use the total score to predict future falls, but it is more important to identify risk factors using the scale and then plan care to address them.
The inclusion of the history of falling as a variable in fall risk assessment tools emerged as researchers and healthcare professionals sought to better understand and predict the likelihood of patient falls. Studies have consistently shown that a previous history of falling is one of the most significant predictors of future falls. This critical piece of information can help clinicians identify at-risk individuals and implement appropriate interventions to minimize the risk of falls and their associated complications.
As a result, many fall risk assessment tools, such as the Morse Fall Scale (MFS), the STRATIFY (St. Thomas’s Risk Assessment Tool in Falling Elderly Inpatients) tool, and the Hendrich II Fall Risk Model, incorporate a patient’s history of falling as a key variable. By evaluating factors such as the frequency, causes, and circumstances of previous falls, healthcare professionals can gain valuable insights into a patient’s individual risk profile and tailor fall prevention strategies accordingly.
Incorporating secondary diagnoses as a variable in fall risk assessments acknowledges the multifaceted nature of fall risk factors and the need to consider patients’ overall medical conditions when evaluating their likelihood of falling. Secondary diagnoses refer to medical conditions that coexist alongside a patient’s primary diagnosis and can potentially impact their stability, mobility, and cognitive functioning, thereby increasing their risk of falling.
Examples of secondary diagnoses that may contribute to an elevated fall risk include, but are not limited to:
Fall risk assessments include ambulatory aids as a variable to emphasize the importance of assessing a patient’s mobility status and assessing the potential impact of assistive devices. Patients who have trouble walking, balancing, or strengthening due to various medical conditions, injuries, or aging often use ambulatory aids such as canes, walkers, crutches, or wheelchairs.
In a fall risk assessment, ambulatory aids are evaluated for a couple of reasons:
Healthcare professionals can better understand how mobility aids affect a patient’s risk profile by including the use of ambulatory aids in fall risk assessments. It improves patient safety, promotes independence, and reduces fall-related accidents with this comprehensive approach.
Getting fluids, medications, or nutrients intravenously (IV) can affect a patient’s risk of falling. In fall risk assessments, healthcare professionals can take into account the history of intravenous therapy as a variable to better understand how IV-related factors may impact a patient’s stability, mobility, and cognition.
A fall risk assessment considers the history of intravenous therapy for several reasons. Infusion pumps, IV lines, and poles can limit a patient’s mobility and create obstacles, which makes it hard for them to navigate their environment safely. Additionally, some IV medications may cause side effects such as dizziness, drowsiness, or hypotension, which could increase the likelihood of falls. Medications administered IV can also cause cognitive changes, like confusion, disorientation, or impaired judgment, which increases the risk of falling. Last but not least, IV therapy patients, especially those with full urinary catheters, may have an urgent need to use the bathroom, which can cause hurried movements. These factors can help healthcare professionals identify and address intravenous therapy’s specific risks, enhancing patient safety.
It’s important to include weak or impaired gait as a variable in fall risk assessments so we can identify patients who are at risk of falling. People’s gait can be affected by a lot of things, including muscle weakness, neurological problems, joint pain, and more. A gait impairment can manifest as unsteadiness, shuffling, limping, or trouble maintaining balance.
When healthcare professionals evaluate the gait of a patient to determine fall risk, they can:
Identifying patients at risk of falling due to cognitive or psychological factors requires assessing their overall mental status in a fall risk assessment. When healthcare professionals recognize dementia, delirium, or mild cognitive impairment patients, they can get a better understanding of how emotional states like anxiety, depression, or agitation affect their stability and the likelihood of falling. Using this comprehensive understanding, targeted fall prevention strategies can be developed based on cognitive or emotional factors identified, like medication adjustments, cognitive therapy, or safety changes in the environment. The ability to monitor a patient’s mental status over time also allows them to assess the effectiveness of our interventions and make adjustments to our treatment plans as needed, ultimately improving patient safety.
If you have an elderly loved one and want to learn more about their fall risk, you can help them fill out the Morse Fall Scale calculations. It could help them as they speak to their primary care physician.
History of falling (during a present hospital admission or an immediate history)
Secondary diagnosis (more than two medical diagnoses in the past / on their chart)
Bed rest/nurse assist 0
Intravenous therapy/heparin lock inserted
Weak gait 10
Impaired gait 20
Oriented to own ability 0
Overestimates or forgets limitations 15
Total Score: ______________
Once you have all the factors weighed, tally them up:
If there’s a risk of falling, you might want to change how your loved one lives. Some tactics include:
If you need help making the best choice for your at-risk loved one, let the team at SonderCare help!
A fall risk assessment is a systematic evaluation of an individual’s risk of falling, taking into account their physical condition, medical history, environment, and other factors that may contribute to falls.
Fall risk assessment is essential in identifying individuals who are at an increased risk of falling and implementing targeted interventions to prevent falls and reduce their severity, ultimately improving the quality of life and reducing healthcare costs.
The following five steps are typically involved in a falls risk assessment:
Assess gait, balance, and mobility of the patient after gathering information about their medical history, including previous falls and chronic conditions.
Analyze the environment in which the patient lives and identify any hazards that may contribute to a patient’s fall risk.
The primary goal of functional assessment is to determine the patient’s ability to perform activities of daily living, including strength, range of motion, and activity of daily living abilities.
Identify any medications that may contribute to fall risk through a medication review.
An analysis of the risk factors that may contribute to the patient’s fall risk should be conducted after the information collected in the previous steps has been gathered.
Many fall risk scores are calculated by comparing demographic, medical, and functional characteristics. In order to determine the fall risk score, these factors are scored and weighted according to their relationship to fall risk. The scores are then summed up to determine the overall fall risk score. The exact factors and scoring method will vary depending on the tool being used. Fall risk assessments take into account a number of factors, including age, history of falls, medication use, cognitive impairment, and mobility problems.
An individual with a low fall risk score indicates they are in less immediate danger of falling injury. The exact threshold for a “good” score varies according to the fall risk assessment tool used. In general, scores that fall into the low-risk range (below a certain threshold) indicate good fall risk, whereas scores falling into the moderate- or high-risk range indicate a greater risk of falling. A comprehensive fall risk assessment, which includes a comprehensive medical, functional, and environmental evaluation of the patient, should be conducted in conjunction with fall risk scores.
Older adults, individuals with a history of falls, or those with medical conditions that increase the likelihood of falling should undergo a fall risk assessment. Healthcare professionals may also recommend assessments for patients with certain risk factors.
Interventions to reduce fall risk may include physical therapy, balance and strength training, medication review and adjustment, environmental modifications, assistive devices, and patient education on fall prevention strategies.
Some common fall risk assessment tools include the Morse Fall Scale (MFS), the Timed Up and Go (TUG) test, the Berg Balance Scale (BBS), the STRATIFY tool, and the Hendrich II Fall Risk Model.
The Timed Up and Go (TUG) test measures the time it takes for an individual to stand up from a chair, walk three meters, turn around, walk back to the chair, and sit down. Longer times indicate a higher fall risk.
The Berg Balance Scale (BBS) is a 14-item scale that evaluates an individual’s balance and functional mobility. Each item is scored on a scale of 0 to 4, with a maximum total score of 56. Lower scores indicate a higher fall risk.
The STRATIFY tool evaluates fall risk based on five factors: history of falls, agitation, visual impairment, toileting needs, and transfer or mobility limitations. Each factor is assigned a score, and the total score determines the individual’s risk level.
The Hendrich II Fall Risk Model evaluates fall risk based on eight factors: confusion, depression, altered elimination, dizziness, gender, medication use, poor mobility, and previous falls. Each factor is assigned a score, and the total score determines the individual’s risk level.
This fall risk assessment tool, the Morse Fall Scale (MFS), is used to identify patients at increased risk of falling in acute care settings. There are 14 items in the questionnaire, each of which is scored based on a series of questions. A 3-point scale is used to score each item, with higher scores indicating a greater risk of falling. Items are grouped into three categories: demographics, medical factors, and functional factors. As a result of the summation of all scores, the overall fall risk score is calculated. MFS is an easy-to-use tool that does not take into account environmental factors that may contribute to falls, but it is simple and quick to use. It ranges from 0 to 28, with higher scores indicating a higher risk.
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