Falls Awareness Week: An Ounce of Prevention Is Worth a Pound of Cure
By Kara Gainer, JD
According to the Centers for Disease Control and Prevention, emergency departments treat 3 million older adults for falls each year. More than 800,000 patients are hospitalized after a fall, approximately 20% of falls result in serious injuries, and falls are the second leading cause of accidental or unintentional injury deaths worldwide. Despite these often preventable statistics, individuals enrolled in Medicare often are not screened for risk of falling at their annual wellness visit.
Currently, during the initial annual wellness visit, a provider is required to assess an individual’s functional ability and level of safety with regard to the ability to successfully perform activities of daily living, falls risk, hearing impairment, and home safety. However, the Centers for Medicare and Medicaid Services (CMS) does not require functional status and safety assessments in follow-up wellness visits, in part due to the fact that the United Stated Preventative Services Task Force (USPTSF) has not proffered a recommendation for such.
However, both the American Geriatrics Society and the British Geriatrics Society do recommend an annual screening for all adults aged 65 and older for a history of falls or balance impairment. Accordingly, APTA is advocating for CMS to require functional ability and level of safety screening elements that includes a falls screen during every annual wellness visit for individuals covered under Medicare.
APTA is requesting this change in its comments to CMS on the 2020 Medicare physician fee schedule proposed rule, making the case that falls are both a serious and preventable health risk for older adults and that physical therapists (PTs) are "movement experts with knowledge and skills in identifying, measuring, and improving balance system deficits, functional limitations, and strength and flexibility deficits that have been shown to contribute to falls."
- Assess falls risk
- Design individualized falls-prevention plans
- Conduct home safety assessments and modifications
- Educate older adults about risk factors for falls
- Provide appropriate interventions to decrease falls risk, such the Otago exercise program and strength, balance, and gait training
- Work with other health care professionals to address any underlying medical conditions that could increase falls risk
- Provide recommendations on evidence-based community programs
Physical therapists are a vital component of multifactorial interventions that address modifiable risk factors for falls, and they may work interprofessionally with or within primary care provider offices in this capacity. We see the positive effects of falls prevention up close.
By increasing its focus on falls prevention, APTA suggests, CMS would be demonstrating its commitment to addressing this serious, yet preventable, public health problem.
Kara Gainer, JD, is APTA's director of regulatory affairs. You can connect with Kara on Twitter at @karagainer.