Monday, August 27, 2018 Study: Widespread Fall-Risk Screening Efforts, Followed by Appropriate Interventions, Could Produce 'Striking' Results If health care providers delivered consistent, widespread screening for fall risk, would it make a difference in health outcomes? Authors of a new study think so, asserting that assessments, followed by connecting patients to interventions that address their specific risk areas, could result in a "striking" reduction in falls and associated medical costs—as many 45,000 fewer falls in a single risk area, with a resultant $442 million drop in expenses. The study, published in the American Journal of Preventive Medicine, paired a review of meta-analyses on various fall interventions with data on the percentage of older adults with various risk factors for falls. Researchers established an "effectiveness" score for each intervention's ability to reduce falls over 1 year, determined the percentage of adults potentially eligible for each intervention, and then assigned a 10% compliance rate to estimate both the overall number of falls that could be prevented with each intervention and the number medically treated falls prevented. Last, they estimated the direct medical costs that could be averted through each intervention. The risk factors and related interventions studied were: poor balance associated with neurologic gait disorders or mobility problems addressed through tai chi or the Otago Exercise Program managed by a physical therapist (PT); taking a medication possibly linked to falls addressed through a medication review; vitamin D insufficiency addressed through vitamin supplementation; cataracts addressed through expedited first-eye cataract surgery; poor depth perception due to multifocal eyewear addressed through single-vision distance lenses for outdoor activities; and home hazards addressed through home modifications delivered by an occupational therapist. Here's what they found: The fall risk affecting the largest number of adults aged 65 and over was home hazards, with an estimated 38 million individuals demonstrating a risk factor for falls. The intervention—home modifications delivered by an occupational therapist—was estimated to result in the prevention of nearly 400,000 falls, resulting in $442,000 in medical cost reductions. Visual impairments, either from cataract or poor depth perception related to eyewear, was a risk factor estimated to affect 27.3 million older adults, with the related interventions (cataract surgery and single-vision distance lenses) preventing an estimated 500,641 falls combined. The Otago program managed by a PT potentially could be used on a subset of 11.5 million older adults with neurologic gait disorders and 13.1 million older adults with mobility problems, resulting in a reduction of a little more than 62,000 falls and $229 million in averted medical costs. Even a basic medication review and modification program could produce results if applied consistently, according to the study, with an estimated reduction of 114,000 falls leading to a medical cost reduction of $418 million. When all the numbers were crunched, researchers foundhe results convincing. "The potential for reducing falls and averting the associated direct medical costs was striking," authors write, adding that the falls reduction and savings estimates are likely on the conservative side, since they looked at risks factors separately rather than approaching the issue from the more realistic perspective of individuals having 2 or more risk factors for falls. Authors acknowledged that in addition to the its focus on individual risk factors, the study also was limited through its application of a 10% participation rate that may or may not be accurate across all interventions, and did not consider the costs associated with implementing the various interventions. However, authors pointed out, an earlier study of the Otago program and a tai chi program known as "Moving Better for Balance" showed that both programs were cost-effective. "Healthcare providers are well positioned to implement evidence-based clinical interventions, such as those described in this analysis," authors write, through a combination of easy-to-conduct in-office screenings for medications and vitamin D intake, referral to specialists, and community- and home-based interventions. "When put into practice, clinical fall prevention efforts…could prevent falls and help America's older adult population live safe, healthy, and independent lives." APTA provides extensive resources on falls prevention at its Balance and Falls webpage. Offerings include consumer-focused information, online courses, and links to other sources of information, including the CDC and the National Council on Aging. In addition, APTA's PTNow evidence-based practice resource offers a unilateral vestibular hypofunction clinical summary, a summary on falls risk in community-dwelling elders, an osteoporosis clinical summary, and tests and measures such as a fracture risk assessment, a clinical test of sensory interaction and balance, and a self-paced walk test. The association's scientific journal, PTJ (Physical Therapy) has also published a clinical guidance statement from the APTA Academy of Geriatric Physical Therapy on management of falls in community-dwelling older adults. Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.