Healthcare Provider Relationship

 

Your health care provider should be asking you about falls, thus doing a falls screening, at every annual visit. The American Geriatrics Society along with the British Geriatric Society release guidelines on how a falls screening should be done. You can click HERE for an outline of it, which also includes some of the questions you will be asked.

The Patient Protection and Affordable Care Act of 2010 (PPACA) (P.L.111-148) creates a new Medicare preventive benefit, an annual preventive care visit. Section 4103 of PPACA authorizes not only an annual preventive visit, but also requires a personal prevention plan. Specific inclusion of falls risk screenings and assessments are in the required elements of the Welcome to Medicare examination (Initial Preventive Physical Exam/IPPE).

Besides asking questions, your health care provider can do either of two quick and easy screening tests to determine your risk of falls

Screen 1: Functional Reach

Source: Duncan, P.W., Weiner, D.K., Chandler, J., and Studenski, S.A. (1990). Functional reach: a new clinical measure of balance. Journal of Gerontology: Medical Sciences, 45 M192-M197

Equipment: Tape Measure. Set up before program begins.

Criteria: Individuals must be able to stand for at least one minute without any type of assistance.

Description: Individual stands with one side next to a wall, feet shoulder width apart. Attach a tape measure to the wall at shoulder height parallel to the floor. The individual is asked to make a fist and raise the arm nearest the wall to 90 degrees (arm will be parallel to the floor), fist at beginning of tape. The individual is asked to lean forward as far as possible without touching the wall and without moving the feet (the individual may bend at the waist). The examiner notes the finish position of the fist on the tape.

Put figure for screening test in here.

Procedures: Allow one or two practice trials and then perform the test trial.

Interpretation of results:

  • High Risk for falls : < 6 inch reach
  • Moderate Risk for falls: 6-10 inch reach
  • Low Risk for falls: > 10 inch reach

Screen 2: Timed “Up and Go” Test

Sources: Podsiadlo, D., & Richardson, S. (1991). The timed “up and go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatric Society, 39, 142-148, Shumway-Cook,A. et al. (2000), Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up and Go Test, Physical Therapy, Vol 80(9), 896-903.

Equipment: Chair (with arms) and stopwatch. Ten feet must be marked.

Criteria: Individuals must be able to walk at least 200 feet with/without any type of assistive device.

Description: Start with individual seated with back against chair. Individuals are asked to rise from the chair on the signal “GO”, walk 10 feet, turn, walk back to the chair, turn and sit down. The total time to complete the test is recorded in seconds. The goal is to complete the test in the shortest time possible.

  • Interpretation of results
  • Individuals taking 13.5 seconds or longer to complete the test are at risk to fall.

If you answer yes to any of the screening questions or test positive in any of the tests, you will need to be assessed further. These assessments are described in the guidelines previously mentioned.