As Falls Experts, Physical and Occupational Therapists Can Prevent Dangerous and Costly Senior Falls

Falls-related injuries and deaths among seniors are increasing: the Centers for Disease Control and Prevention (CDC) predict that senior falls will rise to 52+ million annually by 2030. This staggering statistic underscores the need for more Medicare beneficiaries to receive a falls assessment from a falls expert: a physical or occupational therapist (PT and OT).

APTQI recently spoke to Deborah D. Bueche, LOTR, CHT, CLT, an occupational therapist at Baton Rouge Physical Therapy, about what these falls assessments look like. Deborah’s insights about the process provide great information for anyone looking to get a falls risk assessment for themselves or a loved one—as well as for policymakers who are working to expand access to this important service.

Here’s how a falls risk assessment works:

PTs and OTs begin by asking three critical questions to screen for a falls risk:

1. Have you fallen (or almost fallen) in the past year?
2. Do you feel unsteady when standing or walking?
3. Do you have a fear of falling?

The physical or occupational therapist also asks about specific symptoms the patient may be having, the layout/location of where the patient spends the most time to identify any tripping hazards, and any activities that might prove challenging such as walking up stairs.

Following these questions, the therapist will screen the patient for falls risk through three quick tests:

• Timed Up-and-Go (TUG): When the therapist says “go,” the patient stands up from the chair, walks to a line on the floor, turns, walks back to the chair, and sits down again. This exercise allows the therapist to check a patient’s gait.
• 30-Second Chair Stand: When the therapist says “go,” the patient will cross their arms across their body and repeatedly stand up from a chair and return to sitting for 30 seconds. This exercise checks strength and balance.
• 4-Stage Balance Test: The patient is asked to stand in four different positions of increasing difficulty and hold each position for ten seconds. This exercise checks how well someone can keep their balance.

Based on these assessments, as well as supplemental evaluations the therapist can use as needed, the falls expert can estimate a patient’s risk for a fall.

Finally, physical and occupational therapists create a patient-centered plan of action.

Following the falls risk assessment, the therapist and patient can work together to develop an individualized treatment plan that can improve their strength, endurance, and balance as needed.

Therapy interventions may include:

• Lower extremity strength and endurance training.
• A walking program.
• Balance training activities.
• Training on the use of appropriate assistive device (cane, walker, etc.) as needed.
• Recommendations on supportive footwear.
• Home safety and fall prevention adjustments in the home.
• Patient-specific post-discharge home exercise program to maintain functional improvement.

The Big Picture

Physical and occupational therapists are a key factor in reducing the epidemic of senior falls, yet these services are underutilized by older Americans who can benefit from them.

Fortunately, Congress is taking action with new legislation to expand access to falls assessments by our healthcare system’s falls experts!

The Stopping Addiction and Falls for the Elderly (SAFE) Act (H.R. 7618) would allow Medicare beneficiaries to receive a no cost fall risk assessment from a physical or occupational therapist as part of their wellness benefit. We need your help to get this vital legislation passed. Urge your lawmaker to support the SAFE Act today!