Falls Assessment in the Geriatric ED
Expert Panel Webinar
Monday, Sept 27, 2021
3:00–4:00 PM EST
This webinar has completed and is now available on-demand. Please see below for webinar recording and supporting materials.
- To describe practical changes that an ED can implement to more completely assess older people who have fallen or who are at risk of future falls.
- To review both evidence and experience that supports the benefit of those programmes
- To present two real-life examples from EDs that have implemented falls assessment programmes.
Shan Liu, MD
Teresita Hogan, MD, GEDC Core Faculty
University of Chicago
Jessica Babbitt, PT, DPT, CEEAA
Inpatient Physical therapist
Elizabeth Goldberg, MD
Providence, Rhode Island
Main Learning Points
Our panel of experts considered the assessment of falls in a high-quality ED from several perspectives:
Dr. Shan Liu (9:30)
Dr. Liu, an emergency physician and researcher at Harvard, reviewed the literature about older people and falls and specifically as it relates to the ED. Her reading of the evidence suggests that falls are common in the older population – one in every three older people fall every year. They are complex because they represent a syndrome not just an event. The presentation of an older person with a fall often represents a sentinel event – the first stage of a decline in function and health that perhaps can be reversed or slowed with the right approach. EDs and the staff in them can make a difference in that decline. However, the main barriers to effective intervention are both time (time available and time taken) and knowledge on the part of the ED staff.
Dr. Elizabeth Goldberg (20:30)
Dr. Goldberg, an emergency physician at Brown University, described a grant-supported falls assessment that she led in her ED and its outcomes. Called GAPCare, it involved a standardized assessment. First a pharmacist, spent 20 minutes with the patients, preformed a review of their medications, and used open-ended questions to clarify the patient’s attitudes about and use of their meds. The pharmacist made recommendations back to the person’s primary care provider. Next, a physical therapist performed a Timed Up and Go test, as well as a gait assessment and observing the patient’s use of their gait aid. Depending on their assessment, the patient could be referred to acute rehabilitation, or to community services. Key findings from the intervention were that it did NOT increase length of stay and succeeded in reducing subsequent falls-related and all-cause ED re-visits. Having the PT assessment helped patients and families understand their care needs after a fall. And significantly the brief motivational interview by an ED pharmacist had a big impact on reducing fall-risk medications. An essential part of both interventions was ensuring that the transition of care and communication back to the patient’s primary care physicians was thorough and complete. Without that communication, only about 28% of older people going to an ED with a fall every report that fall to the PCP.
Dr. Jessica Babbitt (33:30)
Dr. Babbitt, a physical therapist in hospital practice in Cleveland, frequently sees older patients in the ED. She described what she thinks of as key components of a falls assessment which all ED clinicians could add to their practice. First, she thinks it’s essential to ask for additional details about the fall itself, not just “oh, you fell.” What happens when you fall? Did your legs give out? Did you feel dizzy (room spinning or light-headed)? Are you tripping over things? How frequently? When did the falls start? Where did it happen? What time of day? What was the physical environment at the time? What was the person wearing? Who or what were around? Her approach to her exam is to observe bed mobility; transfers; and gait. She says that a gait assessment is essential to determine diagnosis and to see if the person needs an assistive device. Three things that she assesses are: is the person reaching for things when he walks (furniture cruising); how wide are his feet compared to his shoulders? Are they shuffling? Finally, she described the importance of considering and addressing the fear of falling that comes with an initial or multiple falls. Clinicians need to be cautious in order to gain the trust and confidence of the patient
Dr. Don Melady is an emergency physician at Mount Sinai Hospital in Toronto, Canada and a founding member of the Geriatric Emergency Department Collaborative. He is the author of the website www.geri-EM.com – a CME accredited program for geriatric emergency medicine education – and the chair of the Geriatric EM committee of the International Federation of Emergency Medicine.