title: Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls.
abstract: A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.
authors.affiliation: Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle, WA, USA; Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Phelan
authors.affiliation: Violence and Injury Prevention Program, Utah Department of Health , Salt Lake City, UT , USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Aerts
authors.affiliation: Program Design and Evaluation Services, Multnomah County Health Department, Oregon Health Authority , Portland, OR , USA.
authors.forename: David
authors.initials: D
authors.lastname: Dowler
authors.affiliation: Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health and Science University , Portland, OR , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Eckstrom
authors.affiliation: Providence Health & Services , Portland, OR , USA.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Casey
keywords: accidental falls/*prevention and control; aged 80; medical audit; physicians/*standards; practice patterns; risk assessment/standards; risk factors