Geriatric Fall-Risk Prevention and Assessment

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Table of Contents

Case Study
FRAX Assessment
Tinetti Performance Oriented Mobility Assessment (POMA)
Patient Assessment Results
Strategies to Reduce Falls
Conclusion
References

Falls prevention is a significant part of geriatric health care because older patients are at a high risk of falls due to diseases, frailty, and aging factors (Holroyd-Leduc & Reddy, 2012). To decrease the number of falls in older people, medical professionals have to assess their clients’ possibility of falling. For this purpose, there exist a variety of evaluation tools focused on different aspects such as one’s gait, habits, previous falls, or age (Resnick, 2016). The Fracture Risk Assessment Tool (FRAX) collects data about a patient to calculate his/her risk of injury. Another tool that can be used is the Tinetti Performance Oriented Mobility Assessment (POMA) – it incorporates several tasks to evaluate one’s balance. The combination of multiple tools can help to analyze the health of an older patient with Parkinson’s disease and develop suggestions for fall prevention.

Case Study

The patient under the pseudonym JK is a 75-year-old white male. He was diagnosed with Parkinson’s disease eight years ago, but his condition started becoming increasingly worse recently as has been noted by his neurologist during the last visit a week ago. He has such problems as urinary and bowel incontinence, tremors, and difficulty walking. After his previous appointment, JK started to take medications that help relieve tremors. However, these and other symptoms continue to progress and affect JK’s everyday life.

FRAX Assessment

FRAX is a tool that evaluates the probability of fractures in older people in the next ten years after the assessment (Roux et al., 2014). There are twelve sections in the test, each having a question or a numerical measurement of the patient. FRAX incorporates a variety of patient characteristics, including one’s age, sex, as well as family and patient history of previous fractures (Roux et al., 2014). Moreover, it considers patient behaviors such as smoking, drinking, and medication use and inquires about the presence of osteoporosis and arthritis (“Calculation tool,” n.d.). The combination of these facts is used to calculate the risk of fractures. FRAX does not require patients to complete many tasks, making the test reasonably simple.

Tinetti Performance Oriented Mobility Assessment (POMA)

The second chosen tool is POMA which is performed in the form of 16 different exercises, where each of them is focused on a separate type of motion. The first portion of tasks measures one’s balance with such activities as sitting, arising, standing, nudging, turning, and sitting down (“POMA,” n.d.). The second part evaluates gait by asking the patient to walk and looking at his/her steps, path, and stance (“POMA,” n.d.). The test calculates the possibility of falls depending on the successful or failed completion of exercises and one’s confidence during their performance. This tool was selected because, in a contrast to FRAX, it appraises the patient’s actual movements. Also, it does not require many devices or items, apart from a chair.

Patient Assessment Results

According to the FRAX tool, the patient’s probability of fracture is low, showing a score below 7% (“Calculation tool,” n.d.). However, there exist multiple issues with this test. First of all, it does not include a history of previous falls or one’s previous incidents that did not lead to a fracture but were substantial. According to Roux et al. (2014), this lack of acknowledgment of other events decreases the reliability of results. Furthermore, one’s possible comorbidities that increase the possibility of falls are also not included. The patient has Parkinson’s disease, in which tremors and gait problems may cause falls. His condition puts him at high risk of damage and, therefore, increases the probability of fracture. JK’s incontinence problems are also not recognized in the test.

According to POMA, the patient is at high risk of falling. JK’s gait is shuffled – his steps are small and slow and increasing tremors disrupt his balance. His score after completing the tasks is 17 points, which the majority of points coming from his sitting balance. On the other hand, when the patient walks, his walking stance is unstable. In comparison to the previous test, POMA assesses the risk of falls, not fractures. It cannot predict what outcomes the patient’s falling incident will have. Nonetheless, this type of assessment presents visual evidence of the patient’s current condition.

Strategies to Reduce Falls

Parkinson’s disease progresses with time and is difficult to suppress. To reduce the risk of falls, the patient should follow the plan of care, take prescribed medications, and manage symptoms. Furthermore, JK should make some lifestyle changes and have a balanced diet. Exercising may help JK to increase balance and muscle strength, as well as improve his posture (Canning et al., 2015). While it does not directly impact the probability of falls, it positively influences one’s health. JK should also consider acquiring walking aids and equipping his house with some safety devices. Occupational therapy is another way to reduce the risk of falls and simplify everyday activities.

Conclusion

Assessment tools for falls probability focus on different characteristics of patients, their actions, and movements. One test may not provide a full picture for a patient or acknowledge all conditions and habits. FRAX tool uses information and patient history to calculate risks, failing to include many individual details. POMA uses actual evidence but does not account for the outcomes of falls. The presented case study considers a patient with Parkinson’s disease, whose incontinence, tremors, and gait problems increase the risk of falls. He should pay significant attention to his lifestyle and daily living activities to avoid falling.

References

Calculation tool. (n.d.). Web.

Canning, C. G., Sherrington, C., Lord, S. R., Close, J. C., Heritier, S., Heller, G. Z.,… Fung V. S. C. (2015). Exercise for falls prevention in Parkinson disease: A randomized controlled trial. Neurology, 84(3), 304-312.

Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

Roux, S., Cabana, F., Carrier, N., Beaulieu, M., April, P. M., Beaulieu, M. C., & Boire, G. (2014). The World Health Organization Fracture Risk Assessment Tool (FRAX) underestimates incident and recurrent fractures in consecutive patients with fragility fractures. The Journal of Clinical Endocrinology & Metabolism, 99(7), 2400-2408.

Tinetti Performance Oriented Mobility Assessment (POMA). (n.d.). Web.

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