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An Effective Community–Academic Partnership to Extend the Reach of Screenings for Fall Risk

The figure outlines the flowchart process for fall risk screening. The process begins with simple questions about fall history and balance. Depending on responses to the questions, individuals will either be directly identified as having an increased or lower risk for falls, or be directed to undergo physical performance screening. Scores on physical performance screening tests are then used to identify individuals as at an increased or lower risk of falls. Individuals identified at an increased risk of falls are referred to their health care provider for a comprehensive fall risk assessment, while those identified as at a lower risk of falls are referred to community programs for continued wellness.

The algorithm starts with question 1a, which is to ask the person being screened, “In the past 12 months have you had a fall?” Response options are yes or no. If no, proceed to questions 2 and 3. If yes, proceed to questions 1b and 1c.

Question 1b is to ask the individual, “How many times?” and Question 1c is to ask the individual, “Were you injured?” If responses to questions 1b and 1c indicate 1 fall but no injury, then perform the Timed Up and Go (TUG) Physical Performance Screening. Proceed to TUG outcomes below.

If responses to questions 1b and 1c indicate 2 or more falls or 1 fall with injury, the person is considered at an increased risk of falls. TUG is not performed and the person is referred to their health care provider for comprehensive fall risk assessment.

Question 2 is to ask the person being screened, “Do you sometimes lose your balance, but are able to catch yourself?” Question 3 is to ask, “Have you changed your normal routine because you are concerned about your balance?” If responses to questions 2 and 3 are both no, then the person is considered at lower risk of falls. TUG is not performed and the person is referred to community programs for continued wellness. If the response to either question 2 or 3 is yes, then perform the TUG.

In the TUG screening, if the person being screened is unsteady or has difficulty performing the test or if time to complete the TUG is 14 seconds or longer, then the person is considered at increased risk of falls. Refer him or her to a health care provider for comprehensive fall risk assessment. If time to complete the TUG is less than 14 seconds, then the person is instructed to perform the Single Leg Stance Performance Screening.

In the Single Leg Stance Performance Screening, if time for single leg stance is 5 seconds or less, then the person is considered at increased risk of falls. Refer him or her to a health care provider for comprehensive fall risk assessment. If time for single leg stance is longer than 5 seconds, the person is considered at lower risk of falls. Refer him or her to community programs for continued wellness.

Figure. Original 2010 North Carolina Falls Prevention Coalition (NCFPC) Fall Risk Screening Algorithm (later revised). Provided by the NCFPC for use by trained health care and community service providers.

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