Have you had your annual fall risk assessment?

Falls remain the leading cause of injury-related hospitalizations among Canadian aged 65 and older, and between 20% and 30% of seniors fall each year. These falls harm the injured senior but also affect their family, friends, care providers and the healthcare system. However, we do know that these personal and economic consequences can be avoided through prevention screening & activities such as physiotherapy.

The National Institutes of Health in the US cite a number of health conditions normally faced by older patients that play a role in falling. Loss of muscle mass makes legs and feet weaker which upsets the ability to balance. Changes in reflexes and loss in reaction time decrease the body’s ability to regain balance after sudden movement or a shift in body weight.

Falls can also occur from loss of depth perception by trying to focus ahead through the reading portion of bifocal or trifocal glasses.

Medications taken to treat other health conditions, such as high blood pressure and heart disease, or conditions that require taking diuretics, muscle relaxers or tranquilizers, also increase the risk of falling as a result of side effects such as dizziness, confusion, disorientation or slowed reflexes.

Fear of falling – and being afraid to admit it – is a very real and debilitating issue for many elderly patients. Leading experts suggest that the often unspoken fear of losing independence as a consequence of admitting the fear of falling can be a significant obstacle to beginning prevention planning at the earliest opportunity when it can provide the greatest chance to reduce the risk of a debilitating fall.

Because of the heightened risk of falling for people 60 and older, the Panel on Fall prevention in Older Persons, American Geriatrics Society (AGS) and British Geriatrics Society (BGS) recommend to conduct a multifactorial risk assessment. The AGS and BGS recommend that a primary health care provider like a physiotherapist perform this assessment.

The assessment should include:

  • Medical history, physical examination, cognitive and functional assessment;
  • History of falls;
  • Gait, balance, strength & mobility analysis
  • Analyze footwear and mobility aid requirements as well as environmental hazards

Our Physiotherapy Fall Prevention Assessment includes the following 4 categories:

    1. Individual risk factors: The risk to fall is increased 78% when four or more of the following factors are present together:
      a. Muscle weakness
      b. Gait deficit
      c. Balance deficit
      d. Visual deficit
      e. Gait deficit
      f. Arthritis
      g. Impaired ability to perform daily activities
    2. Physiotherapy tests and measurements:a. Muscle strength – A detailed assessment of each individual muscle’s strength is performed to identify key muscles that may be weak. Emphasis is placed on the muscles that are most active during standing, balance and walking. Weakness in these muscles can lead to falls.b. Balance – Balance during standing and walking is assessed both on firm surfaces like the floor and on uneven surfaces like carpet. It is important to test balance with the eyes both open and closed to get the most accurate and meaningful results from these systems. Physiotherapy exercises can help improve responses to factors that challenge stability.

      c. Functional limitations – Assessment of specific functional task such as stair climbing, curbs, and ramps is completed. Other aspects of walking are assessed like pivot turns and sudden stops to see if balance is sufficient to complete these activities safely. Physiotherapy exercises can help restore functional limitations.

    3. Review of drug interactions: The implication of all medications on the risk to fall should be undertaken with your doctor. It’s important to periodically review risk-to-fall symptoms and determine which ones may be due to medications. It is also important to not stop taking any medication without first consulting with your doctor.
    4. Survey of home environment: Complete a survey of the following conditions in your to assess how your home environment may be contributing to your risk to fall:a. Presence of obstacles that can cause you to trip

b. Presence of handholds throughout the household
c. Good lighting in all spaces, including hallways
d. Footwear used inside
e. Difficulty getting on and off the toilet
f. Difficulty getting in and out of the shower or bath
g. Difficulty getting up and down stairs
h. Items on shelves within easy reach
i. Presence of uneven surfaces outside
j. Availability of help if a fall occurs

Physiotherapists not only offer a comprehensive fall risk assessment but can also devise a treatment plan to lower the risk of falling. Physiotherapy can improve muscle strength and balance through a series of clinically-proven exercises that show results regardless of the patient’s age.


Public Health Agency of Canada, Seniors’ Falls in Canada: second Report:  https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/assets/pdf/seniors_falls-chutes_aines-eng.pdf

Panel on Fall prevention in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc. 2011;59(1):148-157.

CDC on broken hip from falling


Mortality rate after hip fracture:


Conditions that contribute to risk of falling in elderly patients: