Application of the world guidelines for falls prevention and management's risk stratification algorithm to patients on a frailty intervention pathway and the potential utility of sensory impairment information.

BACKGROUND

The 2022 world guidelines for falls prevention and management suggest measuring sensory function including dizziness, vision, and hearing. These variables are not included in the falls risk stratification algorithm. This study sought to investigate the utility of the guidelines and potential avenues for improvement. This study applied the falls risk stratification recommendations and reviewed the individual sensory impairment risk factor variables predictive of falls and falls risk grouping in those assessed by a frailty intervention team (FIT) based in an emergency department (ED).

METHODS

Patients over 65 years old who attended the ED and had a comprehensive geriatric assessment carried out by FIT over a period of four months were included in this retrospective cross-sectional study. Patient characteristics, medication, physical and sensory function status data was retrieved and analysed with respect to falls and falls risk grouping.

RESULTS

Data was gathered retrospectively from 392 patients. Excluding those with missing data, almost all attendees were in the high-risk of falls category (n = 170, 43.4%), or the low-risk category (n = 149, 38.0%). Few people were in the intermediate-risk category (n = 19, 4.8%). Hearing loss and dizziness were significantly associated with falls incidence, whereas vision and balance were not. Hearing loss, balance and dizziness were significantly associated with risk grouping, whereas vision was not.

CONCLUSIONS

Most older adults included in the analysis fell into the low- or high-risk categories, with a minority in the intermediate-risk category. This suggests that the inclusion criteria for the intermediate category could be altered for greater sensitivity. While impaired balance and vision were the most common impairments, hearing status, balance and dizziness were associated with risk group. These results, through a practical application of the world guidelines for falls to an acute clinical sample, raise the possibility of refining the falls risk stratification criteria, and highlight the capacity for additional sensory intervention to mitigate falls risk.