Risk Stratification, Assessments and Management for Elderly
What is New?
- 2 Entry Points.
- Notes: 3 Key Questions (3KQ) any positive answer to a) Has fallen in the past year? b) Feels unsteady when standing or walking? or c) Worries about falling? prompts to “fall severity” step. TUG: timed up and go test. Fall severity: fall with injuries (any severe enough to require a consult with a physician), laying on the ground with no capacity to get up, or a visit to the emergency room (ER), or loss of consciousness/suspected syncope. Frailty. Commonly used frailty assessment instruments include the Frailty phenotype (FP) and the Clinical Frailty Scale (CFS). *Syncope suspicion should trigger syncope evaluation/management. †Exercises on balance/leg strength should be recommended for the intermediate group. Evidence shows that challenging balance exercises are more effective for fall prevention. In several settings, this intermediate group is referred to a physiotherapist. ‡ High risk individuals with falls can deteriorate rapidly, and close follow up is recommended and should be guided on the frequency of consequent health service utilization.
Low Risk
- 1/3 who are deemed low risk experience a fall.
- Low risk individuals are offered exercise and education.
Intermediate Risk
- Individuals who benefit for tailored exercise or physiotherapist referral.
- No frail, no recurrent falls.
High Risk
- Offer Comprehensive Geriatric Assessment,
- Multi-domain interventions.
- Close follow-up for high risk of injury or recurrence.