The risk of falls increases significantly with age, and is one of the leading causes of morbidity and mortality in older Australians(1, 4).
Falls prevention in the older generation is a priority for health services, with previous trials showing that targeting multiple risk factors related to falls can reduce the risk of falls in patients(6, 3).
Common drugs that may contribute to falls include:
Patients who have fallen and been on the floor for over an hour are at a higher risk of complications, such as pneumonia, pressure areas, rhabdomyolysis, dehydration and hypothermia(9).
Patients who report unexplained falls or episodes of collapse should be assessed for the underlying cause(3).
The Falls Risk Assessment Tool (FRAT) is a validated tool, and should be performed on any patient than has fallen or considered at risk of falls(3).
Allocate the appropriate FRAT score (0-5) by determining the value and score associated with each of the five variables(14).
|Has the patient had a fall within the last 12 months?||Yes||1|
|Does the patient take four or more prescribed medications per day?||Yes||1|
|Does the patient have a diagnosis of Stroke or Parkinson's disease?||Yes||1|
|Does the patient report any problems with their balance?||Yes||1|
|Does the patient need to use their arms to stand from a chair of knee height?||Yes||1|
The total score is used to predict the patient's falls risk:
|Score of 3 – 5||High falls risk|
|Score of 0 – 2||Low falls risk|
The FRAT score should be documented on the ePCR and handed over to the recieving clinical staff(14).
Australian Commission on Safety and Quality in Healthcare (2012). Standard 10, preventing falls and harm from falls. https://www.safetyandquality.gov.au/sites/default/files/migrated/Standard10_Oct_2012_WEB.pdf
St John WA (2019). Safety performance. https://stjohnwa.sharepoint.com/sites/connect-Safety/Shared%20Documents/Safety-Performance-2018-2019_30365.pdf
Australian Commission on Safety and Quality in Healthcare (2009). Preventing falls and harm from falls in older people. https://www.safetyandquality.gov.au/sites/default/files/migrated/Guidelines-HOSP1.pdf
Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention of falls in the elderly—a review. Osteoporosis International, 24(3), 747-762. https://doi.org/10.1007/s00198-012-2256-7
Infinger, A., Dowbiggin, P., Seymour, R., Wally, M., Karunakar, M., Caprio, A., Patt, J., & Studnek, J. R. (2020). Development of a content valid and reliable prehospital environmental falls risk assessment tool for older adults. Prehospital Emergency Care, 24(3), 349-354. https://doi.org/10.1080/10903127.2019.1634777
Halter, M., Vernon, S., Snooks, H., Porter, A., Close, J., Moore, F., & Porsz, S. (2011). Complexity of the decision-making process of ambulance staff for assessment and referral of older people who have fallen: A qualitative study. Emergency Medicine Journal : EMJ, 28(1), 44-50. https://doi.org/10.1136/emj.2009.079566
St John WA (2021). Policy: Clinical Incident Management. https://stjohnwa.sharepoint.com/sites/connect-clinical-governance/SiteAssets/SitePages/connect-clinical-governance/2021-Clinical-Incident-Management-Policy.pdf
Falkson, S. (2021). Grasp reflex. https://www.statpearls.com/ArticleLibrary/viewarticle/22413
Brown, S. N., Kumar, D. S., James, C., & Mark, J. (Eds.). (2019). JRCALC clinical guidelines 2019. Class Professional.
Queensland Ambulance Service (2021). The older patient. https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_The%20older%20patient.pdf
Watanabe D, Matsunobe I, Okuma Y, et al. (2019). Releasing forced grasp reflex by use of concomitant imitation behaviour during rehabilitation of a stroke patient. BMJ Case Reports CP 2019;12:e228304.
Health Education England (2021). Make every contact count. http://www.makingeverycontactcount.com/
Department of Health WA (2014). Falls Prevention Model of Care. https://ww2.health.wa.gov.au/~/media/Files/Corporate/general-documents/falls/PDF/Falls_Model_of_Care.pdf
Queensland Ambulance Service (2021). Falls Risk Assessment Tool. https://www.ambulance.qld.gov.au/docs/clinical/cpp/CPP_FRAT.pdf
Department of Health Victoria (2009). Falls Risk Assessment Tool.