AN ORGAN SYSTEMS-BASED APPROACH TO FALLS ASSESSMENT

Melodie J. Kolmetz, EdD, MPAS, PA-C, DFAAPA

University of Rochester Medical Center

Geriatrics Group

ADMINISTRATIVE INFORMATION

DISCLOSURE

• I have no relevant relationships with ineligible companies within the past 24 months to disclose.

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UNLABELED/INVESTIGATIONAL USE

• This presentation does not include any information about unlabeled or investigational use of medications or devices.

AI DISCLOSURE

• AI was used only to assist with slide layout for this presentation, and I have confirmed and validated this information.

LEARNING OUTCOMES

At the conclusion of this session, participants will be able to:

1. Identify key intrinsic and extrinsic factors contributing to falls in adult and geriatric populations.
2. Conduct a systems-based clinical assessment to evaluate the causes of falls.
3. Differentiate between benign and serious causes of falls using history, physical exam, and targeted diagnostics.
4. Develop an evidence-based management plan to reduce fall risk and address underlying medical conditions.
5. Select evidence-based, patient-centered fall risk reduction techniques.

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BACKGROUND INFORMATION

BACKGROUND INFORMATION

• Patient falls are the most common preventable adverse event within hospitals.
• Approximately 700,000 to 1 million patients fall in hospitals in the United States each year.
• Patient death or serious injury from a fall is considered a never event.
• Despite substantial research to identify fall risk factors and develop evidence-based prevention strategies, preventing patient falls remains an ongoing challenge.
• The Joint Commission’s National Patient Safety Goal (NPSG) 09.02.01 focuses on reducing patient fall-related injuries by requiring organizations to assess fall risks, implement tailored interventions, and monitor effectiveness. 

OUTPATIENT SETTINGS

• Approximately 30%–40% of community-dwelling adults over age 65 fall annually, with roughly half resulting in injuries.
• CDC data shows that more than one in four older adults falls annually, leading to 3 million emergency room visits
• Nearly 50% of lift-assist patients require EMS to return within 30 days.
• Another study found that 32.8% of patients refusing transport after a fall had a repeat EMS call within one month

INPATIENT SETTINGS

• Patient falls are categorized as the most common preventable adverse event in healthcare settings
• Approximately 700,000 to 1 million patients fall in U.S. hospitals annually, with roughly one-third of these incidents resulting in injury.
• Approximately 30% to 50% of inpatient falls result in injuries
• Falls were associated with an average increased cost of $36,000

SUB-ACUTE/LONG-TERM CARE

• The prevalence of falls during the past 90 days was 26.4%. 
• Among those who had fallen, 36.4% had fall‐related injuries.
• Overall fall rate was identified as 8.48 falls per 1000 occupied bed days.
• The overall injury rate was 37.2 injuries per 100 falls.

EMS ENCOUNTERS

• Falls account for nearly 2% of emergency medical services (EMS) calls, but rise to 11.5% in adults >60.
• Fall-related EMS calls increased by 268% from 2007 to 2017.
• Fall-victim refusal rates range from 11–56%.
• 49% of fall victims had an unplanned healthcare encounter within 28 days.
• Lift assists, or assistance after a fall without intent for EMS transport, may represent a sentinel event for patient care. 
• Within 14 days of a lift-assist call, approximately 21% of patients visit the Emergency Department (ED), 11.6% are admitted to the hospital, and 1.1% die. 

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HEALTHCARE DISPARITIES

• Sex and race are associated with differences in clinical in-hospital outcomes and expenditures in older adult fall hospitalizations.
• This suggests potential variations in treatment, recovery, and access to care.
• Further research is needed to better understand these disparities and inform strategies for more equitable care.

THE CLASSIC APPROACH

INTRINSIC RISK FACTORS

• Age
• Gender
• Previous falls
• Muscle weakness
• Gait & balance problems
• Sensory deficits
• Postural hypotension
• Chronic conditions (including arthritis, stroke, incontinence, diabetes, Parkinson’s, dementia)
• Acute conditions (such as delirium)
• Fear of falling

EXTRINSIC RISK FACTORS

• Lack of assistive devices (stair handrails, bathroom grab bars)
• Improper use of assistive device
• Poor stair design
• Dim lighting or glare
• Obstacles & tripping hazards
• Slippery or uneven surfaces
• Medications (including side effects and interactions)

THE SYSTEMATIC APPROACH

STRUCTURAL/FUNCTIONAL SYSTEMS

CARDIOVASCULAR

• Essential hypertension 
• Hypotension
• Coronary artery disease
• Heart failure
• Cardiac dysrhythmias
• Deep vein thrombosis 
• Pulmonary embolism
• Peripheral vascular disease
• Valve disorders 

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ENDOCRINE

• Diabetes Mellitus
• Obesity
• Thyroid disorders
• Hyperparathyroidism
• Cushing’s syndrome
• Addison’s disease

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GASTROINTESTINAL

• Gastroesophageal reflux disease 
• Gastritis/Duodenitis
• Biliary tract disease
• Acute pancreatitis
• Irritable bowel syndrome 
• Constipation
• Diarrhea/Gastroenteritis
• Hemorrhoids
• Peptic ulcer disease
• Hernias 
• Intestinal obstruction
• Esophagitis

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INTEGUMENTARY

• Contact dermatitis
• Moisture-associated dermatitis
• Benign neoplasms of the skin
• Atopic dermatitis
• Xerosis
• Psoriasis
• Cellulitis
• Tinea infections 
• Urticaria 
• Herpes zoster
• Pressure injuries 
• Corns/Calluses
• Diabetic foot wounds
• Nail problems

LYMPHATIC/IMMUNE

• Malnutrition
• Sepsis
• Lymphedema
• Sjogren’s syndrome
• Scleroderma
• Vasculitis
• Rheumatoid arthritis
• Sicca syndrome
• Polymyalgia rheumatica
• Giant cell arteritis

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HEMATOLOGIC

• Vitamin deficiencies (B12, folate, etc.)
• Iron deficiency anemia
• Anemia of chronic disease
• Liquid malignancies

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MUSCULAR

• Back pain
• Bursitis
• Fibromyalgia
• Sarcopenia
• Tendonitis
• Weakness
• Plantar fasciitis

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NERVOUS

• Dementia (Alzheimer’s disease/Vascular/Others)
• Seizure disorder
• Parkinson’s disease
• Multiple sclerosis
• Peripheral neuropathy
• Transient ischemic attack (TIA)
• Cerebrovascular Accident (CVA)
• Hydrocephalus
• Hearing impairment
• Visual disorders

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REPRODUCTIVE

• Vulvovaginal candidiasis 
• Atrophic vaginitis
• Uterine prolapse
• Cystocele
• Rectocele
• Pessary use

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RESPIRATORY

• Acute respiratory infections 
• Pneumonia
• Chronic obstructive pulmonary disease 
• Asthma
• Respiratory failure/insufficiency
• Obstructive sleep apnea
• Pleural effusion
• Pulmonary hypertension
• Bronchiectasis
• Interstitial lung disease

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SKELETAL

• Foot deformities (bunions, hammertoes, etc.)
• Osteoarthritis
• Spondylopathies/Spondyloarthropathy
• Rheumatoid arthritis
• Gout
• Osteoporosis
• Herniated disc
• Fractures
• Muscular dystrophy

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RENAL/URINARY

• Electrolyte and mineral imbalances
• Vitamin D deficiency
• Urinary tract infections (UTI)
• Acute or Chronic kidney disease
• Benign prostatic hyperplasia (BPH)
• Nephrolithiasis
• Prostatitis
• Incontinence
• Hydronephrosis

BEHAVIORAL HEALTH

• Anxiety disorders
• Major depressive disorder
• Substance abuse/Dependence
• Post-traumatic stress disorder 
• Obsessive-compulsive disorder (OCD)
• Personality disorders
• Insomnia/Sleep disorders
• Adjustment disorders
• Panic disorder
• Phobias

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ACROSS ALL SYSTEMS

• Medication side effects
• Medication interactions
• Pain
• Environmental factors

MANAGEMENT & PREVENTION

FALL PREVENTION-AN INTERDISCIPLINARY PROCESS

MOBILITY ASSESSMENTS

ENVIRONMENTAL HAZARDS

FALL MANAGEMENT

TARGETED TOOLS

• STEADI (Stopping Elderly Accidents, Deaths, and Injuries): A comprehensive CDC algorithm that includes standardized tests (TUG, 4-Stage Balance, 30-Second Chair Stand) and clinical assessments of medications and vision.
• Hendrich II Fall Risk Model: Quick assessment for acute care settings, focusing on confusion, symptomatic depression, and altered elimination.
• FES-I (Falls Efficacy Scale—International): Assesses the fear of falling.
• Humpty Dumpty Scale: Specific to pediatric fall risk assessment.

CONCLUSIONS

TAKE HOME POINTS

RESOURCES

Fall Prevention

• https://www.nia.nih.gov/health/falls-and-falls-prevention/preventing-falls-home-room-room

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Fall Assessment

• https://www.cdc.gov/steadi/hcp/clinical-resources/index.html

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ADDITIONAL RESOURCES

https://padlet.com/melodie21/Organ_System_Approach_to_Falls

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REFERENCES

• Barr J, Selman K, Hunter K, Kuc A. Refusal of Emergency Medical Transport After a Fall: Patient Characteristics and Outcomes of Repeat Callers. West J Emerg Med. 2025;26(5):1291-1295. Published 2025 Aug 20. doi:10.5811/westjem.33524
• Gibbons MJ, Mallick S, Coaston T, et al. Sex and racial disparities in clinical outcomes and healthcare costs among hospitalized older adult fall patients: A nationwide analysis. Surg Open Sci. 2025;27:120-125. Published 2025 Aug 8. doi:10.1016/j.sopen.2025.07.003
• Locklear T, Kontos J, Brock CA, et al. Inpatient Falls: Epidemiology, Risk Assessment, and Prevention Measures. A Narrative Review. HCA Healthc J Med. 2024;5(5):517-525. Published 2024 Oct 1. doi:10.36518/2689-0216.1982
• Ongoing journey to prevent patient falls. Patient Safety Network (PSNet), Agency for Healthcare Research and Quality (AHRQ). Accessed April 25, 2026. ahrq.gov
• McGibbon CA, Slayter JT, Yetman L, et al. An analysis of falls and those who fall in a chronic care facility. J Am Med Dir Assoc. 2019;20(2):171-176. doi:10.1016/j.jamda.2018.06.022
• Moore EA, Schoenfeld DW, Fritz CL, et al. Geriatric "lift-assist" EMS calls with transport refusal: characteristics of short-term repeat calls and hospitalizations. Am J Emerg Med. 2025;95:77-82. doi:10.1016/j.ajem.2025.05.041
• Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Med Clin North Am. 2015;99(2):281-293. doi:10.1016/j.mcna.2014.11.004

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THANK YOU!

Melodie J. Kolmetz, EdD, MPAS, PA-C, NRP, CP-C

melodie@amedicaltypeperson.com

www.amedicaltypeperson.com

Melodie-Kolmetz