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AN ORGAN SYSTEMS-BASED APPROACH TO FALLS ASSESSMENT

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

UR Medicine

Geriatrics Group

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ADMINISTRATIVE INFORMATION

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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.

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AI DISCLOSURE

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

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LEARNING OBJECTIVES

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

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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. 

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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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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

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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

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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.

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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.

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THE CLASSIC APPROACH

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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

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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)

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THE SYSTEMATIC APPROACH

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STRUCTURAL/FUNCTIONAL SYSTEMS

Cardiovascular

Digestive

Endocrine

Integumentary

Lymphatic/Immune

Muscular

Nervous

Reproductive

Respiratory

Skeletal

Urinary

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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

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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

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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

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  • Recent surgery/procedure requiring anesthesia or sedation
  • Frailty
  • Medication side effects
  • Medication interactions
  • Pain
  • Environmental factors

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MANAGEMENT & PREVENTION

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FALL PREVENTION-AN INTERDISCIPLINARY PROCESS

Mobility Assessment: Gait, strength, and balance evaluation.

Medication Review: Identifying meds that increase fall risk (e.g., Beers Criteria).

Environmental Assessment: Evaluating for hazards.

Orthostatic Blood Pressure: Ensure that it is done correctly, no shortcuts.

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MOBILITY ASSESSMENTS

Timed Up and Go (TUG): measures mobility and balance.

Berg Balance Scale: 14-item scale that assesses static and dynamic balance

20-second Chair Stand Test: measures lower limb strength and endurance

4-Stage Balance Test: assesses static balance, including single-leg standing

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ENVIRONMENTAL HAZARDS

Flooring/walking surfaces

Lighting

Clutter

Furniture

Bathroom (grab bars, toilet height)

Stairs

Pets

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FALL MANAGEMENT

Head-to-toe assessment for injury

Vital signs

Environmental assessment

Organ-system-based assessment of possible causes

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TARGETED TOOLS

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CONCLUSIONS

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TAKE HOME POINTS

Falls are a significant concern in healthcare, from an injury perspective and from a financial perspective

Traditional methods of assessment leave significant gaps

We can do better-be systematic!

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RESOURCES

Fall Prevention

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Fall Assessment

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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, PA-C, NRP, CP-C

melodie@amedicaltypeperson.com

www.amedicaltypeperson.com

Melodie-Kolmetz