This reference correlates to the online continuing education course Managing Falls In the Nursing Home: Who, Why, and What Next?.

Purpose of Fall Risk Assessment

Identify patient/resident problems (rational basis for deciding whether risk exists)
Identify those patients/residents most likely to fall
Trigger further fall-related assessments (multidisciplinary)
Identify interventions (guide patient/resident care planning)
Raise staff awareness of fall/injury risk.

Common Fall Risk Components/Factors

Components	Fall Risk Factors
Diseases/Conditions	History of falls Impaired vision/hearing Urinary problems (toileting needs) Muscle weakness Gait/balance impairment Dizziness Orthostatic hypotension Mobility impairment (impaired bed, chair and/or toilet transfers) Uses cane/walker
Medications	Polypharmacy (>5 medications) Psychotropics Diuretics Antihypertensives Antiseizure Benzodiazepines Hypoglycemics Sedative/hypnotics
Mental Status	Dementia Depression Delirium Impaired 'safety' judgment Disruptive behaviors Non-English speaking Exhibits unsafe behavior Lacks understanding of mobility limitations
Situational Conditions	New admission Floor-to-floor transfer Post fall Change of condition and/or starting fall risk medication

Tideiksaar, R. Falls in Older People: Prevention and Management. 4th Edition. Health Professions Press, Baltimore, MD 2010

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Fall Risk Assessment