Original Publication
Open Access

Falls in the Elderly: A Multidisciplinary Approach to Screening and Evaluation of Falls in Resident Primary Care Clinics

Published: December 22, 2015 | 10.15766/mep_2374-8265.10316

Included in this publication:

  • Falls Instructor's Guide.doc
  • Evaluation Form.pdf
  • Falls Ambulatory Lecture with Speakers Notes for Teaching Script.ppt
  • Falls Peer Assessment.doc
  • Falls Pre-work Interactive Case.pdf
  • Gait Assesment.m4v
  • Interactive Cases.doc
  • PT Exercises.m4v
  • PT Exercises.pdf
  • PT Initial Assistive Device Selection.m4v
  • Quad Cane Indications.m4v
  • Resident Survey.pdf
  • Standard Cane.m4v
  • Walker Indications.m4v

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

Introduction: Internal medicine residents working in their primary care clinics have an increasing number of geriatric patients for whom they are providing care. Unfortunately, many residents do not have a geriatric medicine rotation, or what they do have is either so brief or comes so late in training (as in our program) that there is not a positive impact on the patients they care for. Lack of confidence in screening their geriatric patients for falls as well as limited education can lead to many missed opportunities to help prevent falls. Methods: This workshop is highly interactive and designed to take 1.5 hours, although it can be modified to fit in an hour. It is intended to be delivered in a small-group setting to approximately 10-15 learners. Results: We assessed resident attitudes and confidence on addressing the topic of falls with their patients with a premodule survey. Questions were rated using a 5-point Likert scale. Residents rated how confident they felt in their ability to identify an older patient at risk for falls (3.43), in performing a fall screening on their patients (3.05), in performing a comprehensive falls history (3.28), in performing a comprehensive falls physical exam (2.80), and in prescribing evidence-based interventions to patients with falls (2.58), as well as if they believed falls were an important problem in the elderly population (4.58). Discussion: This was the first year incorporating this module into the ambulatory block and the responses were overwhelmingly positive. In terms of future directions we plan to distribute this to residents and students in other disciplines (family medicine, nursing, physical therapy). Data will be collected throughout this year and future years to determine whether or not the residents’ self-efficacy increased and was sustainable after their ambulatory module.


Educational Objectives

By the end of this module, learners will be able to:

  1. Describe which primary care patients need to be screened for falls.
  2. Demonstrate the components in a comprehensive falls history.
  3. Demonstrate how to do the timed up and go test and the four-stage balance test.
  4. List three evidence-based interventions for falls.
  5. Demonstrate three basic exercises that would be recommended by physical therapy for their patients.
  6. Prescribe the appropriate assistive device for their patients.

Author Information

  • Jennifer Lom, MD: Emory University School of Medicine
  • Jonathan Flacker, MD: Emory University School of Medicine
  • Rachael Walton-Mouw, PT, DPT: Grady Memorial Hospital

Disclosures
None to report.

Funding/Support
The John Hartford Foundation has supported the development of this material.


References

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  7. Rolita L, Ark TK, Moroz A, Lanyi V, Southwell J, Sutin D. Evaluation of an elderly faller by medical students and rehabilitation residents. J Am Geriatr Soc. 2009;57(4):709-713. http://dx.doi.org/10.1111/j.1532-5415.2009.02187.x
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Citation

Lom J, Flacker J, Walton-Mouw R. Falls in the elderly: a multidisciplinary approach to screening and evaluation of falls in resident primary care clinics. MedEdPORTAL. 2015;11:10316. https://doi.org/10.15766/mep_2374-8265.10316