Primary care physicians perceptions and practices regarding fall prevention in adult's 65 years and over

Falls are the leading cause of injury deaths and the most common cause of disability, premature nursing home admissions, medical costs, and hospitalizations among people 65 years and over. Interventions targeting multiple fall risk factors can reduce fall rates by 30-40%. Yet, national studies show that screening conducted by physicians for older adult falls is short of acceptable standards. Tri-County Health Department (TCHD) in Colorado conducted a study to examine fall prevention practices among primary care physicians in our jurisdiction.

TCHD randomly sampled primary care physicians (n=100) obtained from a statewide healthcare provider database and surveyed them about fall prevention screening practices and perceived barriers to screening. Data were examined using single and multiple logistic regression analysis.

The response rate was 67.6%. Only 8% of responding physicians based their fall prevention practices on clinical guidelines from any recognized organizations. Frequently reported barriers included a lack of time during visits, more pressing issues, and a lack of educational materials. Physicians who did not accept Medicare (OR 0.163 [CI 0.03-0.84]) remained significantly less likely to refer patients for home safety assessments than those who did, on multivariate analysis.

This study reveals certain physicians require targeted interventions to improve fall prevention practices and use of clinical guidelines. Recommendations include providing physicians with trainings, screening guides, educational materials, environmental/home safety checklists, and referral resources.