Qualitative assessment of component-specific, fall-risk screening procedures to create a fall risk screening form

The Day Center, Case Management, and Home Care components of a local senior health agency each have used different screening forms for assessing their clients for fall risk. A common instrument, easily administered by all components as part of their routine practice, would be helpful in systematically identifying elders at risk of falling. Developing a common screening instrument would be useful at other senior health agencies as well.

To gather information on the content and features that are most useful for fall screening, based on the needs of individual geriatric care workers in each component of a local senior health agency.

A semistructured interview was used to gather feedback from geriatric care workers on what was needed for universal fall risk screening.

Two major themes emerged: (1) factors that are relevant in assessing fall risk and (2) factors that affect the utility of the fall risk screening procedure. Under theme 1, there were 6 categories: fall history, physical function, impairments, medications, mental and psychological status, and home environment. Under theme 2, there were 3 categories: methods of gathering information for fall risk assessment, features useful to a fall risk assessment form, and actions taken in response to fall risk assessment. The 6 fall risk categories identified in the interviews were combined with 2 other categories identified in the literature, health status and fear of falling, to produce a universal form for use by different agency components.

Integrating all fall-risk categories into a universal form improves the completeness of the form used in different agency components. However, to increase the utility of fall risk screening, service plans integrated with each screening procedure need to be developed according to specific agency structures. A 3-step procedure is proposed to improve the effectiveness of fall-risk screening: (1) initial screening with an outreach worker using a quick question assessment; (2) follow-up with a more comprehensive fall risk assessment while receiving services from the Day Center, Case Management, or Home Care; and (3) a "what-to-do" action is presented for each item on the basis of each question's response on the comprehensive form.

When designing a fall risk screening procedure, integrating all fall-risk factors into a single comprehensive form may not be the ideal strategy. The environment, the person who gathers the information, and the actions required to respond to information gathered should also be considered. On the basis of the results of this qualitative study, we have presented a 3-step procedure, with supporting forms to address these considerations.