Fall Risk Evaluation and Treatment

Question 1

Common assessment tools

Answer 1

• Functional reach
• Balance outcome measure (BOOMER)
• Morse fall scale
• Time up and go
• MAHC 10 fall risk
• Activity specific balance scale

Question 2

Functional Reach

Answer 2

• In standing measure distance between length of outstretched arm in forward reach while maintaining fixed base of support
• 6” or less high fall risk

Question 3

Functional Reach- Low fall risk

Answer 3

10” or greater

Question 4

Functional Reach- Moderate fall risk

Answer 4

6” to 10”

Question 5

Functional Reach- High risk for falling

Answer 5

6” or less or unwilling to reach

Question 6

Functional Reach- how is score determined?

Answer 6

Assessing difference between start and end position

Question 7

Balance Outcome Measure for Elder Rehabilitation (BOOMER)

Answer 7

Assesses standing balance and fx’al mobility
It is a combination of standardized tools

Question 8

Morse Fall Scale

Answer 8

Assesses patient’s likelihood of falling
Items include:
- History of falling
- Secondary diagnosis
- Ambulatory aid
- Intravenous therapy
- Gait
- Mental status

Question 9

Timed Up and Go

Answer 9

Assesses mobility, if patient takes more than 12 seconds to complete they are at risk for falling

Question 10

Missouri Alliance for Home Care (MAHC)-10

Answer 10

Fall risk assessment
Items:
- 65+
- 3 or more coexisting diagnoses
- prior history of falls
- incontinence
- impaired fx’al mobility
- environmental hazards
- pain affecting function
- cog impairment
Score of 4 OR MORE is at risk for falling

Question 11

Activity Specific Balance Scale

Answer 11

Patient rates confidence on their balance skills while performing activities requiring walking, standing, or reaching