5 reasons why self-reported fall history isn’t reliable

A fall risk assessment is required as part of the Welcome to Medicare Assessment, and PCPs can be reimbursed for fall risk assessment through Medical Annual Wellness Visits and through MIPS. Many fall risk assessments rely at least in part on self-reports of falls. Relying on self-reported fall history likely causes many at-risk patients to miss out on necessary fall-prevention interventions.

  1. Forgetfulness. When older adults do experience a fall, fewer than half of them go on to discuss the fall with their healthcare provider. Thus, fall risk assessments that rely on self-reports of fall history will fail to identify this majority of patients who don’t report their falls. These patients will then miss out on the chance to get the comprehensive balance and fall risk screening that they need. Why might this be happening?

  2. Resignation. Older adults often believe that falls are a normal and inevitable part of aging. In fact, this is one of the National Council on Aging’s (NCOA) top myths on falling. If someone believes that falling at their age is totally normal, they may not feel the need to discuss it with their doctor.

  3. Hubris. Older adults tend to underestimate their personal risk of falling. They may think that falling will happen to someone else, but not to them. Thus, even if they’ve fallen before, they may underestimate their risk of falling again, and not bring it up to their provider.

  4. Miscategorization. What is considered to be a “fall” can be subjective, and patients may minimize what happened to them by categorizing it as “not a fall.” CMS defines a fall as “a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force.” Some individuals may feel that their falls weren’t serious enough to be called falls if they didn’t get injured, yet they regularly do fall and wind up on the floor.

  5. Misattribution. People tend to view environmental and behavior factors as playing a role in their falls, rather than internal factors related to their own health. For example, people may blame their fall on being distracted and tripping over an object that was in their way. Thus, they may assume that they are not at risk of falling again because it was an external object that “caused” their fall. What people don’t realize is that a situation of distraction or an encounter with a trip hazard is less likely to result in a fall for someone who has good balance, because internal health factors do play an important role in navigating environmental hazards. People with good balance have good control over their body’s movements and are generally able to “catch their balance” when they trip or slip, before they hit the floor.

These five reasons demonstrate that relying on self-reported fall risk history for fall risk assessment is not ideal. Physical tests can provide a more objective way to assess fall risk which can cut through patient denial and help patients get on a better trajectory for reducing their fall risk.

Woman stands on ZIBRIO Stability Pro scale for a fall risk assessment while man in scrubs supervises the test.

Patient is screened for balance and fall risk on ZIBRIO Stability Pro scale

The ZIBRIO Stability Pro Scale can be used to screen patients for fall risk in the clinic. The scale performs a 60-second standing balance test which gives a balance score from 1-10 and the associated fall risk categorization. Patients scoring 1-3 are 3 times more likely to fall in the next 12 months. Receiving this score can help patients get an objective, realistic view of their fall risk level.

BalanceCare Software gives personalized recommendations for fall risk reduction

Giving a patient their balance score is just the beginning, they also need to know what they can do to reduce their fall risk. Healthcare providers can also used ZIBRIO’s BalanceCare software to provide personalized fall prevention counseling for patients.

Individuals tend to select ineffective fall prevention strategies for themselves. Few older adults utilize proven strategies like balance exercises, and instead attempt to “be more careful” in an effort to avoid falling. Unfortunately, there is not evidence that being more careful is an effective strategy to prevent falls. Healthcare providers are well-positioned to give patients more effective, personalized recommendations for reducing their fall risk. To learn more, download our case study to see what a leading clinical practice learned when they adopted ZIBRIO technology for fall-risk assessment:

Want to learn more how ZIBRIO might help your practice? Schedule a 20 minute personal zoom demo and get all your questions answered:

Sources:


https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2020_Measure_154_MIPSCQM.pdf

https://www.ncoa.org/article/debunking-the-myths-of-older-adult-falls

Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Med Clin North Am. 2015 Mar;99(2):281-93. doi: 10.1016/j.mcna.2014.11.004. PMID: 25700584; PMCID: PMC4707663.

Forth et al. 2020. A Postural Assessment Utilizing Machine Learning Prospectively Identifies Older Adults at a High Risk of Falling. Front. Med., 7, 926.

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