Fall Risk Assessment Tool (FRAT): Prevention of Fall Among Older People

This article discusses the Fall Risk Assessment Tool (FRAT) and its role in preventing falls among older people. It explains the risk factors for falls and the importance of regular assessments. The article also highlights the impact of falls on individuals and the healthcare system. It provides strategies for managing and reducing fall risks, including environmental modifications, exercise programs, and medication reviews. The article emphasizes the need for a multifactorial approach to fall prevention and mentions organizations involved in promoting safety and conducting research in this area.

FALL RISK ASSESSMENT TOOL (FRAT): PREVENTION OF FALL AMONG OLDER PEOPLE 1
Fall Risk Assessment Tool (FRAT): Prevention of fall among Older People
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FALL RISK ASSESSMENT TOOL (FRAT): PREVENTION OF FALL AMONG OLDER PEOPLE 2
Fall Risk Assessment Tool: Prevention of fall among the Older People
Risk assessment involves improving the quality and safety of healthcare by identifying
factors that put clients at risk and management and control of such risks. The prevailing hazards
and risks need to be identified and efforts channeled towards their elimination. The healthcare
setting may pose a risk to the clients in the process of healthcare service provision. Risk
assessment is a necessity to the client during admission and on regular intervals preferably at
weekly intervals.
A fall is preceded by an event that causes one to rest inadvertently on a surface. There are
a number of factors which increase the risk of falling among the older people. The fall risk
factors among the older people have been classified into two main categories: extrinsic and
intrinsic fall risks. Intrinsic risks include: impaired mobility and gait, impaired cognition,
nutritional deficiencies, foot problems and visual impairments. On the other hand, extrinsic
factors include: environmental hazards, inappropriate walking aids and the choice of footwear or
clothing. Generally, in order to advice an older person on the necessary precautions to mitigate
the fall risks, a Fall Risk Assessment Tool (FRAT) is used to assess the extent of the fall risk.
Most falls are not fatal, however, few cases of fall lead to death. Human fall is the second
leading cause of accidental injury globally. Annually, 646,000 people die in the world due to
falls. 80% of the deaths occur in underdeveloped and developing countries and 37.3 million fall
cases require medical intervention due to severity. The most affected age bracket is adults aged
65 years and above. However, children and athletes are also more susceptible to fall. Human fall
has recently become a concern in public healthcare. The concern has been triggered by the
impact that fall has on the victims. Victims of fall may suffer a disability, especially older adults,
fall associated injuries such as bone fractures incur substantial medical costs and some victims

FALL RISK ASSESSMENT TOOL (FRAT): PREVENTION OF FALL AMONG OLDER PEOPLE 3
end up being institutionalized for care. Fall is associated with increased dependency with
disability, (Tofthagen, Visovsky, and Berry, 2012) infections, hypothermia, pressure related
injury and psychological problems of depression, mental trauma and isolation.
It is important to carry out a risk assessment of fall in a client, in order to identify the
causes of fall in a person. The assessment tool used should be the Fall Risk Assessment Tool
(FRAT) because of it has proved to be effective when it comes to assessing fall risk factors. The
initial assessment should be accompanied by successive assessments because a client’s health
and prevailing circumstances are dynamic. Assessment is a safety initiative for the prevention of
fall (Covello, and Merkhoher, 2013). Reassessments help in managing the prevailing risks of
fall. The safety initiative against the risk of fall helps in cutting low on the cost of fall to the
United Kingdom National Health Service which is estimated to be more than £2.3 billion per
year. In the United Kingdom, the major cause of emergency admissions is an accidental fall. For
instance, In England, the ninth cause of disability-adjusted life years (DALYs) is a human fall.
The unresolved hazards of fall in the elderly homes in England in particular, cause the National
Health Service £435 million. Such victims are left with both physical and psychological effects
ranging from fear of fall, fractures, movement restrictions, trauma and isolation.
The risk factors of fall increase the chances of fall in a person. The more the risk factors
the more prone a person becomes to falling. However, as one advance in age, the number of risk
factors increases hence an increase of the risk of fall (McMahon, Talley, and Wyman, 2011,
p.292). The risk factor can majorly be grouped into the external factors referred to as the
extrinsic factors (environmental factors) and the internal factors called intrinsic factors. The
environmental factors feature hazards that pose a threat to an individual such as unleveled
surface, failure to install handrails in public and residential places. The personal factors feature

FALL RISK ASSESSMENT TOOL (FRAT): PREVENTION OF FALL AMONG OLDER PEOPLE 4
an individual’s personal attributes such as age, gender, fear of falling, health condition, impaired
gait, and balance impairment, limited physical capabilities in performing activities of daily
living, visual impairment and muscle weakness. Polypharmacy is a risk factor that is most
common to the elderly (Kojima, et al, 2012, p.428). Polypharmacy is the phenomenon of
concurrent use of multiple medications such as five or more medication at the same time such as
antidepressants and antipsychotics. The rationale is that the elderly are more prone to suffer
diverse medical complication at the same time due to low body immunity.
Fall is associated with multifactorial etiology and therefore multifactorial intervention
strategies should be devised to deal with the phenomenon. The multifactorial approach can only
be used where the risk factors have been identified and modified. Identification and modification
of the risk factors that pose a threat to a group of individuals help reduce the rate of fall. The
intervention strategies are effective to increase the independence of the clients, boost the
functionality of the body muscles and curb the associated complication costs. However, not all
the factors are modifiable; for instance, the age of a person cannot be modified rather
environmental factors can easily be improved.
Balance impairment as a risk factor is caused by wasting muscles, low muscle mass and
imbalanced weight distribution. Impaired vision causes distortion or even loss of central vision
and poses risk to the person since one lacks accurate judgment of distance, direction and minute
details. Polypharmacy results to multiple dangerous drug reaction which in some cases causes
hallucinations and loss of accurate judgment.
The strategies involved for management of the risk factors include a thoroughly
conducted education awareness program, exercise schedules, review of medication, nutritional

FALL RISK ASSESSMENT TOOL (FRAT): PREVENTION OF FALL AMONG OLDER PEOPLE 5
improvements and environmental changes in elderly homes, clinic centers and institutions
(Mahoney, 2010, p.1118). The strategic interventions should be geared towards extrinsic factors
such as environmental hazards that pose a threat to the people in the United Kingdom as well as
intrinsic features of strength, poor drug use, mobility factors and visual impairments. The
government should make the multifactorial approach against risk factors of fall the Centre of
focus. This would greatly reduce the mortality rate and morbidity rate in the United Kingdom.
The National Service Framework (NSF) covers falls and targets a majority of the people who are
more at risk of fall. They target to reduce the injury of falls by improving treatment procedures
and rehabilitation of the older people at risk of fall. According to the National Service
Framework, their intervention strategies are targeted on: prevention and treatment, improvement
of care, rehabilitation, advisory services and long term support system.
The action plan to be implemented to reduce the risk factors of fall would target different
groups of people based on their exposure to the risk due to their environmental setting.
Clinic centers
For the hospital inpatients, a group of measures could be undertaken to regulate the risk
and minimize the impact of fall. Physical restraints and bedsides are not effective for the
prevention of fall; however, they increase the impact of injury in case the patient falls. Therefore,
other strategies are to be used in controlling and minimizing the risk of fall. Hospitals should
adopt the use of lower beds, the use of thick floor mats, and the safe transfer of patients from one
ward to another to minimize the risk of fall. The patient exercise training should be conducted
and approached cautiously with the utmost care due to the vulnerability of the inpatients.
Identification bracelets have been used for inpatients which are useful for other safety measures

FALL RISK ASSESSMENT TOOL (FRAT): PREVENTION OF FALL AMONG OLDER PEOPLE 6
but don’t reduce the risk of fall. Bed alarms are more productive in minimization of the risk and
impact of fall. A key area of consideration is the risk assessment in discharge and referral
procedures. A careful discharge plan would help in minimizing fall-related injuries and medical
costs. The registered nurse has an obligation to facilitate effective and efficient transfer to the
appropriate care in the referral institution, home care or residential care facility. The rationale is
that the inpatient faces multiple risk factors such as nutrition imbalance, gait imbalance,
cognitive impairment and visual impairment. The solution has been geared towards the
modification of the inpatient environment. The implementation of the recommended actions
would reduce the impact of the risk factors.
Rehabilitation centers and efforts
The residential care dwellers in need of long term care require appropriate strategic
interventions against fall. A multifactorial intervention scheme is needed to reduce the risk factor
of cognitive impairment, especially for dementia patients. Hip protectors should be used as
protective gear to reduce bone fractures. Vitamin D and food supplements would help in strong
bone formation. An effective training program should be offered for both the staff and dwellers.
Staff education is meant to improve their supervisory capabilities while for the dwellers, the
objective is to improve their use of support tools and gait modification. Environmental
improvements should be done by ensuring levelled ground surfaces and instilling handrails with
little obstruction to movement. In an effort to minimize the risk of fall, a medication review
(Söderberg, Laflamme, and Möller, 2013, p.157) should be conducted to stop cases of
Polypharmacy.
Environmental modification (Community and Home)

FALL RISK ASSESSMENT TOOL (FRAT): PREVENTION OF FALL AMONG OLDER PEOPLE 7
In a home setting especially with older people, young children, and people living with
disabilities should be assessed for hazard control. Any threat posing feature in the home should
be eliminated. A training program should be tailored towards them to improve in the survival
techniques. The use of the supportive device can be helpful for mobility. However, a
multifaceted approach is more efficient to minimize the risk of fall as opposed to the utilization
of a single technique. A community-wide health promotion program would improve the quality
of life and reduce the impact of some of the risk factors such as environmental hazards.
Assessment of environmental hazards can be done in means of record keeping of accidental falls
when and where they occur in order to track the pattern and cause.
Physical exercise
Physical Exercise is the most credited prevention strategy against the risk of fall.
Enrolling parties prone to the risk of fall reduces the risk of fall by 12% and the fall rate by a
margin of 19%. The rationale behind physical exercise builds on muscle strength, mass, power
and flexibility, postural balance and gait balance. The diverse features of physical exercise need
to be professionally coordinated, such as type, the level, the duration of time and the intensity.
Healthy physical exercise is associated with the positive functioning of the mind and heart. The
exercise schedule has to be tailored to individual needs and offer a high challenge. Gait training
in the community can be group based and incorporate a home modelled exercise curriculum
(Cadore, et al, 2013, p.109). Research has revealed that it is never too late to benefit from
physical exercise. The older people should be encouraged to engage in physical activity. This is
because physical exercise is not gender-bound.
European Review of Injury Surveillance and Control (EURORISC

FALL RISK ASSESSMENT TOOL (FRAT): PREVENTION OF FALL AMONG OLDER PEOPLE 8
European Review of Injury Surveillance and Control (EURORISC) would be involved in
the collection and distribution of of injury-related information. This would help in resource
allocation in the fight against fall. Proper gathering of data permits comparisons of information,
drawing contemporary trends for the collected data and ease accessibility of relevant
information. EURORISC Engages in new strategy formulation in the prevention of fall, good
practice in injury surveillance and control (Kirkwood, Parekh, and Pollock, 2010, p.232). It also
engages in thorough research work and the formulation of recommendations for
implementations.
European Home and Leisure Accident Surveillance System (EHLASS)
This is a body that aims at promoting safety at home and adventurous leisure sites. Their
aim is to prevent accidents. This is attained through the promotion of the safety of household
commodities, promoting consumer education on both local and at the national level. Such data
on accident prevalence from the household surveys may help in the environmental modification
for minimization of the risk of fall (Jan Meerding, et al, 2010, p.18).
Prevention of falls network Europe (Profane)
It is involved in assessing and managing clinics, grouping trials, assessing the
functionality of balance and the study of the relationship between fall and psychology. Profane is
aiming at ensuring appropriate methodology in the assessment and handling of people at risk of
fall. (Coote, Sosnoff, and Gunn, 2014, p.182).There is an increasing effort by profane to create
assessment tools and good practice in assessing the balance function and the psychological
consequences of fall. Profane will help reduce the fear of fall among people at higher risk of
falling and boost compliance with strategic multifactorial prevention interventions.

FALL RISK ASSESSMENT TOOL (FRAT): PREVENTION OF FALL AMONG OLDER PEOPLE 9
In summary, the risk to fall and its consequences have a negative impact on the wellbeing
of the population. The government in collaboration with corporate bodies has channeled
resources and strategies to minimize the risk and prevention of fall. More research is being
recommended in the impact of risk of fall on psychology and mental health.
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