Complexities of fall prevention in clinical settings: a commentary

Falls and associated injury and mortality are of increasing concern among aging Americans. Effective fall risk management is a complicated process requiring involvement by both health care professionals and older adults for three related actions: (a) early screening to detect risk factors; (b) prescription of tailored interventions; and (c) implementation of, adherence to, and compliance with the intervention by the older adult. Early detection of fall risk can prevent future falls; however, uptake of evidence-based screening and assessment protocols in the clinical setting has been limited. A variety of practice guidelines and financial incentives are available to health care professionals to facilitate adoption. Yet, there remains a gap between recommended practices and current clinical activities. This commentary addresses the complexities of fall prevention practices and offers solutions that can facilitate adoption by clinical practices. Toward this end, this commentary will present two models (i.e., a clinical approach and a financial incentive approach) to summarize current clinical recommendations and practice guidelines for fall risk management in clinical settings. The various drivers to encourage adoption of evidence-based fall risk management strategies will be described. In this context, we will discuss how understanding the different system wide practice improvement initiatives and factors that drive action in physician groups, can facilitate adoption and implementation of fall risk management behaviors by clinicians. Additional efforts are needed to explore and assess similar initiatives to adopt and implement fall risk management practices at different entry points into the system (e.g., community settings, patients, caregivers).