Guideline Development Group

Action statement 12: SCREEN FOR FALL RISK.

Physical therapists should screen for fall risk whenever a patient is taking an anticoagulant medication. (Evidence Quality: III; Recommendation Strength: Weak)

Action Statement Profile

Aggregate Evidence Quality: Level III
Benefits: Decreased risk of hemorrhage due to falls
Risk, Harm, Cost: Immobility versus risk of falling
Benefit-Harm Assessment: Preponderance of benefit over harm
Value Judgments: Fall prevention is a prudent step in managing patients who are at increased risk for bleeding

Role of Patient Preference: None
Exclusions: None

Summary of Evidence

A major bleed event is a common complication in patients taking an anticoagulant medication. Use of oral anticoagulants increases the risk of intracerebral bleeds by 7-10 times.⁹⁹ Individuals who fall while on long term anticoagulation have higher rates of mortality than those not on these medications due to a subsequent major bleed..^{100, 101} However, the benefits of being on an anticoagulant outweigh the risk of a major bleed.^{102, 103} Because of this, patients at high risk for falls are not automatically excluded from receiving anticoagulants and will receive these medications when it is considered medically beneficial.

Age is considered a major risk factor for falls. Those 75 years and older have the highest rate of falls and one in three individuals over the age of 65 fall each year.^{104, 105} Because of the risk of falls associated with age, the National Institute for Health and Care Excellence, the American Geriatric Society, and the US Preventive Services Task Force all recommend screening for fall risk in all older adults.^106-108 Individuals should be asked about feelings of unsteadiness and falls over the last year. If there has been a fall or unsteadiness reported, further assessment of strength, balance, and other risk factors should be completed. In general, the population of individuals on anticoagulants is made up of older adults who would benefit from fall risk screening. ^{4, 109} The Center for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit provides physical therapists and inter-professional team members with an evidence based tool to improve fall prevention in clinical practice.