Strengthening the Role of Caregivers in Promoting Fall-Risk Screening for Older Adults during the Annual Wellness Visit

Each year nearly one- third of older adults experience a fall, and a fall injury can have devastating long-term impacts on quality of life. Maria Roldos from the University San Francisco de Quito, Rita Noonan from the Centre for Disease Control and Prevention in Atlanta, and Lynn Beattie, Centre for Healthy Aging in Washington, discuss the importance of assessing individual fall-risk factors with a healthcare provider, and highlight specific actions that caregivers can take to mitigate fall risk.Falls are a major threat to the health and independence of older adults. Each year, nearly one-third of older adults, people aged 65 and older, experience a fall,1 although less than half of them talk to a healthcare provider about it.2 The promising news is that falls are largely preventable. They are not an inevitable consequence of ageing, but rather they result from a combination of risk factors usually associated with health, behaviour and environmental conditions.3One of the most effective strategies to prevent falls is a clinical assessment by a healthcare provider to identify an individual's fall-risk factors, followed by individualized treatment and/or referrals.3-5 However, these healthcare-based strategies face great implementation challenges. Many clinicians are more experienced at managing discrete diseases than managing multifactorial conditions such as falling and, as such, providers may base their treatment recommendations on information provided by the patient, who volunteer information about falls.6 In addition, providers may neglect to speak with accompanying caregiver(s) to discuss recommended treatment or discuss strategies to adhere to treatment plans.Supporting caregivers is often a high priority to policy makers. The Patient Protection and Affordable Care Act signed into law by President Barack Obama on March 23, 2010, includes specific measures to involve caregivers in the decision making with healthcare providers, as well as provide preventive health services, such as the annual wellness visit.7 Specifically these provisions are detailed in sections 936 entitled "program to facilitate shared decision making" and section 4103 entitled "Medicare coverage of annual wellness visit providing a personalized prevention plan".7The purpose of the Medicare annual wellness visit is to promote health, identify diseases in the early stages, and provide education, counseling and referral services.8 Through the annual visit, a patient's medical and family history, various biometrics, and cognitive assessments including mental health screenings will be used to develop a fiveto- ten year schedule of screening tests and treatment follow-up plans.8 The visit may include health education or preventive counseling services designed to reduce risk factors that have been identified during the visit. Examples of such education and counseling services include those designed to promote selfmanagement, wellness, and fall prevention strategies.8A caregiver who accompanies an older adult to a wellness visit has the opportunity to discuss falls and fall prevention with the A caregiver who accompanies an older adult to a wellness visit has the opportunity to discuss falls and fall prevention with theSupporting efforts to exercise and increase activity levels* Encourage and support older adults' adherence to physical activity recommendations and prescribed home exercises.* Facilitate building an exercise routine into each day.* Help older adults select proper footwear and clothing for use inside and outside the home.* Encourage and facilitate older adults to join exercise groups that focus on lower-body strength and balance or are designed specifically to address falls.* Encourage and facilitate older adults to enrol in a multi-component fallprevention class, for example Stepping On.* Provide transportation to programmes that are designed specifically for older adults, for example Tai Chi: Moving for Better Balance or Stepping On. …