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Missed Opportunity for Fall PreventionA Teachable Moment

Educational Objective: To encourage clinicians to use a simple framework to stratify fall risk, determine if multifactorial interventions are appropriate, and recommend physical therapy, community-based programs, or home-based exercise programs.
1 Credit CME

A 76-year-old community-dwelling woman with a history of chronic obstructive pulmonary disease presented to the emergency department with hip pain after a fall. The results of imaging showed a displaced fracture of the left inferior pubic ramus. She was admitted for surgical treatment of the fracture.

When interviewed, the patient reported recurrent falls during several years. A recent hospital discharge summary included falls on her problem list, but no fall risk assessment had been performed and no interventions had been recommended. She reported being under the care of a primary care physician but denied being asked about falls.

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Article Information

Corresponding Author: Byron Crowe, MD, Internal Medicine Residency Program, Department of Medicine, University of Colorado School of Medicine, CU Anschutz Medical Campus, Academic Office One, 12631 E 17th Ave, #8601, Aurora, CO 80045 (byrondcrowe@gmail.com).

Published Online: March 22, 2021. doi:10.1001/jamainternmed.2021.0221

Conflict of Interest Disclosures: Dr Crowe reported equity in Solera Health outside the submitted work. Dr Eckstrom reported funding from the Centers for Disease Control and Prevention for fall prevention (16IPA1605223) outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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Moreland  B , Kakara  R , Henry  A .  Trends in nonfatal falls and fall-related injuries among adults aged ≥65 years—United States, 2012-2018.   MMWR Morb Mortal Wkly Rep. 2020;69(27):875-881. doi:10.15585/mmwr.mm6927a5 PubMedGoogle ScholarCrossref
2.
Burns  ER , Haddad  YK , Parker  EM .  Primary care providers’ discussion of fall prevention approaches with their older adult patients—DocStyles, 2014.   Prev Med Rep. 2018;9:149-152. doi:10.1016/j.pmedr.2018.01.016 PubMedGoogle ScholarCrossref
3.
Grossman  DC , Curry  SJ , Owens  DK ,  et al; US Preventive Services Task Force.  Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(16):1696-1704. doi:10.1001/jama.2018.3097 PubMedGoogle ScholarCrossref
4.
Ganz  DA , Latham  NK .  Prevention of falls in community-dwelling older adults.   N Engl J Med. 2020;382(8):734-743. doi:10.1056/NEJMcp1903252 PubMedGoogle ScholarCrossref
5.
Stevens  JA , Burns  ER .  A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. 3rd ed. CDC, NCIPC; 2015.
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