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Lifestyle Behaviors

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

JAMA Internal Medicine

Published Online: March 22, 2021

Teachable Moment

Article Information and Disclosures

Byron Crowe, MD¹;

Elizabeth Eckstrom, MD, MPH²;

Juan N. Lessing, MD³

Author Affiliations

¹Internal Medicine Residency Program, Department of Medicine, University of Colorado School of Medicine, Aurora
²Division of General Internal Medicine & Geriatrics, School of Medicine, Oregon Health & Science University, Portland
³Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora

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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

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

Stevens JA , Burns ER . A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. 3rd ed. CDC, NCIPC; 2015.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.