langcare-fall-risk

Fall Risk Assessment

When to Use This Skill

Use when a clinician needs to evaluate fall risk for hospitalized or ambulatory patients using validated scoring tools and medication review.

Clinical Workflow

1. Use fhir_read to retrieve Patient demographics (age -- risk increases >65)
2. Use fhir_search to pull Condition resources: fall history, gait/mobility disorders, cognitive impairment, orthostatic hypotension, visual impairment, neuropathy
3. Use fhir_search to pull active MedicationRequest resources; flag fall-risk medications (see references/morse-fall-scale.md): benzodiazepines, opioids, antihypertensives, antipsychotics, antidepressants, sedative-hypnotics, anticonvulsants, anticholinergics
4. Use fhir_search to pull Observation resources: recent vital signs (orthostatic BP), mobility assessments, cognitive screening scores
5. Apply Morse Fall Scale scoring from available data
6. Present risk stratification with specific medication and non-pharmacologic intervention recommendations

FHIR Resources

• Patient -- Age
• Condition -- Fall history, gait disorders, cognitive impairment, visual impairment, neuropathy
• MedicationRequest -- Fall-risk medications
• Observation -- Orthostatic vitals, mobility assessments, cognitive scores, visual acuity

FHIR Query Examples

Pull Fall-Related Conditions

fhir_search(resourceType="Condition", queryParams="patient=[patient-id]&clinical-status=active")

Pull Active Medications

fhir_search(resourceType="MedicationRequest", queryParams="patient=[patient-id]&status=active&_count=100")

Clinical Guidelines

• CDC STEADI (Stopping Elderly Accidents, Deaths & Injuries) Initiative
• Morse Fall Scale for hospitalized patients
• AGS/BGS Clinical Practice Guideline for Fall Prevention (2010, updated)
• NICE CG161 Falls in Older People

Interpretation Guide

• Morse Fall Scale: 0-24 low risk (standard precautions), 25-50 moderate risk (implement fall prevention protocol), >50 high risk (high-risk interventions)
• Count fall-risk medications: >=4 fall-risk medications is an independent risk factor
• Orthostatic hypotension: SBP drop >=20 mmHg or DBP drop >=10 mmHg on standing; correlate with symptoms
• For each high-risk medication, recommend: taper if possible, reduce dose, schedule review, or provide specific rationale for continuing