Case Managers: Considerations for Helping Patients Reduce
the Risk of Falls
Overview
Falls can be serious and are among the most common health problems facing seniors today.
Falls can be associated with increased morbidity, rising use of healthcare services, and
substantial costs.1 Consider these data:
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Every year in the United States, 1 in 3 adults aged 65 and older falls2
In 2010, over 2.3 million fall injuries resulted in treatment in emergency departments2
In one study, each fall injury in patients aged 72 and older averaged $19,440 in hospital,
emergency room, nursing home, and home healthcare costs even before including
doctors’ services1
See the program resource “Falling: A Growing Problem That May Be Preventable” for
more details.
Interventions May Help Reduce the Risk of Falls
Falling is not a single disease, so clinicians may not recognize it as a health issue that can be
treated.3
Interdisciplinary, multifaceted intervention programs may have the greatest chance of helping to
reduce falls among community-dwelling older adults.4
 In such programs, public health professionals, social service agencies, and healthcare
providers can work together to build an effective fall prevention program for seniors4
 The interdisciplinary team can apply its collective expertise to help guide program policies,
while also identifying critical services and key educational messages.4 Healthcare providers
should use their clinical judgment to tailor the program to meet individual patient needs
 An advantage of the multifaceted approach is that it can provide multiple sources of referral
to the program, as well as ready opportunities to encourage continued participation by
seniors in the community4
The [health plan name here] QualitySolutions360 Fall Prevention Program is designed to
bring together primary care providers (PCPs), hospital staff, physical/occupational therapists
(PTs/OTs), home care nurses (HCNs), and health plan case managers in a collaborative effort
to help prevent falls in seniors.
The materials associated with this program are not intended to serve as a
comprehensive fall prevention program for quality management or improvement
purposes. They have not been reviewed or validated by any third party for any purpose,
including medical accuracy or quality management or improvement, and do not include
all current best or recommended practices.
Considerations for the Case Manager*
The case manager can play an important role in a treatment plan by contacting patients and
coordinating their care among selected members of the interdisciplinary team. 5
 In collaboration with hospital discharge planners and hospital case managers, the case
manager can identify hospitalized patients who would be candidates for case
management services
 The case manager may coordinate with the interdisciplinary team members to
collaboratively assess, plan, and intervene to meet the individual’s health needs. By using
available case-management resources and communications with the interdisciplinary team
and patients and their families, the case manager can promote quality, cost-effective
outcomes5,6
 The case manager may contact the interdisciplinary team for follow-up activities such as
assessment, rehabilitation, and environmental inspection5
 Based on the findings and recommendations of the interdisciplinary team, the case
manager, in cooperation with the PCP and other healthcare providers, can arrange for
patient-specific services5,6
 For patients identified as candidates for assessment and interventions to reduce the risk of
falls, some of the interdisciplinary team members may include:
– PTs, who can play a role in assessments and interventions intended to improve gait,
balance, and muscle strength.7,8 If the patient is found to be at risk, PTs may make
recommendations to the PCP and case manager for rehabilitative interventions
designed to address these deficiencies
– OTs, who may conduct environmental evaluations of patients’ homes for potential fall
risks.8,9 They can also assist patients and families to ensure that fall prevention
activities recommended by the PCP and case manager are understood and followed7
 The case manager may follow the progress of patients during rehabilitation or hospitalization
until discharged home and under the care of their PCP
 Some fall prevention activities can be initiated by the PCP through a routine patient
examination and may not need to involve the case manager
The risk of falling among our senior population continues to create challenges for patients,
families, caregivers, and the healthcare professional. Interdisciplinary, multifaceted intervention
programs aimed directly at community-dwelling seniors may help in reducing falls among
older adults.4
*Not an all-inclusive list. Healthcare professionals should use their clinical judgment in determining the best
approach for managing patients.
References
1. Costs of falls among older adults. Centers for Disease Control and Prevention Web site.
http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html. Updated December 8, 2010.
Accessed June 1, 2011.
2. Falls among older adults: an overview. Centers for Disease Control and Prevention Web site.
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html. Updated December 8, 2010.
Accessed June 1, 2011.
3. The Connecticut Collaboration for Fall Prevention. Fall Prevention Web site. Clinical approach.
http://www.fallprevention.org/pages/clinicians.htm. Last modified June 24, 2010.
Accessed June 1, 2011.
4. Washington State Department of Health. Falls among older adults: strategies for prevention.
http://www.doh.wa.gov/hsqa/emstrauma/injury/pubs/FallsAmongOlderAdults.pdf. Posted September
2002. Accessed June 1, 2011.
5. Mullahy CM. Case management and managed care. In: Kongstvedt PR, ed. The Managed Health
Care Handbook. 4th ed. Gaithersburg, MD: Aspen Publishers, Inc; 2001:371-401.
6. Standards of Practice for Case Management, Revised 2010. Case Management Society of America
Web site. http://www.cmsa.org/portals/0/pdf/memberonly/StandardsOfPractice.pdf. Accessed August
14, 2014.
7. American Geriatrics Society and British Geriatrics Society Panel on Prevention of Falls in Older
Persons. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical
practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148-157.
8. Tinetti ME. Preventing falls in elderly persons. N Engl J Med. 2003;348(1):42-49.
9. Cumming RG, Thomas M, Szonyi G, et al. Home visits by an occupational therapist for assessment
and modification of environmental hazards: a randomized trial of falls prevention. J Am Geriatr Soc.
1999;47(12):1397-1402.
This information has been developed by Johnson & Johnson Health Care Systems Inc. as part of the
QualitySolutions360 platform supporting healthcare management programs.
© Johnson & Johnson Health Care Systems Inc. 2014
September 2014
017966-140707
Approved 10/10/2014