Submitted by Tamala Sammons, MA CCC-SLP, Senior Therapy Resource

Contributed from the American Speech and Hearing Association (ASHA.org)

https://www.asha.org/practice/reimbursement/medicare/medicare-patient-driven-payment-model/#Fall

Factors such as depression, hearing loss, medication management, cognitive impairments and poor sleep all impact a patient’s risk for falls as well as their ability to report them in a timely fashion. Good clinical practice dictates determining whether these risk factors play a role in the care of the patients in SNFs. Approximately 60% of older adults with cognitive impairment fall annually, almost two times more than their peers without a cognitive impairment (Eriksson, et al., 1993). Among individuals with dementia, fall frequency can even reach as high as 80% (Shaw et al, 2003). The high prevalence of falls among patients with dementia, despite relatively intact motor function, highlights the idea that falls are often not just a motor problem (Van Iersel, et al, 2006). Risk of persistently high expenditures for fall-related injuries among older Medicare community-dwelling fee-for-service beneficiaries is significantly higher for individuals with cognitive impairments, which leads to hospital/facility readmissions (Hoffman, et al., 2017).

SLPs can help detect cognitive impairment to identify older adults who are at higher risk for falling. Cognitive impairment can be a risk factor for falls and a barrier to safe/independent discharge to prior living environments consequent to the fall. SLPs have a critical role in assessing cognitive-communication and cognitive deficits in patients of all ages, including patients who have had a stroke, traumatic brain injury, or suffer from a neurodegenerative condition such as Parkinson’s disease, and all forms of dementia. Appropriate referrals can help SLPs design interventions so the patient can reduce their fall risk (e.g., designing memory aids and cues to help the individual follow safety precautions and self-regulate impulsive behaviors). Emerging evidence indicates that cognitive interventions have effects that carry over from the cognitive to the physical domain to enhance gait, and may reduce fall frequency (Segev-Jacubovski, et al, 2011).