How Often Should Patients Be Assessed for Fall Risk?

September 28, 2025 •

5 min read

According to the Centers for Disease Control and Prevention (CDC), over one in four adults aged 65 and older fall each year, with falls being a leading cause of fatal and non-fatal injuries. Understanding how often should patients be assessed for fall risk is a critical component of effective preventive care and patient safety programs.

Quick Summary

Fall risk screening is recommended annually for all adults 65 and older. More frequent, comprehensive assessments are vital upon admission to a healthcare facility, after a fall, or whenever a patient's condition changes.

Key Points

Annual Screening: All adults aged 65 and older should receive a fall risk screening at least once a year during their annual check-up.
Assessment on Admission: In healthcare facilities like hospitals and nursing homes, patients must be assessed for fall risk upon admission.
Triggered by Events: Any acute change in a patient's condition, a fall incident, or a transfer to a new unit should trigger an immediate reassessment.
Regular Monitoring in Facilities: Nursing home residents require quarterly assessments, while hospitalized patients' risk should be monitored regularly, often daily.
Multifactorial Approach: A comprehensive assessment should be performed for high-risk patients, examining medical history, medications, mobility, and environmental hazards.
Patient Involvement: Successful fall prevention strategies require engaging patients and caregivers in education and personalized intervention plans.

Why Is Fall Risk Assessment So Important?

Falls pose a significant threat to a patient's health, independence, and overall quality of life, particularly among older adults. A fall can lead to serious physical injuries, including fractures, head trauma, and long-term disability. Beyond the immediate physical harm, falls can also cause a psychological fear of falling, leading to reduced activity, social isolation, and depression.

For healthcare facilities, falls represent a major patient safety concern and a significant economic burden due to extended hospital stays and increased treatment costs. By implementing consistent and timely fall risk assessments, healthcare providers can proactively identify at-risk individuals and implement targeted interventions to mitigate these risks. This approach shifts the focus from reacting to falls to actively preventing them.

Assessment Frequency in Different Settings

The frequency of fall risk assessments varies depending on the patient's care setting and overall health status. Guidelines from major health organizations, such as the CDC and the American Geriatrics Society, provide clear recommendations to ensure consistency and thoroughness.

Community-Dwelling Older Adults

For older adults (aged 65 and older) living independently, the standard recommendation is for an annual fall risk screening. This screening is often incorporated into a yearly check-up or a Medicare Annual Wellness Visit. The screening typically involves simple questions to identify risk factors, such as:

Have you fallen in the past year?
Do you feel unsteady when standing or walking?
Are you worried about falling?

If the screening indicates a potential risk, a more comprehensive, multifactorial assessment is warranted.

Acute Care (Hospital) Settings

In hospital environments, the frequency of assessment is far more intensive. Patients should be assessed for fall risk:

On admission: A baseline assessment must be performed as soon as practical upon the patient's arrival.
Daily or regularly: As a patient's condition can change rapidly, their fall risk should be reviewed and documented daily, or according to hospital policy.
Following a fall: Any fall incident necessitates an immediate, post-fall assessment to determine contributing factors and prevent recurrence.
Upon transfer: When a patient is transferred to a new unit or department, a new assessment should be conducted to account for any changes in environment or care plan.

Long-Term Care (Nursing Facility)

Nursing home residents are at an increased risk of falls, making continuous assessment critical. Guidelines from bodies like Texas Health and Human Services recommend that patients in a nursing facility be assessed:

Within 24 hours of admission.
Quarterly, at a minimum.
Whenever there is an acute change in condition, such as new medication, illness, or cognitive status decline.

Common Triggers for Reassessment

Beyond the standard intervals, several triggers necessitate a prompt reassessment of a patient's fall risk. These are key moments where a patient's stability might be compromised, demanding a focused re-evaluation.

Change in medication: The addition or removal of certain drugs (e.g., sedatives, diuretics, antihypertensives) can affect balance, cognition, and blood pressure, increasing fall risk.
Change in medical status: A new illness, an exacerbation of a chronic condition, or a decline in cognitive function can alter a patient's risk profile.
Use of assistive devices: Starting or changing the use of a cane, walker, or other ambulatory aid requires an assessment to ensure the device is used correctly and is appropriate for the patient's needs.
Environmental change: For community-dwelling individuals, significant home modifications or changes to their living situation warrant a reassessment. For hospitalized patients, a transfer to a different unit is a prime trigger.
Patient report: If a patient expresses new fear or unsteadiness, or reports a near-fall, this should prompt a reassessment.

Screening vs. Comprehensive Assessment

It is important to distinguish between a quick screening and a comprehensive, multifactorial assessment. This understanding ensures the right tool is used at the right time.

Screening

Purpose: Rapidly identify individuals who require further evaluation.
Method: Simple questions, observation of gait and balance (e.g., Timed Up-and-Go), or validated checklists.
Timing: Performed at routine, set intervals (e.g., annually) or upon first contact with a healthcare provider.

Comprehensive Assessment

Purpose: Perform an in-depth evaluation of all potential risk factors to create a tailored intervention plan.
Method: Includes detailed patient history (falls, medications), focused physical exam (gait, balance, vision, cognitive screen), and functional/environmental assessments.
Timing: Initiated when a screening indicates increased risk, or following a fall.

Comparison of Fall Risk Assessment Triggers


Trigger	Community-Dwelling Adults	Hospitalized Patients	Nursing Facility Residents
Routine	Annually (e.g., at Annual Wellness Visit)	Daily or per institutional policy	Quarterly, at a minimum
Admission/Intake	N/A	Upon admission	Within 24 hours of admission
Change in Condition	Any significant change in health or medication status	Any acute change in physical, mental, or behavioral status	Acute change in condition
Post-Fall	After any fall incident	Immediately following a fall	Immediately following a fall
Transfer	N/A	Upon transfer to a new unit	Upon transfer to a different area of the facility

Building a Proactive Fall Prevention Strategy

An effective fall prevention program is built on accurate and timely risk assessments. It requires a collaborative effort from healthcare providers, patients, and caregivers.

Use Validated Tools: Employ standardized tools like the Timed Up-and-Go (TUG) or the Morse Fall Scale, which are reliable for identifying risk.
Tailor Interventions: Interventions should be customized based on the individual's risk factors identified during the comprehensive assessment. Examples include strength and balance exercises, medication adjustments, or home environment modifications.
Encourage Patient Engagement: Involve patients and their families in the prevention plan. Educating them on their specific risks and the importance of interventions can improve adherence and outcomes. The CDC provides helpful resources for patients, which can be found at their STEADI page: What You Can Do To Prevent Falls.
Promote Ongoing Monitoring: For high-risk patients, ongoing monitoring and follow-up are essential. Providers should check in with patients regularly to ensure interventions are effective and adjust them as needed.

Conclusion

Understanding how often should patients be assessed for fall risk is fundamental to patient safety. While annual screening is appropriate for community-dwelling older adults, heightened vigilance and more frequent assessments are necessary in institutional settings. By consistently screening, assessing, and reassessing, and by tailoring interventions to individual needs, healthcare providers can significantly reduce fall incidents and their associated injuries, fostering a safer, healthier environment for all patients.

Frequently Asked Questions

Fall risk screening is recommended for all adults aged 65 and older. Additionally, any patient admitted to a hospital or long-term care facility, or any individual with a history of falls or mobility issues, should be assessed.

A screening is a quick, initial check to determine if a person is at risk for falling, often using simple questions. A comprehensive assessment is a more detailed, multifactorial evaluation performed for those identified as high-risk, exploring all contributing factors.

In a hospital, a patient's fall risk should be reassessed upon admission, after any fall incident, and following any significant change in their medical, physical, or cognitive condition. Reassessment is also necessary when a patient is transferred to a different unit.

Nursing home residents should have a fall risk assessment within 24 hours of admission. A comprehensive reassessment is required at least quarterly and with any acute change in their health status.

Yes, several standardized tools are used, including the Timed Up and Go (TUG) test to measure mobility, the Berg Balance Scale to evaluate static and dynamic balance, and the Morse Fall Scale, which uses a points-based system.

Many medications, especially psychoactive drugs, antihypertensives, and diuretics, can cause dizziness, drowsiness, or imbalance. A change in a patient's medication regimen requires a re-evaluation of their fall risk.

Yes, factors like home hazards (e.g., loose rugs, poor lighting), inappropriate footwear, and lack of grab bars can significantly increase fall risk. An environmental assessment is often part of a comprehensive fall risk evaluation.

If a high risk is identified, a healthcare provider will create a personalized fall prevention plan. This may include referrals to physical therapy, medication adjustments, assistive devices, and home environment modifications.