Nurse-Led Community Fall Prevention Program: A Singapore Experience

Background: Falls and fall-related injuries are common among older adults. It can lead to severe physical and psychological consequences and incur significant healthcare cost. Falls prevention and screening is the key to an essential holistic approach. Objective: To identify fall risk factors among older adults through early screening and provide timely intervention. Methodology: A nurse-led community falls prevention program was established in the Southeast region of Singapore. The program consists of fall risk screening using the adapted FROP-COM screener and domain-specific assessments for those identified with high fall risk. The screening will be conducted at various community sites, i.e., community centres, active aging centres, faith-based premises. Older adults with high fall risk will receive group/individualized falls prevention health coaching, medication review, targeted chronic disease management, home safety assessment, assistance in mobility aids and home modification application, home-based exercise education and referrals for community-based activities (structured exercises, rehabilitation program) and medical consults. Results: A total of 3,614 older adults (mean age: 74, SD=7.89) were screened between April 2019 and October 2023. 1180 participants were identified as having high fall risk, with the mean age of 78 (SD= 7.97). Majority of those with high fall risk were females (65%). 777 (65.8%) of them (mean Clinical Frailty Score = 4) completed domain-specific assessment. Their findings were as follows: i) 279 (35.9%) presented with gait and balance issues (Short Performance Battery Test ≤ 6), ii) 231 (29.7%) had postural hypotension, iii) 68 (8.8%) might have cognitive issues (Abbreviated Mental Test ≤ 6), and iv) 42 (5.4%) failed vision function test. 607 (78.2%) of the older adults with high fall risk received individualized interventions. Conclusion: Community fall prevention program is important in early identification of fall risks and preventive health promotion among the pre-frail older adults. Our study cohort shows that those presented with high fall risks are generally female, frail with advanced age, presenting with poor gait and balance issues, postural hypotension, cognitive issues and/or vision deficits. These screening findings provide valuable insight for subsequent targeted screening initiatives and intervention. A larger scale of study could include identifying predictors of falls among older adults in the community.