Three-Level Fall Risk Assessment Method for Hospitalized Older Adults: A Practical Protocol Based on Comprehensive Geriatric Assessment

Falls in older adults result from multiple interacting factors, making it difficult for a single assessment tool to comprehensively identify fall risk. This study describes a three-level fall risk assessment protocol based on comprehensive geriatric assessment to support progressive fall risk identification and standardized risk classification in hospitalized older adults. A single-center retrospective descriptive analysis of prospectively collected clinical data was conducted in 151 hospitalized older adults. The First Level combined the Morse Fall Scale (MFS) with fall-severity screening. The Second Level used the FRAIL Scale to conduct supplementary frailty screening for participants classified as low risk at the First Level. The Third Level applied a multifactorial fall risk assessment to participants classified as moderate or high risk at the First Level and those identified with pre-frailty or frailty at the Second Level, followed by final risk classification. At the First Level, 94 participants (62.2%) were classified as low risk, 57 (37.7%) as moderate or high risk, and 17 (11.3%) had a positive fall-severity screen. Among the 94 participants entering the Second Level, 23 (15.2%) had abnormal FRAIL Scale results. Eighty participants proceeded to the Third Level. Final risk classification identified 80 participants (53.0%) as low risk, 22 (14.6%) as moderate risk, and 49 (32.5%) as high risk. Among the 23 participants with abnormal FRAIL Scale results, 15 were classified as moderate or high risk after the Third Level assessment. These findings suggest that the protocol may improve the identification of hospitalized older adults at moderate to high risk of falls while reducing under-identification; however, its performance requires further validation.