By: Mark Cifarelli


Director of Physical Therapy Services

Working in senior care, especially in an assisted living environment, we are acutely aware of the risk for falls. Knowing that one in every four older adults will fall each year, fall reduction and prevention needs to stay “top of mind.” Unfortunately, many older adults do not receive the follow up care needed after a fall.

A recent study from Florida Atlantic University’s Schmidt College of Medicine published in the American Journal of Emergency Medicine showed that of older adults who had a fall with a head injury and were seen in the emergency department, only 59% had a follow up with a primary care physician and 44% never received any fall prevention interventions. Couple this with the fact that the fear of falling and having a prior fall contribute to fall risk means this population becomes even more vulnerable. Furthermore, this study only accounts for the small number of older adults who fell, went to the emergency department and had a head injury. Many individuals who fall may not have a hospital or emergency room admission after a fall but could end up with worse injuries the next time.

Richard Shih, MD, senior author, and a professor of emergency medicine in FAU’s Schmidt College of Medicine, said in a statement, “Given the importance of fall prevention in this high-risk group, we strongly endorse that fall-risk assessment and patient education is performed in the emergency department or by the primary care physician. The physician follow-up should include fall-risk assessment and initiation of any appropriate interventions to prevent subsequent falls and fall-related injury.”

However, not all older adults who sustain a fall will see their primary care physician, and if they do, their physician may not have the time to do a full fall risk assessment or be able to provide fall prevention strategies tailored to the individual’s needs. Physical therapy is perfectly suited to fill this missing piece of healthcare. In the study’s conclusion, Dr. Shih states, “When referred to physical therapy, patients may be more likely to adopt fall prevention interventions and home safety modifications that have been shown to reduce recurrent falls, hospitalization, and mortality”.

In the article The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk, published in 2019 in the American Journal of Preventative Medicine, the authors, Judy Stevens, PhD and Robin Lee, PhD, MPH, state, “PTs and PTAs are key partners in evidence-based multifactorial fall prevention in the community.  Physical therapists and PTAs are key members of the fall prevention team as experts who assess and treat balance, strength, and mobility deficits. Referral to a PT is one of the evidence-based interventions recommended by the CDC and the United States Preventive Services Task Force to manage falls risk.” In this peer-review literature review, they looked at articles discussing falls, fall risk, and costs of falls. The results showed that, “Depending upon the size of the eligible population, implementing a single intervention could prevent between 9,563–45,164 medically treated falls and avert $94–$442 million in direct medical costs annually.”

That’s millions of dollars saved each year by implementing a single fall prevention intervention. 

At Legacy Healthcare Services, we train our therapists to look at 8 different factors that contribute to falls and to custom design a multifactorial approach to intervention. We look at factors that can indicate a fall risk and provide intervention to prevent a fall because we know, as costly as falls are, the best way to reduce that cost is to prevent the fall from happening. If a fall has happened, we create customized intervention plans including treating strength, balance, and gait. But we know that older adults with adequate strength, balance, and gait can still fall, so we look to treat beyond that to be as comprehensive as possible taking into account components such as a person’s cognitive function, visual capabilities among other factors. 

Reducing the occurrence of falls and the risk for falls isn’t just about lowering the numerical healthcare cost; in fact the “costliest” aspect of a fall is to the individual. Pain, reduced independence, and a lowered quality of life are hard to put a price on and can be devastating to an older adult and their family. With a referral to physical therapy, the savings go far beyond the wallet.


  1. Richard D. Shih, Joshua J. Solano, Gabriella Engstrom, Maya Khazem, Lisa M. Clayton, Michael Wells, Patrick G. Hughes, Leila Posaw, Lara Goldstein, Charles H. Hennekens, Joseph G. Ouslander, Scott M. Alter,. “Lack of patient and primary care physician follow-up in geriatric emergency department patients with head trauma from a fall”, The American Journal of Emergency Medicine, Volume 75, 2024, Pages 29-32, ISSN 0735-6757, (
  2. Stevens, Judy A, and Robin Lee. “The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk.” American journal of preventive medicine vol. 55,3 (2018): 290-297. doi:10.1016/j.amepre.2018.04.035 (

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