Fall Prevention and Mobility Enhancement in Older Adults

• Utilisez des soins culturellement adaptés qui tiennent compte des traumatismes et des violences. Expliquez pourquoi les questions sont importantes, demandez la permission avant d'aborder des sujets sensibles et adaptez la communication à la langue, à l'identité, à la culture, au handicap et aux expériences de soins de santé antérieures du patient (Agence de la santé publique du Canada, 2018).
• Informations sociodémographiques : age, sex, gender identity, language, living arrangement, supports, caregiving responsibilities, health literacy, occupation or volunteer roles, and communication or access needs.

Principales préoccupations

• Fall and near-fall history: ask opportunistically about falls in the past year. Record number, date, place, activity, direction and mechanism; footwear or mobility aid; injury or medical attention; loss of consciousness or memory; ability and time needed to get up; time on the floor; warning symptoms; witnesses; and whether a diary or caregiver report would improve recall (NICE, 2025; Montero-Odasso et al., 2022).
• Unsteadiness and concerns about falling: ask whether the person feels unsteady while standing or walking, worries about falling, restricts activity, needs furniture or another person for support, or has changed routines because of confidence or safety (Montero-Odasso et al., 2022).
• Mobility change: onset and course of slower walking, reduced endurance, difficulty turning, stairs, transfers or rising from the floor, freezing, tripping, dragging a foot, new aid use, deconditioning after illness or admission, and fluctuation across the day.
• Symptoms before, during or after an event: dizziness or vertigo, light-headedness on standing, palpitations, chest discomfort, shortness of breath, weakness, numbness, speech or vision change, headache, seizure-like activity, confusion, fever, pain, urgency or incontinence, and post-event recovery.
• Injury, functioning and participation: head impact; bone, joint or soft-tissue pain; bruising; ability to bear weight and use the limbs; sleep; self-care; household and community mobility; work, volunteering, caregiving, recreation and social participation.
• Revue des systèmes corporels : neurological, cardiovascular, musculoskeletal, vestibular, vision, hearing, cognition, mood, genitourinary, gastrointestinal and nutritional, skin, foot and sensory symptoms relevant to falls, mobility or injury.
• Santé, mode de vie et histoire : frailty; osteoporosis and fracture history; neurological, cardiovascular, metabolic and musculoskeletal conditions; recent illness, hospitalization or surgery; pain; sleep; hydration and nutrition; alcohol or substance use; physical activity; footwear; and current medications and supplements, including recent changes and adherence.
• Environment and supports: lighting, stairs, rails, bathroom setup, loose rugs or cords, uneven surfaces, pets, seasonal hazards, access to a phone or alert system, mobility-aid fit and use, transportation, caregiver availability and the person’s ability to summon help after a fall.
• Déterminants sociaux de la santé : housing quality, income, food security, discrimination, social isolation, caregiver strain, neighbourhood accessibility, transportation, digital access and availability or affordability of assessment, exercise, equipment and home modifications (Agence de la santé publique du Canada, 2026).
• Soins et interventions antérieurs : fall-prevention education, exercise, rehabilitation, mobility aids, footwear or vision care, medication review, home assessment, medical investigation and what helped, did not help or was difficult to continue.
• Point de vue du patient : understanding of the fall or mobility change, priorities, acceptable risk, preferences, cultural context, concerns, confidence, expectations and previous experiences of care.
• Signaler un avis : Vérifiez les signaux d'alerte et référez-vous aux modules distincts « Signaux d'alerte orange » et « Signaux d'alerte jaune » lorsque cela est pertinent.

​​Mesures des résultats :

• Use measures that are meaningful to the patient and practical to repeat. Record a baseline and reassess often enough to guide decisions. Do not use a score on its own to predict whether an individual will fall.
• Fonctionnement propre au patient : Échelle fonctionnelle propre au patient (PSFS).
• Handicap et participation : Échelle d'évaluation du handicap de l'OMS 2.0 (WHODAS 2.0).
• Qualité de vie : WHOQOL-BREF.
• Falls and concerns: fall and near-fall count or diary, plus the Falls Efficacy Scale International (FES-I) when concerns about falling are a meaningful target.
• Mobility and lower-limb performance: a repeatable task matched to ability and goals, such as the Timed Up and Go ou Five Times Sit-to-Stand Test. Record setup, aid and assistance so repeated results are comparable.
• Objectifs individuels : agree on patient-defined goals and how progress will be recognized. SMART wording may be used when helpful.

Les signaux d'alerte orange indiquent qu'un problème de santé mentale ou de toxicomanie peut nécessiter une évaluation d'urgence ou rapide, voire une prise en charge partagée, et peut influencer la prise en charge musculo-squelettique. Ce n'est pas un diagnostic. En cas d'inquiétude, posez des questions directes et respectueuses en tenant compte de la sécurité immédiate, de la gravité du problème, de tout changement par rapport au fonctionnement quotidien habituel et du contexte. Les facteurs psychosociaux susceptibles d’affecter le rétablissement, mais ne nécessitant pas d’évaluation médicale ou psychiatrique distincte, sont abordés sous la rubrique « Signaux d’alerte jaune ».

ACTION : Organisez immédiatement une évaluation d'urgence en cas de danger immédiat ou de besoin médical urgent :

• Suicide, automutilation ou violence envers autrui : intention ou plan actuel, tentative récente, incapacité à rester en sécurité ou comportement suggérant un risque immédiat de préjudice grave.
• Changement grave de l'état mental : agitation extrême, confusion, désorganisation, psychose ou manie possible avec altération du jugement ou comportement dangereux, ou incapacité à satisfaire les besoins fondamentaux lorsque cela crée un danger immédiat.
• Urgence médicale ou liée à la consommation de substances : Suspicion de surdosage, intoxication grave, sevrage dangereux, délire ou autre changement soudain nécessitant des soins médicaux urgents.

En cas de danger immédiat, ne laissez pas la personne seule pendant que les secours sont organisés. Suivez les procédures d'urgence locales et composez le 911 en cas de danger immédiat ou d'urgence médicale. Si la personne a des pensées suicidaires, téléphonez ou envoyez un SMS. 9-8-8 : Ligne d’assistance en cas de crise suicidaire avec eux ou les aider à le faire.

En cas de violence, d'abus ou d'exploitation avérés ou soupçonnés, assurez immédiatement la sécurité des personnes concernées et respectez les procédures de sécurité et de signalement applicables.

ACTION : Organisez rapidement une évaluation médicale ou psychiatrique si :

• Pensées suicidaires ou d'automutilation : Des pensées sans danger immédiat.
• Symptômes ou effets importants : symptômes graves, persistants ou s'aggravant de dépression, d'anxiété, de traumatisme, de psychose ou de manie possible, de troubles alimentaires ou de consommation de substances qui affectent considérablement la vie quotidienne, la prise de décision ou la participation en toute sécurité aux soins.
• Autres motifs d’évaluation : un changement marqué par rapport au comportement ou au fonctionnement habituel ; une inquiétude concernant les effets des médicaments ou des substances ; une présentation qui dépasse les compétences du clinicien ; ou une demande d'aide.

Informer le patient des personnes à contacter, du délai de contact et de la marche à suivre en cas d'aggravation de son état. S'assurer que le patient a bien pris contact avec le service lorsque cela est cliniquement nécessaire.

ACTION : Adapter et coordonner les soins musculosquelettiques :

• Soins en toute sécurité : Les soins peuvent se poursuivre lorsqu'ils sont sécuritaires et acceptables et ne retardent pas l'évaluation nécessaire. Adaptez la communication, l'examen et les soins ; obtenir un consentement continu ; et coordonnez-vous avec les autres professionnels de la santé avec la permission du patient.
• Poursuivre l'évaluation musculosquelettique : Ne présumez pas qu'un problème de santé mentale ou de toxicomanie explique les symptômes musculo-squelettiques. Continuez à considérer les causes physiques et à tenir compte du récit du patient.
• Questionnaires: Ils peuvent soutenir la discussion et le suivi, mais ne permettent pas d’établir un diagnostic et ne remplacent ni les questions directes, ni le jugement clinique, ni les mesures à prendre.
• Soutien acceptable : Demandez à la personne quel type d’aide lui convient et si le soutien linguistique, culturel, familial, communautaire ou autre est important pour elle.

ACTION : Documentation et suivi :

Consignez la préoccupation, les questions pertinentes et les réponses de la personne, la décision relative à la sécurité et les raisons qui la justifient, les mesures prises, les conseils donnés et les références effectuées, les communications et le consentement, le suivi prévu ainsi que toute préoccupation non résolue. Respectez les exigences applicables en matière de confidentialité, de sécurité et de signalement.

Pour obtenir des renseignements sur les services provinciaux, territoriaux et nationaux, consultez : Soutien en santé mentale : obtenir de l’aide (Agence de la santé publique du Canada, 2026).

Les signaux d’alerte psychosociaux (drapeaux jaunes) sont des facteurs personnels, sociaux, professionnels, scolaires, liés aux soins de santé, environnementaux ou structurels qui peuvent influencer les symptômes, le fonctionnement, la participation aux activités ou la réponse aux soins. Ils sont liés au contexte et ne constituent ni des diagnostics ni des prédictions certaines. Ils ne signifient pas que les symptômes sont d’origine psychologique. Ils permettent d’adapter la prise en charge et ne nécessitent pas, à eux seuls, une orientation urgente vers un autre professionnel de la santé. Explorez ces facteurs par la discussion et le suivi continu des résultats, en tenant compte des priorités, des forces et de la situation de la personne. Il n’est pas nécessaire d’utiliser un score distinct pour les signaux d’alerte psychosociaux (drapeaux jaunes). Les nouveaux signes ou l’aggravation de signes d’une maladie physique grave doivent être traités selon la procédure relative aux signes d’alerte (drapeaux rouges). Les préoccupations liées à la santé mentale ou à la consommation de substances qui nécessitent une évaluation distincte, ainsi que toute préoccupation immédiate concernant la sécurité, doivent être traitées selon la procédure relative aux signaux d’alerte psychosociaux urgents (drapeaux orange) et aux protocoles d’urgence ou de protection applicables.

Explorez les facteurs pertinents :

• Compréhension, attentes et expériences en matière de soins de santé : Préoccupations liées aux blessures ou aux dommages, incertitude, attentes quant au rétablissement, confiance en ses capacités, conseils contradictoires, expériences antérieures de banalisation des symptômes ou de préjudices subis, et confiance envers les soins reçus.
• Réactions aux symptômes et à l’activité : Inquiétude, peur, évitement, alternance entre périodes d’activité excessive et périodes de repos prolongées, difficulté à gérer le rythme des activités, stratégies d’adaptation, sommeil, confiance en sa capacité à gérer ses symptômes et reprise des activités significatives.
• Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
• Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
• Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
• Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

• Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
• Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
• Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
• Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
• Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.

Select examination elements that answer a clinical question or may change care. Adapt the examination to the patient’s presentation, comfort, consent and abilities.

• Consent and comfort: explain what you propose, provide choices about positioning, pace, footwear, mobility aids and caregiver involvement, and confirm ongoing consent.
• Condition-specific safety: use guarding and an appropriate environment; provide the person’s usual aid and needed assistance; stop or modify testing for chest symptoms, presyncope, marked dyspnea, acute neurological change, severe pain, unsafe fatigue or loss of control.
• Observation: alertness, posture, spontaneous movement, transfers, gait, turning, footwear, mobility-aid use, confidence, breathlessness, asymmetry and protective behaviour.
• Vital signs and cardiovascular assessment: heart rate and rhythm, blood pressure, oxygen saturation when indicated, hydration and signs of acute illness; include lying and standing blood pressure when orthostatic symptoms, unexplained falls or medication effects are plausible and the test is safe and within scope (NICE, 2025; Montero-Odasso et al., 2022).
• Gait, balance and mobility: gait initiation, speed, step length, foot clearance, turning, stopping, dual-task effect, surface or stair demands and response to an aid. Use selected tasks to describe performance and change, not to predict a fall in isolation.
• Strength, power and transfers: sit-to-stand, lower-limb and trunk strength, functional reach, bed or chair mobility and ability to rise from the floor when this can be tested safely and the person agrees.
• Neurological and cognitive examination when indicated: cranial and focal neurological findings, strength, sensation, reflexes, coordination, parkinsonism, attention, orientation, cognition, mood and delirium features.
• Vision, hearing and vestibular assessment when indicated: functional vision, eye movement, hearing, dizziness pattern, positional triggers, vestibulo-ocular findings and condition-specific tests that may change referral or care.
• Musculoskeletal, foot and footwear assessment: pain, swelling, injury, joint movement, alignment, lower-limb and spinal findings, foot sensation, skin, callus, deformity and the fit, condition and traction of footwear.
• Functional and environmental assessment: observe patient-prioritized self-care, household or community tasks and, when appropriate, the interaction among the person, aid, lighting, surfaces, stairs, bathroom setup and other hazards.
• Imagerie : not routine for fall risk or uncomplicated mobility decline. Use imaging when acute injury, fracture, head or spinal injury, serious pathology or another result is likely to change care or referral.
• Repeat and adapt: repeat focused findings when needed to review progress, revisit the working presentation or decide whether further assessment or referral is appropriate.

Working clinical presentations

These presentations can overlap or change. They guide the depth of assessment and coordination rather than predicting whether an individual will fall. Falls-risk prediction tools are not used as stand-alone predictors (NICE, 2025).

• Mobility concern without a recent fall: unsteadiness, slower gait, transfer difficulty, deconditioning or concerns about falling without a reported past-year fall. Explore change, function, safety and modifiable factors, and support appropriate physical activity.
• Single fall without gait or balance impairment: one past-year fall without injury needing medical care, loss of consciousness, inability to get up, frailty or an identified gait or balance problem. Education, physical activity and safety review can be matched to the person’s context (NICE, 2025).
• Single fall with gait or balance impairment: one fall plus observed or reported gait, balance, strength or mobility difficulty. Falls-prevention exercise and home-hazard review can form part of care (NICE, 2025).
• Recurrent or consequential falls: two or more falls, frailty, injury requiring medical treatment, loss of consciousness, inability to get up or a prolonged time on the floor. A comprehensive falls assessment and coordinated management are indicated (NICE, 2025; Montero-Odasso et al., 2022).
• Post-illness or transitional mobility decline: new weakness, reduced endurance, delirium recovery, changed medications or equipment, or altered supports after illness, hospitalization or a move. Reassess health, environment, assistance and previous baseline.
• Multifactorial or complex presentation: interacting medication, cardiovascular, neurological, sensory, musculoskeletal, cognitive, environmental and social factors. Do not assume one cause. Identify which factors are most important and can be addressed safely.
• Condition-linked, atypical or uncertain presentation: the fall or mobility change may be related to syncope, vestibular disease, stroke, Parkinson disease, neuropathy, dementia, acute injury or another condition. Document the working impression and follow Red Flags or the relevant condition pathway.

Fondez la prise en charge sur le tableau clinique, la sécurité, les objectifs, le contexte et la réponse aux interventions. Privilégiez des principes et des options adaptables plutôt qu’une séquence d’interventions prédéterminée, et réévaluez régulièrement les résultats pertinents afin d’orienter les ajustements à apporter à la prise en charge.

Éducation, autogestion et participation aux activités

• Build a practical fall plan: discuss individual risk factors, safe ways to maintain valued activity, what to do after a fall, how to summon help and which new symptoms need urgent assessment. Involve family or caregivers with the person’s agreement (NICE, 2025; World Health Organization, 2021).
• Support confidence and participation: use patient-defined goals, graded re-engagement and accessible written or demonstrated information. Avoid implying that all falls can be prevented or that the person is to blame.

Activité physique et exercices

• Falls-prevention exercise: options for community-dwelling older adults include balance-challenging and functional exercise such as stepping and sit-to-stand, with strength or resistance, gait, coordination and endurance work added to identified needs. Individualize, progress and supervise the programme to the person’s abilities, health, goals and response (Sherrington et al., 2019; Montero-Odasso et al., 2022; U.S. Preventive Services Task Force, 2024).
• Programme dose and continuity: an evidence-informed community programme can include sessions at least three times weekly for at least 12 weeks, with continued exercise for ongoing benefit. The actual starting level, progression, supervision and delivery format reflect capacity, safety, adherence, access and setting (Montero-Odasso et al., 2022).
• Delivery options: programmes can be individual or group based and delivered at home, in the community, virtually or through a hybrid model. Match instruction, progression and monitoring to the person. Higher fall risk, frailty or cognitive impairment may require closer supervision (Montero-Odasso et al., 2022).
• Floor-transfer skills: when safe and acceptable, practising how to rise from the floor and use an alert or help plan can reduce harm from being unable to get up after a fall (Montero-Odasso et al., 2022).

Mobility aids, footwear and environment

• Mobility aids: assess, fit and teach the use of a cane, walker or other aid when it may improve stability or reduce effort. Check how the person uses it in relevant settings and review it as needs change.
• Home and environmental modification: a structured home-hazard assessment and action on identified lighting, surface, stair, bathroom, furniture or access problems can form part of care, ideally with an occupational therapist or another appropriately trained provider (NICE, 2025; World Health Organization, 2021).
• Feet and footwear: address pain, skin or sensory problems and review fit, fastening, heel, sole condition and traction when these affect mobility. Foot or footwear needs beyond scope call for podiatry, orthotic, medical or other appropriate care.

Health conditions and medication coordination

• Révision de la médication : a pharmacist or authorized prescriber can review fall-risk-increasing medicines, psychotropic medicines, polypharmacy, recent changes, adverse effects and adherence. Any change or withdrawal is individualized and coordinated rather than made abruptly outside scope (NICE, 2025; Montero-Odasso et al., 2022).
• Condition-specific care: medical, rehabilitation or specialist care can address orthostatic hypotension, syncope or arrhythmia, cataract or other vision loss, vestibular disorders, osteoporosis, continence, nutrition and hydration, hearing, cognition, mood, neurological disease, pain or other identified contributors (NICE, 2025).

Soutien psychologique, social et interdisciplinaire

• Concerns about falling: explore the relationship among confidence, gait, balance, actual risk and activity restriction. Psychologically informed education, graded activity and falls-prevention exercise can be combined; cognitive behavioural care can form part of shared care when concerns remain limiting (NICE, 2025; Montero-Odasso et al., 2022).
• Interdisciplinary and community support: primary care, geriatrics, pharmacy, physiotherapy, chiropractic, occupational therapy, nursing, optometry or ophthalmology, audiology, podiatry, nutrition, mental health, social care, community programs and caregivers can be coordinated around identified needs and the person’s priorities.
• Access and feasibility: transportation, cost, housing, caregiver availability, language, technology and community accessibility can shape the plan. Select options the person can use and revisit barriers when participation is difficult.

Suivi et réévaluation

• Convenez d’un moment pour la réévaluation en fonction du tableau clinique, de la sécurité, des objectifs, des interventions mises à l’essai, des besoins de la personne et de l’accès aux soins, plutôt que de suivre un calendrier de visites prédéterminé.
• Repeat the small outcome set recorded at baseline and review falls and near falls, mobility, relevant neurological and cardiovascular findings, functioning, participation, confidence, benefits, harms, treatment burden and progress toward patient-defined goals.
• Continue what is useful and acceptable; adapt or stop what is not; and revisit the clinical presentation, differential diagnosis, referral or shared care when another fall occurs, progress differs from expectations or new safety concerns emerge.

• Évolution attendue : fall risk and mobility can change with health, activity, medications, environment and supports. Falls are not inevitable, and appropriately designed exercise reduces falls on average in community-dwelling older adults, but no intervention guarantees that an individual will not fall (Sherrington et al., 2019; Public Health Agency of Canada, 2022).
• Facteurs associés à une évolution moins favorable : previous recurrent or injurious falls, gait or balance impairment, weakness, frailty, cognitive or neurological disease, multimorbidity, fall-risk-increasing medicines, orthostatic or cardiovascular symptoms, vision impairment, concerns about falling with activity restriction, environmental hazards and inability to get up may be associated with further falls or loss of mobility. These are group-level patterns, not certain individual predictions (Montero-Odasso et al., 2022; Colón-Emeric et al., 2024).
• Facteurs pouvant favoriser le rétablissement : clear information about the person’s fall risks, sustained and appropriately progressed balance and functional exercise, timely management of identified health and medication factors, suitable aids and environments, confidence-building, caregiver and social support, and accessible coordinated care may help the person move and participate more safely.
• Discussion du pronostic : explain that fall risk can change and cannot be predicted with certainty. Avoid promises or blame. Discuss what the person wants to do, what level of risk they accept and how the plan may change as new information and repeated outcomes become available.