Newly Established Multidisciplinary Falls Clinic

Innovations in Geriatric Medicine and Innovations in Ear, Nose & Throat | Fall 2021

One in four adults age 65 and older falls each year.¹ And falling once doubles the likelihood of a future fall.² A novel multidisciplinary Falls Clinic at University Hospitals Cleveland Medical Center is offering comprehensive evaluations to patients who at risk for falls.

Nauman Manzoor, MD

Amanda Lathia, MD

With two locations serving Northeast Ohio communities — University Hospitals Foley ElderHealth Center in Beachwood and St. John Westshore Primary Care in Westlake — the UH Falls Clinic brings together specialists from the University Hospitals Center for Lifelong Health (Geriatrics), rehabilitation services, pharmacy and the University Hospitals Ear, Nose & Throat Institute in a unique design model that leverages expertise from multiple care domains.

Nauman Manzoor, MD, an otolaryngologist at University Hospitals and an Assistant Professor at Case Western Reserve University School of Medicine, collaborated with geriatrics and other departments to start an innovative clinic in response to the significant number of elderly ENT patients who reported dizziness or balance issues.

“At UH, we have robust services for our older patients. The premise of the Falls Clinic is to bring together those services and address falling as a problem that is rooted in several specialties,” he says, noting that falls are linked to injuries, fractures, social isolation and hospitalizations that diminish quality of life and strain healthcare resources.

A Multitargeted Approach

“In the older patient population, there are usually multiple predisposing and precipitating factors that lead to falls,” says Amanda Lathia, MD, a geriatrician at UH Cleveland Medical Center and Assistant Professor at CWRU School of Medicine. “From a geriatric perspective, we’re looking at the patient as a whole and considering the full spectrum of risk factors that could potentially be contributing. The concept of having a multidisciplinary Falls Clinic, particularly with ENT involvement, is unique because we’re able to gather input from other specialists to address individual challenges and mitigate future risk.”

In a convenient single visit, patients receive a thorough evaluation. Appointments generally last two hours, providing time for specialists to consider:

• Previous fall history
• Comorbidities or chronic disease
• Polypharmacy, including potential medication or supplement interactions
• Sensory deficits, including vision or hearing loss
• Cognitive impairment
• Arthritis or musculoskeletal pain
• Gait issues, including balance challenges or neuropathy
• Dizziness and lightheadedness, including vestibular imbalance or orthostatic hypotension
• Depression risk and social support
• Nutritional status and potential deficiencies
• Sleep patterns
• Home environment and the need for safety adaptations

“At the end of the clinic, we generate a list of therapeutic recommendations, appropriate referrals and useful resources tailored to each patient,” Dr. Manzoor says. “Our goal is to loop in the network of primary care physicians here at UH to communicate our findings and ensure seamless treatment across patients’ continuum of care.”

Often, solutions include decreasing or eliminating medications that may be contributing to lightheadedness and balance impairment or improving strength and balance through physical or rehab therapy. For patients who have vestibular issues, ENT providers can offer effective treatments. Follow-up with geriatrics to help ensure implementation of the treatment plan and medication changes is also recommended when needed.

Moving forward, the team plans to publish outcomes of the innovative care model. “We do not know of any place in the country that is involving ENT, rehabilitation services and pharmacy in such a comprehensive manner,” Dr. Manzoor says. He adds that next steps include developing a mechanism to refer appropriately selected patients who fall prior to hospitalization or while in the hospital to the UH Falls Clinic as part of the standard discharge procedure.

“Hopefully, the success of this clinic will highlight the critical need to expand geriatric services that ensure we are providing comprehensive, patient-centered, compassionate care for the growing numbers of older adults,” Dr. Lathia says. “As a nation, we are facing a significant shortage of geriatric specialists committed to helping patients live healthy and fulfilling lives as they age.”

Physicians who have a patient age 55 or older who has fallen or is at risk for falling can generate a referral through the electronic medical record to flag an individual for evaluation at the UH Falls Clinic.

For more information or to refer a patient to the Falls Clinic, please email Hailee Sautter, Intake Coordinator, at Hailee.Sautter@UHhospitals.org.

1, 2 Home and Recreational Safety. Centers for Disease Control and Prevention.

Contributing Experts:
Nauman Manzoor, MD
Otolaryngologist
University Hospitals Ear, Nose & Throat Institute
Assistant Professor
Case Western Reserve University School of Medicine

Amanda Lathia, MD
Geriatrician
University Hospitals Cleveland Medical Center
Assistant Professor
Case Western Reserve University School of Medicine