ArticleEuropean geriatric medicine2026
Evaluation of cardiovascular fall risk assessment and managment in Dutch fall clinics comparing current practice to guideline recommendations.
Article in European geriatric medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCardiovascular disorders are important fall risk factors, especially in unexplained recurrent falls. According to (international) guidelines, a standard workup of cardiovascular fall risk factors is indicated; however, its implementations is lagging. This study aimed to map the daily practice of cardiovascular fall risk assessment and management in Dutch fall clinics, comparing guideline recommendations (work-as-imagined) with actual practice (work-as-done), and to identify barriers to implementation.
methodsThe functional resonance analysis method (FRAM) was used to visualize work-as-imagined and work-as-done. Input for work-as-imagined was the Dutch guideline on fall prevention, which follows the ESC syncope guideline recommendations where applicable. Work-as done and barriers for guideline implementation were derived from semi-structured interviews with Dutch fall clinic professionals.
resultsFourteen participants from eight fall clinics participated. Work-as-done related to the initial assessment of cardiovascular fall risk factors (e.g., ECG recording), was in line with work-as-imagined and implemented across the participating fall clinics. For the implementation of further cardiovascular assessments (e.g., head-up tilt testing), significant variability was observed across fall clinics, resulting in four different work-as-done FRAM models. The variations were mainly driven by the following barriers: unavailability of staff, gaps in knowledge, lack of expertise, and lack of resources.
conclusionThis study highlights important discrepancies between recommended cardiovascular fall risk assessment protocols and current practices in Dutch fall clinics. A structured care pathway could help standardize and optimize cardiovascular fall risk practices. Addressing the identified barriers to implementation and development in standardized care pathways could facilitate the implementation of the care pathway and optimize cardiovascular fall prevention practices in older adults.
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