If you have a loved one in a long-term care facility, you may already know that falls pose a serious risk for their elderly population. An average nursing home with 100 beds reports 100 to 200 falls annually according to the Centers for Disease Control and Prevention (CDC) and many more go unreported. “One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year.” Minimizing the risk of falls for your loved one requires several approaches to deal with the unique factors which can predispose your loved one to this type of injury.
What is a fall? The American Academy of Family Physicians broadly defines a “fall” as a sudden, unintentional change in position, which results in an individual either hitting the ground or another object below his or her starting point.
Just how bad is the problem? Falls are an extreme risk to our elderly. According to the American Academy of Family Physiciansabout 1,800 of our elderly die each year from injuries directly related to falls, and 9,500 older Americans die from injuries associated with falls according to. Falls can cause serious injuries and accidental death in older people. According to the CDC, falls are the leading cause of fatal and non-fatal injuries among Americans aged 65 and older, resulting in approximately over 2 million hospitalizations a year.
Why are falls such a big issue for our elderly? First, they can be symptoms of other health issues. People in nursing homes are generally older, have more difficulty walking, and are likely in poorer health than the general population. As a result, they are predisposed to falling incidents because of risk factors like unsteady gait and balance, weak muscles, poor vision, medications, and dementia. In addition to those, there are environmental factors such as poor lighting, loose rugs, poorly fitting shoes, floor clutter, and beds or toilets without handrails that also may cause falls. Furthermore, medical conditions that are often seen in the elderly such as low blood pressure, stroke, Parkinson's disease, arthritis, Meniere's disease (affects the middle ear, causing vertigo), poorly controlled diabetes, poorly controlled epilepsy, brain disorders and thyroid problems all increase the elderly person's risk for falls.
The CDC also found that falls in the elderly resident results in disability, functional decline and reduced quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation.
What can be done to minimize my loved one's risk of falling? Many of the above listed risk factors cannot be completely eliminated, however steps and precautions can be taken to decrease your loved ones risk for falls. If your loved one has been admitted to a nursing home or other long term care facility, the staff should assess their risk for falls on admission. It is important to know if your loved one is at a higher risk for falls so they can be placed on a higher level of monitoring and a fall prevention program. Also medications should be reviewed by the healthcare facilities staff. Many medications, or combinations of medications, taken by the elderly can have side effects such as dizziness or drowsiness and increase the risk of falling. Having a doctor or pharmacist review all of your loved ones medications can help reduce the chance of risky side-effects and drug interactions. Most elderly long term care residents are also on multiple medications, which places them at increased risk for falls.
Lack of exercise can lead to weak legs and this increases your loved ones risk of falling. All older adults who are at risk of falling should be offered an exercise program incorporating balance, gait, and strength training. Flexibility and endurance training should also be offered according to theAmerican Geriatrics Society. Your loved one should be evaluated at a nursing home for these programs that can increase strength and improve balance, making falls much less likely. Your loved one should also have their eyes checked every year and wear glasses or contact lenses with the correct prescription strength. Poor vision can make it very hard to get around safely, and the staff at a long term care facility should help insure residents have their glasses clean and on when ambulating about the facility. Staff should always insure that your loved ones room and walkways are free of clutter, cords and rugs that could cause them to trip and fall. It is also important to include the use of adaptive equipment and mobility aids as appropriate.
Many elderly people have bladder problems. The elderly population often has urinary continence issues combined with mobility problems. If this is the situation with your loved one, it is very important that they be placed on a routine schedule of being assisted to the bathroom. Many falls occur when residents of long term care facilities experience urgency and frequent urination, and are attempting to ambulate themselves to the bathroom alone or in a hurry.
It is also important to note, physical restraints do not help prevent falls. The Centers for Disease Control found that restraints can actually increase the risk of fall related injuries and death. Also, limiting a resident's freedom to move around leads to muscle weakness. Georgia is a “restraint free” state and while many nursing homes reported an increase in falls after these regulations took effect, there was a drop in fall related injuries.
While nursing homes and assisted living facilities must assess each resident for their risk of falling and implement measures accordingly, some residents may fall even with safeguards in place, but it is very important how the facility handles the care post-fall by obtaining medical attention, notifying the family, and thoroughly investigating all of the circumstances surrounding the incident to prevent similar falls from occurring in the future.
Below is a link to a white paper on fall prevention recommendations.