Transcript Falls Management

Facts About Falls
Jo A. Taylor, RN, MPH
Older Adult Population
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34.9 million people 65 years and older in the
US (13% of the population)
By 2030, 71 million or 20% of US population
Over 1/3 of all older adults fall each year
20-30% have moderate to severe injures
Fall risk increases with age
Falls in Older Adults
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Most common cause of nonfatal injuries and
hospital admissions for trauma
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72% of fall related deaths occur in 13% of
older adult population
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Most common cause of nonfatal injuries and
hospital admissions for trauma
Falls Have Serious Consequences
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Serious injury like hip fracture & brain injury
Increased risk of death
Loss of independence
Decreased ability to function
Increased need for care
Loss of self confidence and fear
Even without injury, falls lead to fear of falling
with self imposed restriction of activity and
reduced social interaction.
decreased quality of life
Healthcare Costs
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Direct medical costs in 2000 were $19 billion
for nonfatal fall injuries
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By 2020, the annual direct and indirect costs
of fall injuries is expected to reach $43.8
billion
Older Adults in Nursing Homes
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Over 50% fall each year
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Of those, 30-40% will fall again
Why Do Residents Fall?
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Average age at admission is 82.6 years
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Over 50% have 3 or more admitting diagnoses
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48% receive full-time skilled nursing care
under a physician’s supervision, 98% require
help with bathing and 45% with eating
Intrinsic Fall Risk Factors
Effects of aging
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Vision – decreased acuity, decreased contrast
sensitivity, increased sensitivity to glare, decreased
peripheral vision, decreased night vision
Hearing – decreased sensitivity
Changes in gait and balance – reduced arm
swing, decreased step length, slower reaction time,
slower movements, weakness
Urinary – feelings of urgency and frequency
Intrinsic Fall Risk Factors
Acute disease such as pneumonia and urinary
tract infection and chronic disease such as
stroke, diabetes & Alzheimer’s disease
Examples of symptoms:
 Confusion, impaired judgment, agitation
 Weakness, dizziness, fainting
 Paralysis, tremors
 Lower extremity weakness
 Incontinence
Intrinsic Fall Risk Factors
Side effects of medications
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Drowsiness, over sedation
Agitation, confusion, pacing
Weakness, unsteadiness,
Gait disturbances
Dizziness, low blood pressure
Extrinsic Fall Risk Factors
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Clutter
Lighting
Flooring
Handrails
Unstable furniture
Hard to reach personal items
Unsafe footwear
New admissions
Equipment
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Missing wheelchair parts
Incorrect wheelchair fit
Inadequate wheelchair seating
Broken wheelchair parts
Research Evidence
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Fall reduction programs are effective when
they have multiple interventions that target
individual risk factors
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Physical restraints do not reduce falls and are
associated with soft tissue damage, injuries,
fractures, delirium and death
It is impossible to prevent all falls in frail, older
nursing home residents but it is possible to
reduce risk.
Staff Strategies to Reduce Fall Risk
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Falls assessment to determine high risk
medications, unsafe behavior, vision loss,
impaired gait and mobility and postural
hypotension
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Medical evaluation
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Medication review
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Gait and balance training
Staff Strategies to Reduce Fall Risk
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Protective equipment (e.g., hip protectors,
helmets, wrist protectors)
Individualized wheelchair seating
Low beds, mats
½ or ¼ side rails
Alarms, sensors
Specialized chairs
Staff Strategies to Reduce Fall Risk
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Toileting assistance
Activities
Muscle strengthening and balance training
Behavioral strategies
How Families Can Help
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Remove clutter and keep pathways clear
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Provide safe footwear
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Promote safety during transfer and mobility
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Use low blood pressure precautions when
needed
Remove Clutter
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Keep pathways around the bed and to the
bathroom clear
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Provide only stable furniture from home
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Remove items that are no longer needed
Help to keep personal items within easy reach
Provide Safe Footwear
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Shoes and slippers with tread or non-skid
soles, with firm shape and low, even heels
Examples: tennis shoes with Velcro fasteners,
oxford style shoes, canvas or leather slip-ons,
and fitted slippers with some form of tread
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Non-skid socks can be useful to wear at night
Promote Safety During Transfer
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Call for help from staff when unsure about
safety
Provide easy to manage clothing with elastic
waist and Velcro fasteners
Lock wheelchair brakes before transfer
Keep all seating items in the wheelchair
Use Low Blood Pressure Precautions
For residents with low blood pressure:
 Sit on edge of bed and dangle feet before
rising
 Flex feet backwards several times before
rising
 Do not tilt head backwards
 Get up slowly with assistance
 Report dizziness
Reducing the fall risk of our residents
is a challenge. With your help, we
can do a better job.
Thank you for your time and support.