Facts About Falls Jo A. Taylor, RN, MPH

Older Adult Population  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  Most common cause of nonfatal injuries and hospital admissions for trauma  72% of fall related deaths occur in 13% of older adult population  Most common cause of nonfatal injuries and hospital admissions for trauma

Falls Have Serious Consequences  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  Direct medical costs in 2000 were $19 billion for nonfatal fall injuries  By 2020, the annual direct and indirect costs of fall injuries is expected to reach $43.8 billion

Older Adults in Nursing Homes  Over 50% fall each year  Of those, 30-40% will fall again

Why Do Residents Fall?  A verage age at admission is 82.6 years  Over 50% have 3 or more admitting diagnoses  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 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 Drowsiness, over sedation Agitation, confusion, pacing Weakness, unsteadiness, Gait disturbances Dizziness, low blood pressure

Extrinsic Fall Risk Factors  Clutter  Lighting  Flooring  Handrails  Unstable furniture  Hard to reach personal items  Unsafe footwear  New admissions

Equipment  Missing wheelchair parts  Incorrect wheelchair fit  Inadequate wheelchair seating  Broken wheelchair parts

Research Evidence  Fall reduction programs are effective when they have multiple interventions that target individual risk factors  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  Falls assessment to determine high risk medications, unsafe behavior, vision loss, impaired gait and mobility and postural hypotension  Medical evaluation  Medication review  Gait and balance training

Staff Strategies to Reduce Fall Risk  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  Toileting assistance  Activities  Muscle strengthening and balance training  Behavioral strategies

How Families Can Help 1. Remove clutter and keep pathways clear 2. Provide safe footwear 3. Promote safety during transfer and mobility 4. Use low blood pressure precautions when needed

Remove Clutter  Keep pathways around the bed and to the bathroom clear  Provide only stable furniture from home  Remove items that are no longer needed Help to keep personal items within easy reach

Provide Safe Footwear  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  Non-skid socks can be useful to wear at night

Promote Safety During Transfer  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.