1. Chapter 12: Falls in Older Adults

2. Learning Objectives
Acknowledge the complex health and cost issues related to falls for older adults.
Describe older adults with a predisposition for falls and falls with injury.
Identify intrinsic and extrinsic risk factors for falls in older adults.
Incorporate a patient-specific fall risk assessment into an individualized plan of care.
Recognize medications associated with falls in older adults.
Identify patients at risk for restraints.
Discuss nonrestraint interventions to prevent falls.

4. Falls in Older Adults Preventable Life threatening
Not a normal consequence of aging
Geriatric syndrome
Frequency increases with age and frailty
May be first indicator of acute problem
May stem from chronic disease
May be a marker for progression of age-related changes in vision, gait, strength

5. Falls in the Hospital Setting
Common problem for hospitalized older adults
Up to 50% of hospitalized patients in the U.S. are at risk for falls; of those, 50% are injured
Most common adverse incident in hospitals: 3-5 falls per 1,000 bed days (about 1,000,000 inpatient falls every year)
Fall represent a national measure of quality and safety in the National Database of Nursing Quality Indicators (NDNQI).

6. Falls in the Hospital Setting (cont’d)
Implications of Falls
20-30% suffer moderate to severe injuries
10-20% suffer fractures
Repeated falls lead to ADL and IADL deficits, high risk for further hospitalization, disability, institutionalization, and death
Cost of fall injuries by 2020 expected to be $54.9 billion

7. Falls in the Hospital Setting (cont’d)
Risk Factors (Table 12-1, p. 460)
Intrinsic: related to the patient’s physiology and physical changes. ex)cognitive/sensory impairments, impaired mobility, frailty, meds..
Extrinsic: related to the physical environment. Ex) stairs, poor lighting, restraints, cluttered environment, side rails, unsuitable footwear…
Fall Risk Assessment
Tinetti Performance-Oriented Mobility Assessment (POMA): measure a pt’s gait and balance (p.462)
Timed Get Up and Go Test

8. Falls in the Hospital Setting (cont’d)
Fall Prevention and Safety Promotion Strategies
Surveillance, make rounding,
Nonrestraint fall prevention interventions
Avoid Physical restraints and Chemical restraints

9. Torso support
Leg restraint
Roll belt
Hand mitten
Soft belt
Seating restraint
Wheel chair positioner

10. Falls in the Community Setting
Risk Factors
Intrinsic Factors (p. 468)
Extrinsic Factors (p.470)
Age
Gender
Race
Cognitive function
Physical function
Physical status
Disease states
Medications
Environmental
hazards
Nonsupportive
footwear
Recent hospitalization
Wheelchair use,
reckless wheelchair
use

11. Falls in the Community Setting (cont’d)
Fall Prevention and Safety Promotion Strategies
Fall risk assessment
Evaluate functional status: ADLs, appropriate use of adaptive equipment such as canes or walkers, and fear of falling
PT evaluation for safe footwear and adaptive devices
OT evaluation for safe living environment: loose cords, rugs, lighting

12. Falls in the Community Setting
Fall prevention (cont’d)
Exercise programs: Tai Chi
Multifactorial intervention tailored to individual cognitive and physical ability
Regular eye exams
Postural hypotension or other cardiovascular conditions
Calcium and Vitamin D

13. Falls in the Community Setting (cont’d)
Medications
Beer’s Criteria identifies medications and doses that may be harmful to adults age 65+
Less is more; Start low and go slow
Regular medication review
Discontinue unnecessary therapy
Medications implicated in falls
benzodiazepines, sedatives and hypnotics, antidepressants, antipsychotics (neuroleptics), antiarrhythmics, digoxin, diuretics, alcohol

14. Falls in the Community Setting (cont’d)
Modify the environment:
Small children, pets
Minimize clutter
Throw rugs
Stairs
Hand rails
Check flooring
Educate client and family
Pressure-sensitive bed alsrms

15. Falls in the Community Setting (cont’d)
Community Resources for Fall Prevention
Los Angeles Falls Prevention Coalition
StopFalls Network California
Centers for Disease Control
National Institute on Health and Aging’s Age Page
Hartford Institute for Geriatric Nursing guidelines

16. Summary
National healthcare organizations have tools and resources nurses can use to provide health care to older adults
Fall risk assessment during routine care may help older adults maintain functional status and improve quality of life.
Reducing falls lowers healthcare costs due to fewer emergency room visits and hospital stays.
Environmental and multifactorial assessments and interventions can make the difference between safety and falling.