Risk Management: Fall Prevention and Intervention
A fall is defined as a sudden, unintentional change in position, which results in an individual either hitting the ground or another object below his or starting point (George, 2000). Falls are a major cause of significant injury and disability among older adults. It is estimated that as many as 75% of nursing home residents fall annually, twice as many as those living our communities.
Many falls are predictable, because a single cause can be identified in about one-third of falls. The two-third of the other falls has more than one risk factor involved and in the long-term care setting, residents are likely to have more than one risk factor for falls. Risk factors are either intrinsic or extrinsic.
Intrinsic risk factors include:
- Cardiovascular problems (such as dysrhythmia, hypotension, etc.)
- Medications such as analgesics, anti-anxiety, anti-convulsants, anti-depressants, anti-hypertensives, anti-psychotics, sedatives, etc.
- Neurological problems (such as cardiovascular accident, Parkinson’s disease, seizure disorder, etc.)
- Normal aging changes in gait due to loss of muscle mass and strength; includes decreased limb coordination, as well as the ability to raise feet very high
- Orthopedic problems (such as arthritis, status-post hip fracture, osteoporosis, osteomalacia, etc.)
- Pain, fear of falling, sleep disorders, and incontinence
- Psychological and cognitive factors, such as depression, apathy, delirium, Alzheimer’s disease, or other dementia
- Sensory or perceptual deficits that include age-related vision or hearing changes, dizziness, vertigo, etc.
- Medical conditions such as low blood pressure, stroke, Meniere's disease (affects the middle ear causing vertigo), poorly controlled diabetes, poorly controlled epilepsy, and thyroid problems.
Extrinsic risk factors include:
- Environmental considerations such as poor lighting, loose rugs, floor clutter or slippery floors, and beds or toilets without handrails.
- Poorly fitting shoes or walking barefoot
- Overly-long clothing
Because there are so many risk factors to consider, it is imperative for caregivers to identify quickly which ones pertain to each resident and then act upon them in order to minimize each resident’s potential for falling. Only by assessing the unique strengths, risks, and preferences of each individual resident can falls be prevented. Every care plan should accommodate the individual elder's preferences while balancing the safety goals with the goal of maintaining the highest level of independent function and mobility.
Patient needs will change over time so continuous observations, even for subtle functional changes, need to guide revision of resident fall prevention plans. Reassessment of resident fall risks should be done at least every 3 months.
When falls occur, the post-fall assessment will often identify new risk factors and will suggest new interventions to prevent the next fall. New care plan interventions following the assessment must be communicated to staff. Ask yourself the following questions:
- Does all staff know about new interventions?
- Are all necessary assignments sheets updated or have staff only been informed orally?
- Is action being taken immediately instead of waiting for a formal assessment of the fall?
- Are the new interventions preventing falls for minimizing the risk of additional falls?
Sometimes there are situations where caregivers think they did all of the right things to minimize a resident’s fall potential, yet later were accused of not doing enough. It is important to make changes appropriate in your facility to prevent such situations.
To obtain further information about the programs Highland Risk Services offer, please contact us today at one of our two offices in Chicago at 847-832-9100 or Lansing at 517-676-7100.