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Preventing Falls

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Each year, one in every three adults age 65 and older falls.   Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Falls are a public health problem that is largely preventable. Fall prevention involves managing a patient’s underlying fall risk factors (e.g., problems with walking and transfers, medication side effects, confusion, frequent toileting needs) and optimizing the facility’s physical design and environment.

How big is the problem? 

  • 1/3 older adults (those aged 65 or older) falls each year, but less than half talk to their healthcare providers about it.
  • Among older adults, falls are the leading cause of both fatal and nonfatal injuries.
  • In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.
  • In 2010, the direct medical costs of falls, adjusted for inflation, was $30 billion.

What outcomes are linked to falls?

 
  • 20% – 30% of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.
  • Falls are the most common cause of traumatic brain injuries (TBI).
  • In 2000, 46% of fatal falls among older adults were due to TBI.
  • Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Many who fall, even if not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and loss of physical fitness, increasing their actual risk of falling.

 

Who is at risk?
Fall-related Deaths
  • The death rates from falls among older men and women have risen sharply over the past decade.
  • In 2010, about 21,700 older adults died from unintentional fall injuries.
  • Men are more likely than women to die from a fall. After taking age into account, the fall death rate in   2010 was 40% higher for men than for women.
  • Rates also differ by ethnicity. Older non-Hispanics have higher fatal fall rates than Hispanics.

Fall Injuries

  • Those 75 and older who fall are 4 – 5 times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.
  • Rates of fall-related fractures among older women are more than twice those for men.
  • Over 95% of hip fractures are caused by falls. In 2010, there were 258,000 hip fractures and the rate for women was almost twice the rate for men.

Rick factors include:

Biological

  • Mobility problems due to muscle weakness or balance problems
  • Chronic health conditions such as arthritis and stroke
  • Vision changes and vision loss
  • Loss of sensation in feet

Behavioral

  • Inactivity
  • Medication side effects and/or interactions
  • Alcohol use

Environmental Risk Factors

  • Home and environmental hazards (clutter, poor lighting)
  • Incorrect size, type, or use of assistive devices (walkers, canes, crutches)
  • Poorly designed public spaces

How can older adults prevent falls?
Older adults can stay independent and reduce their chances of falling. They can:
  • Exercise regularly – increasing leg strength and improving balance
  • Ask their doctor or pharmacist to review their medicines-both prescription and over-the counter-to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.
  • Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.
  • Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways, and improving the lighting in their homes.

To lower their hip fracture risk, older adults can:

  • Get adequate calcium and vitamin D-from food and/or from supplements.
  • Do weight bearing exercise.
  • Get screened and, if needed, treated for osteoporosis.

Which fall prevention practices should you use?

Fall prevention programs need to be tied to the fundamental goal that patient care improve each patient’s function and well-being. Our goal should be keeping fall and injury rates as low as possible, rather than getting to a zero fall rate at the expense of other priorities. Fundamentally, fall prevention is about balancing multiple priorities, as health itself is multifaceted.Falls can be classified into three types: 

Physiological (anticipated) – These occur in patients who have risk factors for falls that can be identified in advance, such as:

  • altered mental status
  • abnormal gait
  • frequent toileting needs
  • high-risk medications

Physiological (unanticipated) – These occur because of an event whose timing could not be anticipated, such as a seizure, stroke, or syncopal episode.

Accidental – These falls occur due to an environmental hazard.

 

Screening and assessment of older patients  

1.Ask older individuals if they have fallen within the past year.

2.Ask about the frequency and circumstances of the fall(s).

3.Ask if they experience difficulties with walking or balance.

4.Coordinate and evaluate a multifactorial fall risk assessment for gait and balance.

5.Those demonstrating no difficulty or unsteadiness during the evaluation of gait and balance do not require a fall risk assessment.

6.The multifactorial fall risk assessment should include the following:

  • focused history
  • physical examinations
  • functional assessment
  • environmental assessment

 

Universal fall precautions 

Universal fall precautions are the cornerstone of any fall prevention program, because they apply to all patients at all times. Universal fall precautions revolve around keeping the patient’s environment safe and comfortable. Some ideas are included here:

 

  • Familiarize the patient with the environment.
  • Have the patient demonstrate call light use.
  • Maintain call light within reach.
  • Keep the patient’s personal possessions within patient safe reach.
  • Have sturdy handrails in patient bathrooms, room, and hallway.
  • Place the hospital bed in low position when a patient is resting in bed; raise bed to a comfortable height when the patient is transferring out of bed.
  • Keep hospital bed brakes locked.
  • Keep wheelchair wheel locks in “locked” position when stationary.
  • Keep nonslip, comfortable, well-fitting footwear on the patient.
  • Use night lights or supplemental lighting.
  • Keep floor surfaces clean and dry. Clean up all spills promptly.
  • Keep patient care areas uncluttered.
  • Follow safe patient handling practices.

For Additional Information

Information for this post was retrieved from the following sites:

Retrieved from www.cdc.gov

Retrieved from www.arhq.gov

Retrieved from www.americangeriatrics.org

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