Patients fall and hurt themselves.  They fall in the acute care hospital (most commonly reported adverse event in the inpatient adult setting); outpatient clinics, surgery centers as well as long term care facilities (LTC) with potentially significant and long-term consequences.

While falls can happen to any individual, they are a common problem in the elderly population. The numbers include:

  • Approximately one third of people over the age of 65 and one half of people over the age of 80 have at least one fall per year.
  • Falls are the leading cause of death from injury among people 65 and over, more than half of all fatal falls involve people over the age of 75.
  • One in 200 falls result in hip fracture (age 65-69) and one in every 10 falls aged 85 and older.

While most falls might not end in death or significant physical injury, there is the potential for prolonged hospitalization or institutional care (LTC). In addition, if the individual has sustained a hip fracture, there is increased morbidity and mortality (one fourth of seniors who fracture a hip will die within 6 months). The increased mortality risk related to dementia, frailty, co morbid conditions, muscular weakness and low bone density.

Falls are attributed to many factors; these can include trauma, disease, age, mental status, medications, length of stay and gender; typically the more the frail the patient, the higher fall risk. Because of the increased risk of falls and potentially related problems, fall prevention is then an important consideration in the care of an elderly patient in both the acute care hospital and LTC setting. The fall prevention program usually includes a multidisciplinary and multifactorial program (see below for common components).

The typical scenario of patient falls includes a patient that is weak, confused or dizzy, trying to get out of the bed or the chair by him or herself. To reduce this risk of falls, a usual method of fall prevention can include the usage of bed alarms. The weight sensitive pads are applied to the bed, chair, wheelchair or commode and when the patient tries to get up, an alarm sounds in the patient’s room and nursing station. The goal of these pads is twofold; the alarm will remind and reorient the patient to wait for assistance as well as alerting the nursing staff so they can hopefully rush to the patient’s side to prevent a fall. Unfortunately, a recent study was unable to prove that bed alarms did reduce falls, instead the study did not prove any statistically or clinically significant decrease in falls or fall related events.

So what does this mean for caregivers and the elderly patients at increased fall risk? The most common interventions include:

  • Evaluating patients at increased fall risk (previous fall, gait disturbances, reduced vision, medical conditions, cognitive impairment and dizziness, to name    a few) with the institution of a fall prevention program.
  • Regular rounds for assessment and monitoring of the patients.
  • Regular rounds to provide necessary care or assistance with bowel and bladder needs.
  • Patient education for patient and family (not necessarily successful for the patient with dementia).
  • Use of side rails (depends on facility policy and can be seen as controversial; however do not appear to increase fall risk).
  • Strengthening exercises to assist in overall strength and safety (as in Physical Therapy.)
  • Environment modifications as in:
  1. Fall mats (Can be seen as potential hazard for ambulatory patient and impaired gait.  Occasionally used in LTC for those patients considered bed bound, however not used in the acute care hospital);
  1. Usage of non slip socks;
  1. Bed in lowest position;
  1. Gait belts to control balance as well as potential fall (with decreased chance of caregiver injury);
  1. Hip pads (slightly decreased chance of hip fracture, not typically used in acute care hospital).

Unfortunately, patient falls and the prevention of fall related injuries will continue to be a challenge across the care continuum (community, acute care and LTC). While the usage of multi modal and multidisciplinary interventions might be effective at reducing falls, it is both unfortunate and highly unlikely that falls and subsequent fall related injuries will ever be totally eradicated.

Do you have a possible case with reported fall and resultant patient injury? Our nurses are skilled at reviewing chart notes, determining if a comprehensive fall prevention program was instituted in either the acute care hospital or a long term care setting.

Resources

http://www.ncbi.nlm.nih.gov/books/NBK2653/

http://ptjournal.apta.org/content/85/7/648.full

https://books.google.com/books?id=b1FtazykqzMC&pg=PA846&lpg=PA846&dq=hip+fracture+and+decline+of+health+status&source=bl&ots=xwxkxtjvAP&sig=-d_p5oVyRygiOSebe53EhC7ocis&hl=en&sa=X&ved=0ahUKEwio58z9mYLKAhUHyGMKHeLLAp84ChDoAQg-MAc#v=onepage&q=hip%20fracture%20and%20decline%20of%20health%20status&f=false

[1] http://annals.org/article.aspx?articleid=1392191

http://ageing.oxfordjournals.org/content/37/4/368.full

[1] http://www.kevinmd.com/blog/2013/01/bed-alarms-work-reduce-patient-falls.html

http://connect.jbiconnectplus.org/viewsourcefile.aspx?0=5394

http://www.ncbi.nlm.nih.gov/pubmed/22130346

http://www.cochrane.org/CD001255/MUSKINJ_hip-protectors-for-preventing-hip-fractures-in-older-people