Analyzing Falls in Nursing Homes Are They Preventable

Falls in Nursing Homes, Are They Preventable

Preventing falls in nursing homes

Falls are quite common in the homes of the elderly with around one hand a half falls for each nursing-home bed-years. Although most falls are not fatal, 10% to 20% lead to admissions in hospitals and fractures. It is, therefore, important that care providers in these homes cut down the falls and the rate of fall-related dangers. Interventions have succeeded in reducing these falls in community- residence for aged patients, but efficiency in reducing them in nursing homes is not evident. Various studies investigate the effectiveness of diverse programs to reduce falls within nursing homes. Examples of the intervention programs comprise of environmental evaluation, assessment and alteration of the assistive device, changes in medication, evaluation, and training of gait, staff education, exercise programs, use of hip protector, and the evaluation of blood pressure. Research shows that the intervention and evaluation of the environment reduce falls within nursing homes and there is a relationship amid falls and a few medications. There are however no indications on the impact of the change in medication and the falls. There is also no evidence that workout programs reduce the falling rates. Even though ineffective in cutting down rates of fall, the usage of hip protectors gives the impression to outcome in fewer fall-associated morbidity (Vu, Weintraub & Rubenstein, 2006).

Keywords

Falls, intervention, prevention, risk factors, hip-protectors, risk assessment, multifaceted.

Falls in Nursing Homes, Are they Preventable

Falls are unintentional coming to rest at a lower level under the effect of gravity. Falls commonly affect the elderly population. Research shows that approximately one-third of the community-dwelling population older than 65 years fall each year, and worryingly half of these experience multiple falls. These reports do not take into account the unreported falls. Also, nursing home dwellers that are older than 65 years are more likely to fall as compared to the home counterparts. 15% to 20% of nursing homes falls result in fractures or hospital admissions compared to 5% of the community falls. There are more consequences such lacerations, internal organ damage, intracranial hemorrhage, increased fear of falling, and exposure of nursing homes to potential suing. The health care provider must, aim therefore, to reduce both the rate of falls as well as the rate of fall-associated morbidity within the long-term care situation (Vu, Weintraub & Rubenstein, 2006). Research shows that approximately 10% to 20% of falls within nursing homes lead to serious injuries and 2% to 6% lead to fractures. Falls can cause debility, functional degeneration along with decreased life quality. Falling fear can lead to additional functional loss, stress, thoughts related to helplessness, along with social segregation (Centers for Disease Control and Prevention).

It is unclear whether interventions will reduce the rates of falls in elderly patients, particularly those residing in long-term care facilities. Falls result from several risk factors acting on the individual, making it difficult to construct fall prevention programs. Potential fall-risk factors include both intrinsic risk factors (cognitive impairment, visual impairment, muscle weakness, neurologic impairment. gait/balance impairment, and cardiovascular derangements) and extrinsic risk factors (environmental and iatrogenic). Because falls are often the result of the interplay of two or more risk factors, interventions targeting only some of the existing risk factors might not be effective in preventing falls (Vu, Weintraub & Rubenstein, 2006).

Research has identified preventive interventions that have an effect in reducing the incidence of falls in community-dwelling patients. These responses include detection of risk factors and abatement programs, exercise interventions, environmental modification, or multifactorial intervention programs that include fall risk assessments, medication adjustments, exercise intervention, environmental hazard changes, and fall-risk education (Vu, Weintraub & Rubenstein, 2006; Quigley et al. 2010). High-quality evidence points out that durable exercise programs for active elderly people as well as environmental alteration within the dwellings of frail aged individuals will cut down falls as well as possibly fall-associated injuries in Ontario's aged population (Weatherall, 2008).

The American Geriatric Society, the British Geriatric Society, and the American Academy of Orthopaedic Surgeon Panel on Falls Prevention published guidelines for health care providers in managing fall risks factors and falls in elderly patients both in the community and in long-term care facilities. A review of the article indicates that several programs on fall prevention were effective in reducing falls within nursing homes. Although these programs in long-term care facilities do not prove to be effective, in many assessments, the practice continues within nursing homes.

The current literature only allows the assessment of environmental assessment/modification, exercise intervention programs, hip protector use, and medication assessment/modification as individual interventions. A review of the literature demonstrates that environmental assessment and modification results in a significant reduction in falls in nursing home residents. Exercise programs for nursing home residents failed to show a similar effect on falls despite improvement in some objective measures of functional status. Similarly, literature does reveal a clear association between the use of certain medications (Sorock et al., 2009) and increased fall rates, but no studies examine the effect of medication reduction or elimination on fall rates in nursing home residents. Finally, a review of the available literature on hip protector use within nursing homes showed a decline in hip fractures (Vu, Weintraub & Rubenstein, 2006; Berry, Lee, Cai & Dore, 2013).

Sadly, there are no trials to examine the effect of the remaining interventions individually on nursing home fall rates. These three components could have significant roles in reducing the fall rates in those multifaceted fall prevention trials that included these particular programs in their respective intervention arm. Clinical trials involving fall prevention measures directed at nursing home residents have been fewer and less conclusive. The fact that fall prevention strategies applied successfully in community-dwelling geriatric patients have often failed to yield similar results in nursing home patients (Vu, Weintraub & Rubenstein, 2006). Group and home-based exercise programs, and home safety interventions reduce the rate of falls as well as the risk associated with falling. Multifactorial evaluation as well as intervention programs can cut down the amount of falls; however, it cannot eliminate the risk associated with falling (Gillespie et al., 2012)