ASSESSMENT and MANAGEMENT:

Recurrent Fallers

 

Ray and colleagues (1997) evaluated an intervention program to prevent falls and fall-related injuries in a group of high-risk nursing home residents. They found that the falls prevention program was most effective for frequent fallers or those residents who had had 3 or more falls in the prior year and who followed the recommendations. These frequent fallers had 50% less injurious falls than the control group. The interventions they recommended targeted four safety domains: environmental and personal safety, wheelchair use, psychotropic drug use, and transferring and ambulation. After performing a thorough multi-disciplinary and structured individual assessment on each of the four domains, they developed an individual treatment plan from each resident’s data. The following are some of their recommendations:

1. Environmental and personal safety: assess resident, resident’s room and bathroom, and common areas to identify potential safety hazards (i.e. resident’s bed, floor surfaces, clutter, lighting, accessibility of objects, bathroom equipment, poor foot care, unsafe footwear)

• Safety recommendations:
• install functional wheel locks for beds
• change lighting
• change flooring
• reposition or repair call lights
• raised toilets
• label wheelchairs, other equipment, furniture, and other belongings with residents’ names
• repair or replace furniture
• use proper fitting shoes
• remove clutter and maintain clear area

 
2. Wheelchair use : for those residents who use a wheelchair, have an occupational therapist assess maintenance and safety features of wheelchair, foot and leg rests, the seat and back, forward moving protection, resident posture, and propelling/reaching

• Safety recommendations:
• Correct wheelchair problems as soon as possible
• adjust/repair brakes
• clean/lubricate moving parts
• install anti-tip rods
• add brake extensions
• implement a wheelchair maintenance program
   

  3. Psychotropic drug use: evaluate appropriateness of psychotropic drugs (antipsychotics, tricyclic antidepressants, benzodiazepines)

• Safety recommendations:
• identify treatment alternatives that pose less fall risk
• suggest psychosocial interventions
• taper and discontinue benzodiazepine
• reduce antipsychotic dos
• implement behaviour management plan

 
4. Transferring and ambulation: have occupational therapist observe residents as they transfer from bed, chair, and toilet to assess safety (in terms of equipment height and stability, transfer process, and quality of staff assistance). Also have O.T. observe residents rise and lower to bed, chair and toilet and assess for sign of postural hypotension, safety of cane/walker use, gait safety

• Safety recommendations:
• increase observation of resident
• toilet/nourish at least every 2 hours
• repair/modify cane
• always assist resident during transfer
• remind resident of safe transferring techniques

References

Ray, W., Taylor, J., Meador, K., Thapa, P., Brown, A., Kajihara, H., Davis, C., Gideon, P., Griffin, M. (1997). A randomized trial of a consultation service to reduce falls in nursing homes. JAMA, 278(7): 557-562. Abstract available at PubMed.

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