Falls in Long-Term Care - www.fallslinltc.ca

OVERVIEW

 

The Significance of the Problem

Risk Factors

The Significance of the Problem


A fall is defined as “an event that results in a person coming to rest inadvertently on the ground or other lower level” ( Ray et al., 1997, p. 559 ). Falls are a serious problem and a major cause of morbidity and mortality among the elderly ( Kannus et al., 1999 ), especially among those in long term care.

Each year, about 40% of nursing home residents fall (Gurwitz et al., 1994; Ray et al., 1997; Thapa et al., 1996; Tinetti & Williams, 1997). This high propensity for falls and fall-related injury in the elderly is due to a high prevalence of comorbid diseases and physiological decline associated with aging which can make even a mild fall potentially dangerous (AGS et al., 2001). The American Geriatrics Society (2001) reported that the incidence of falls in nursing homes is about three times the rate for community-dwelling elders ( Rubenstein, Josephson, & Robbins, 1994) , producing an annual incidence rate of approximately 1.5 falls per bed. The injury rates of those in nursing homes are also higher, with 10–25% of these falls resulting in fractures, lacerations or a need for hospital care (Hignett and Masud, 2006). As well, besides the physical consequences of falls, there is also a psychological component where victims experience fear of falling and thus decrease in their willingness to perform functional activities such as bathing, dressing and walking.


Risk Factors


Several risk factors have been identified for falls; they include age, gait or balance impairment, sensory or cognitive impairment, musculoskeletal diseases, environmental hazards, and many medications. These risk factors are categorized into two types: (1) extrinsic factors or those related to the environment and (2) intrinsic factors, or those related to the person’s condition (Hignett and Masud, 2006). The strongest predictor of falls is having previously fallen (Kiely, Kiel, Burrows, & Lipsitz, 1998) . As well, the risk of falling increases dramatically as the number of risk factors increases (AGS et al, 2001). The following chart published by the National Resource Center for Safe Aging contains a more extended list of risk factors for falls:

  Related to the Person's Condition (Intrinsic) Related to the Environment (Extrinsic)
  • Recent history of falls (most significant risk factor)
  • Incontinence, etc.
  • Cognitive psychological status
  • Mobility balance/strength problems- Dizziness/vertigo
  • Postural hypotension
  • Age (over 65 years old)
  • Osteoporisis (can lead to pathological hip fractures and increases likelihood of fracture if a fall occurs)
  • Overall poor health status
  • Environment (wet floor, floor glare, cluttered room, poor lighting, inadequate handrail support, monochromatic color schemes, loose cords or wires)
  • Inapporopriate or lack of footwear
  • Low toilet seat
  • Wheels on beds or chairs
  • Restraints (including side rails in the up position)
  • Prologed length of stay
  • Unsafe equipment (unseady IV poles)
  • Broken equipment
  • Beds left in high positions
  • Seizures
  • Cardia arrhythmias
  • CVA or TIA
  • Syncope
  • "Drop attacks"
  • individual reactions to medication

Source: National Resource Center for Safe Aging (2004). Falls Toolkit.

* This list is by no means exhaustive.

References

American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention (2001). Guideline for the Prevention of Falls in Older Persons. Journal of the American Geriatrics Society , 49(5): 664-672. Abstract available at PubMed.

Gurwitz, J. H., Sanchez-Cross, M. T., Eckler, M., & Matulis, J. (1994). The epidemiology of adverse and unexpected events in the long-term care setting. Journal of the American Geriatrics Society, 42: 33-38. Abstract available at PubMed.

Hignett, S. and Masud, T. (2006). A review of environmental hazards associated with in-patient falls. Ergonomics. 49(5-6): 605-616. Abstract available at PubMed.

Kannus, P., Parkkari, J., Koskinen, S., Niemi, S., Palvanen, M., & Jarvinen, M. (1999). Fall-induced injuries and deaths among older adults. JAMA, 281(20):1895-1899. Abstract available at PubMed.

Kiely, D. K., Kiel, D. P., Burrows, A. B., & Lipsitz, L. A. (1998). Identifying nursing home residents at risk for falling. Journal of the American Geriatrics Society, 46: 551-555. Abstract available at PubMed.

National Resource Center for Safe Aging (May 2004). Falls Toolkit. Available at: http://www.safeaging.org/model/programs/toolfall_ncps/toolfall_detail.asp#contents

Ray, W. A., Taylor, J. A., Meador, K. G., Thapa, P. B., Brown, A., & Kajihara, H. K. (1997). A randomized trial of a consultation service to reduce falls in nursing homes. Journal of the American Medical Association, 278:557-596. Abstract available at PubMed.

 Rubenstein, L. Z., Josephson, K. R., & Robbins, A. S. (1994). Falls in the nursing home. Annals of Internal Medicine, 121: 442-451. Abstract available at PubMed.

 Thapa, P. B., Brockman, K. G., Gideon, P., Fought, R. L., & Ray, W. A. (1996). Injurious falls in nonambulatory nursing home residents: A comparative study of circumstances, incidence, and risk factors. Journal of the American Geriatrics Society, 44: 273-278. Abstract available at PubMed.

 Tinetti, M. E., & Williams, C. S. (1997). Falls, injuries due to falls, and the risk of admission to a nursing home. The New England Journal of Medicine, 337(18): 1279-1284. Abstract available at PubMed.