The Epidemiology of FallsNursing 702

Maria Lens, RN, MSN, PHN, FNP-BC

EPIDIMIOLOGY OF FALLSMost common in older population and high rank

in clinical problem.

40% of adults 65 and older fall at least once a year at home.

In hospital setting after a fall only half live after a year from a fall.

2/3 of deaths from falls could have been prevented.

In 2000, $0.2 billion was spent on fatal falls, and $19 billion on non-fatal falls.

Estimated to costs in 2020, $ 32.4 billion.

JCAHO implemented national safety goals to reduce falls.

CMS not reimbursing for health care needed after a fall if occurred in hospital.

Incidence of falls in hospital, 1.4 falls per bed per year

Causes of fallsAccidental/environment 31%

Gait/Balance 17%

Dizziness/vertigo 13%

Drop Attack 10%

Confusion/cognitive impairment 4%

Postural hypotension 3%

Visual Impairment 3%

Unspecified or unknown 18%

Assessment ToolsMorse Fall Scale

Schmid Fall Scale

Hendrick Fall Scale

BackgroundAcute care facility in suburb area

Schmid Fall Scale used

Pt assessed every 4 hours for falls on medical/telemetry, ICU, TCU, and peds, every 8 hours med/surg

Many falls occurring still despite interventions

Bed alarms, restraints, room near nurses station

One death this year from from after hip replacement due to fracture from fall.

auditsBed alarms not on

Score not same from observer.

Least restrictive restraint not used (lap belt)

Data on Facility Falls

SurveillanceFigure out PPV and NPV from Schmid Fall

Assessment tool

Determine sensitivity and specificity

Look at retrospectively, for a years worth

Do case-control study.

Look for relationships, associations and causation

Example: diseases (DM, Cardiac, Alzheimer's, CVA)

Diagnosis: (ETOH, ALOC, UTI)

Environment: Specific room, low-staffed day, skill mix

Determine odds/ratios to diagnosis

Figure Odds/Ratio

ALOC No ALOC

Falls a b a/a+b

No falls c d c/c+d

Health PromotionDo pilot study based on outcomes from

retrospective study.

Target most common reasons for falls at our specific facility.

Implement new interventions (low-beds, chair alarms, hip protectors)

After pilot study, determine outcomes

If benefits are seen, implement change in policy and procedure for falls

Contact CNO, Director of adult care services.

Let it be known, it is evidenced-based practice.

Promote health and wellness.

ConclusionChange policy and procedure based on new data

not on outdated policy.

Disseminate results

Decrease falls, injury from falls, and most important deaths

References Boyer, C. (2010). Falls by Quarter. (Email)

Gordis, L. (2009). Epidiomiology. (Fourth edition ed.). Baltimore, Maryland: Saunders Elsevier.

Jensen J. Nyberg, L., Gustafson, Y., & Lundin-Olsson, L. (2003). Fall and injury prevention in

residential care-effects in residents with higher & lower levels of cognition. Journal of  

American Geriatrics, 51, 627-635.

Rubenstein, L. (2006). Falls in older people: epidemiology, risk factors and strategies for  

prevention. Age and Aging, 35-S2, ii37-ii47.

Sizewise. (2010). Sizewise fall risk toolkit: Understanding fall risk, prevention, & protection., 1-

37.