When People Fall: Prevention for Those at Risk by In grid Sidorov, MSN, RN Brian H. Kim, MD and ...

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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia

When People Fall: When People Fall: Prevention for Those at Prevention for Those at

RiskRisk by

Marie Boltz, MSN, CRNP, NHAGerontological Nursing Consultant

Reviewed and updated in summer 2012 by:

Ingrid Sidorov, MSN, RNBrian H. Kim, MD

and Carol A. Maritz, PT, EdD, GCS

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Why Talk About Falls?

Falls happen often 1 in 3 older adults fall each year; 1

in 2 in long term care fall each year Falls are dangerous

25% of falls cause minor injury 11% of falls cause major injury

such as hip fracture 88% of falls are related to medical and

or physical conditions Many (about 2/3) fall associated

injuries and deaths can be prevented

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Seriousness of Falls

After older adults fall 40% become less active 40- 70% report fear of falling

Almost 10% go to the ER for treatment after falling

Falls may be a warning sign of new or worsening illness.

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ObjectivesAt the end of this program you

will be able to:1. Identify risk factors and

common causes for falls.

2. Describe proper assessment after a fall.

3. Discuss intervention and prevention strategies.

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Who Falls?

Older adults who are acutely ill.

Older adults admitted to a new setting.

Those with functional loss. Elders with problems walking, hearing,

vision and memory.

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Where do Falls Happen?

» 10% in long term care» 30% in public places» 60% at home

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Age-Related Risk Age-Related Risk FactorsFactors

Consider age-related changes: Gait Posture Muscle Strength Balance issues Response to medication Response to stress Reduced vision or hearing Urinary frequency/incontinence

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Fear of Falling

• About 30% of older adults have a fear of falling.

• This includes people who have NOT fallen.• Fear of falling affects how people react to

their environment and actually increases the risk of falling.

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Should a Single Fall be of Concern?

• ABSOLUTELY!• Every fall has the potential for being

serious.• Consider changes in health, risk factors.

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Health Problems As Health Problems As RiskRisk FactorsFactors

1. Heart disease and stroke2. Diabetes 3. Osteoporosis4. Gait disorders5. Depression6. Polypharmacy7. Dementia

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Cognitive Loss As a Risk Cognitive Loss As a Risk FactorFactor

Anxiety from not recognizing environment

Lack of insight and judgment about safety

Sundowning Behavior issues

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Environmental Risk Environmental Risk FactorsFactors

Lighting Flooring/PavementStairs Furniture Equipment/Physical

Obstruction Improperly fitted clothing

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Assessment After a Assessment After a Fall: Fall:

What Should Staff What Should Staff Do?Do? Assess all skin and joints for

injuries Check vital signs Move to a safe location off floor Notify nurse supervisor Notify family member

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Strategies to Compensate Strategies to Compensate forfor

Physical Impairment: Physical Impairment: Impairment

Sensory loss

Muscle weakness

Approach

Eyeglasses and hearing aids Exercise – Physical therapy

consult Restorative mobility

program Assistive devices

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Strategies for Cognitive Strategies for Cognitive LossLoss

Biographical profiles

Communication/re-direction

Structured daily routine

A security system

Exercise

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Strategies for Strategies for IncontinenceIncontinence

Medical evaluation

A consistent toileting program

Proper bathroom equipment

Constipation may be the cause

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Prevention and Prevention and Management Management

ProgramProgram Assess each person in your

care Provide a safe and enabling

environmentImplement balance and fitness

programs designed by PT Educate families and staff

about falls and a restraint-free environment

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SAFE ENVIRONMENT

• Lighting• Handrails • Chair height• Equipment and items in reach• Shoes that fit• Carpeting

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THE BATHROOM

• Grab bars by shower and toilet• Rubber mats in bathtub/shower• Raised toilet seat• Drawers kept closed

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Prevention and Prevention and Management:Management:

Fitness & Activity Fitness & Activity ProgramsPrograms

Individual programs: Exercise, self-care, walking

Group programs: Exercise, yoga, walkercise, games/sports, dance/movement, tai chi

Other activity: Art, cooking, gardening, “mental gymnastics”

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Prevention and Management:Prevention and Management:Fitness & Activity ProgramsFitness & Activity Programs

• Exercise programs– Incorporate both balance and strength training– Balance training should include both static and

dynamic activities performed at moderate to high challenge

– Ideal program duration – 3-12 months

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Education ProgramEducation Program

Staff education for each caregiver role

Safety education and fall/injury prevention for all: Staff, older adults, and family

Relaxation techniques

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Education ProgramEducation Program

Education of the person at risk for falls

Nurses are responsible for education programs of older adults. CNAs should remind older adults of safe techniques as they complete assigned tasks.

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Objectives ReviewCan you now1. Identify risks factors and

common causes for falls?2. Describe proper

assessment after a fall?3. Discuss intervention and

prevention strategies?

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Thank you for your attention!

The End

When People Fall: Prevention for Those at Risk by In grid Sidorov, MSN, RN Brian H. Kim, MD and ...

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