Nursing homes have active programs in place to prevent falls and to monitor patients who do fall. This is important because as many as half of all nursing home patients will fall in one year and one in ten who fall will have a serious injury. (1)
Geriatric patients who live independently at home are also at increased risk of falls and of serious injuries from falls. Today, I’ll review the publication “The Falls Management Program: A Quality Improvement Initiative for Nursing Home Facilities” because it contains an approach that can be used to help safeguard seniors living at home.
The common risk factors for falls are both intrinsic and extrinsic. (2)
Intrinsic factors (those related to the patient) include: Difficulty with gait and decreased balance and strength due to normal aging; acute medical conditions (pneumonia, for example, or other infections); chronic diseases; decreased muscle strength from inactivity; and medication site effects (for example, low blood pressure when standing due to high blood pressure medicines).
Extrinsic factors (those that are not related to the patent) include: Enrivonmental hazards (poor lighting, slippery floors, loose throw rugs, etc); unsafe personal equipment (improperly fitted walker, bad breaks on a wheelchair, and others), unsafe personal items (poor footware, too long robes or gowns), improperly stored personal items (hard to get causing falls while reaching).
When a senior falls at home, it is important that he or she alert a loved one or other care giver even if no injury has occurred. This is because the fall may have been due to a medical condition. A medical evaluation including vital signs (pulse, temperature, respiratory rate, blood pressure, and [if available] oxygen saturation). Blood pressure and pulse should be checked lying down and then standing up because a low blood pressure when standing is a frequent cause of falls. And diabetics who fall should have a finger stick blood sugar done at the time of the fall to make sure it wasn’t caused by an abnormal blood sugar.
Appendix B has a complete and outstanding set of forms that you and your loved one’s doctor can use to evaluate the patient after (or even better) before a fall. The Falls Assessment Sheet goes over the risk factors for falls: medications, low standing blood pressure, vision problems, mobility problems, and unsafe behaviors. (p. 76)
The Falls Assessment Cue Sheet (p. 77 and 78) has a great list of medicines that can increase risk of falls, instructions on how to check for low standing blood pressure (orthostatic hypotension), and how to evaluate mobility and transfer safety).
Appendix B has even more detailed forms on the subjects covered in the Cue Sheet and it is worth printing out and reviewing in its entirety.
The Falls Assessment Report (p. 87) is a form that the nursing home faxes to the resident’s physician after a fall and has a list of possible orders for the physician to consider. It is an excellent memory aid and checklist for the physician.
The Falls Intervention Plan (p. 89) is an excellent checklist of possible interventions to lessen the risk for falls.
(1) The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities. From the Agency for Healthcare Research and Quality, 2005 available at www.ahrq.gov/research/ltc/fallspx/fallspxmanual.htm. PDF available at www.ahrq.gov/research/ltc/fallspx/fallspxmanual.pdf.
(2) Ibid., p. 2