For elderly residents, falls are a major concern. Not only are individuals more fragile in general, with reduced bone density and other compromised body defenses, but recovery periods are often longer, more grueling, and a more delicate process in general.
A reported one third of the population 65+ will fall each year, and those 80+ years increase to over half of these incidents – note that these are only the reported facts. Falls commonly result in hip fractures and other injuries. On top of that, approximately half of the adults who experienced a hip fracture from a fall will likely fall again in another 6 months. The concern for elder falls is so great that Congress passed the Elder Fall Prevention Act (H.R. 3513) back in 2003 to support more widespread research, education, and services on this issue.
Assisted Living Education provides some common and typical precautions taken in residential care facilities to prevent falls and injury in elderly residents.
Understanding the Context – What Causes a Fall
For the average person, it seems like an obvious answer: we lose our footing or balance, we trip, and we fall. This is true to an extent, but there are so many more variables to consider with an elderly person as well. Here are some factors that can contribute to the risk of falling in elderly:
Weakened muscle tone, gait problems – Those who are not as active as their peers or have sustained an injury that reduces their activity may experience a decrease in muscle tone. This decrease in strength can cause parts of the body to give out more easily. Arthritis, joint, and other issues can also compromise an individual’s balance.
Blood pressure fluctuation – ‘Postural hypotension,’ or a decrease in blood pressure due to rising too quickly from a sitting or lying position can occur more easily in elderly, sometimes with dizziness. Causes for this may be dehydration, side effects from medication, or another underlying disease like diabetes.
Slowed reflexes – With age comes reduced reflexes and a delay in reaction time. Elders may not physically be able to react quickly enough to prevent a fall.
Sensory issues – Some individuals experience a loss of sensation in the extremities. When this occurs in the feet, it can be difficult to detect changes in the terrain or how you are stepping, leading to a trip or fall.
Poor vision – Vision problems can make it difficult to see a clear (or unclear) pathway, or cause a slower adjustment time to changes in light. Poor depth perception can also cause problems around stairs or unfamiliar environments.
Confusion – Moments of disorientation itself or fear/panic from the confusion can cause a misstep. Also, wheelchair or bed-bound residents may forget that they cannot walk and attempt to get up.
Medications – Some medications can cause dizziness or low blood pressure, causing instability and loss of balance.
Fall and Injury Prevention
Residents in a care facility typically have more compromised health conditions than the ‘outside’ elderly community and can require vigilance to ensure their safety. Familiarity with your residents, their conditions, and risks can help you and your facility think proactively in taking and enforcing preventative measures.
Some common preventative measures often taken in a facility include:
- Maintain clear pathways
- Avoid the use of carpeting or rugs to prevent tripping from uneven surfaces. If there is a carpeted surface, commercial-grade is best for the short fibers and extra durability.
- Use textured adhesives on sloping floors for extra grip
- Use ramps in place of any steps
- Install grab bars in shower spaces and bathrooms
- Use raised toilet seats or commodes
- Use a shower seat or bench for bathing
- Lower bed heights for especially at-risk residents
- Install handrails along the hallways
Also be sure residents’ call buttons are easily accessible, and a timely response also encourages residents to request for assistance.
Individual Concerns & Major Fall Risks
Some residents may use walking aids such as a cane or a walker to help with mobility. Frequent checks that these implements are properly adjusted for the individual helps prevent misuse that could lead to a fall. Ill-fitted clothing can also become a problem, especially with the use of walking aids. If the family is involved, ask them to ensure pants or skirts are properly fitting, or even hemming them slightly can be helpful. Reviewing these types of precautions during the admissions process or a debriefing meeting can help the family become more involved and further assist with the care of their family member.
Residents who repeatedly attempt to get up unassisted can be considered a major fall risk. This can happen in stubborn individuals or those with dementia, especially if they have been bed or wheelchair-bound only a short time. They may forget that they are not supposed to get up unassisted, or are determined to reclaim their independence.
The following are extra preventative measures that can be employed for those who present an elevated fall risk.
Bed or personal alarms – Bed alarms detect when there is a major shift in weight or movement, as in a person attempting to sit up and get out of bed. These alarms help alert a staff member to come quickly and check on the resident. Personal alarms work similarly for use in the wheelchair. One type hangs off the back of the wheelchair and clips on to the back of the resident’s clothing. If the resident leans too far forward in an attempt to rise, the device separates and the alarm is engaged. Another type is a pad which fits on their seat, and when a significant shift/decrease in weight is detected, the alarm will sound.
Room placement – Assigning a high risk fall resident to a room near the nurse’s station can help keep eyes on any independent attempts to get up.
Extremely lowered bed heights – Any time a high risk resident is in bed, adjust their bed height to the lowest setting possible so they are closer to the ground in case of any attempts to get up.
Floor mat – For residents persistent in their attempts, a floor mat placed next to the bed during the night, in addition to the lowered bed height, can also offer added protection.
Hip pads are also an option in an attempts to reduce the impact from elder falls, but they’ve received mixed reviews. Some studies reveal no significant statistical data in their favor. Additionally, many hip fractures can occur not just from an impact, but because of an abnormal movement or rotation of the hip during a fall.
For residents who have little or no issues with cognitive or memory functions, they may benefit from extra education from an occupational or physical therapist to review safety and fall precautions. Those recovering from a procedure or injury should have already received instruction on how to accommodate their new (i.e. limited) range of movement. If the resident has limited mobility and uses a walker or wheelchair the majority of the time, physical and/or occupational therapy generally covers how to safely and properly transfer from bed to standing position/wheelchair and vice versa, as well as commode and shower seat/bench transfers.
Other residents can benefit from such education as well, but may require frequent prompts and assistance due to difficulty in recalling steps and sequences.
Keeping the residents active as much as possible is not only good for their overall health, but can help keep muscle tone and prevent stiffness or muscle atrophy, which can contribute to a fall. Non-ambulatory residents can still exercise to maintain strength in their arms and hands.
The Big Picture
Looking at the overall health of the resident is crucial to their care. Information from the initial comprehensive health examinations, mental & cognitive evaluations, fall risk assessments, and review of resident’s health or care history all help in designing an individualized care plan. This information can also be useful in planning for future changes or adjustments to the facility itself, for additional precautions or measures throughout the campus.
Assisted Living Education is committed to providing the best in quality education for assisted living services. Our professional instructors have years of real, hands-on, and practical experience that enrich our already-extensive courses. We offer RCFE classes, licensing, and other products and services for assisted living, plus RN, LVN, and SNF continuing education through our online classes. Explore our website for more information, visit our contact page, or call 1-855-200-0188 for immediate service. We look forward to working with you!