The risk of falling increases with age. Often falling is a sign of other health problems. Persons older than 65 years are at risk. A history of falls increases the risk of falling again. Falls are the most common accidents in nursing centers.

According to the Centers for Disease Control and Prevention (CDC):

• About 1800 nursing center residents die each year from falls.

• Nursing center falls can cause serious injury including fractures. Fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand are the most common. Hip fractures and head trauma increase the risk of death.

• Falls result in disability, decline in function, and reduced quality of life.

• Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation. This may increase the person’s risk of falling again.

Causes and risk factors for falls

Most falls occur in resident rooms and bathrooms. Poor lighting, cluttered floors, incorrect bed height, and out-of-place furniture are causes. So are wet and slippery floors, bathtubs, and showers. Wheelchairs can cause falls if they do not fit the person or are in poor repair. Needing to use the bathroom, usually to urinate, is a major cause of falls. For example, Mrs. Hines has an urgent need to urinate. She falls trying to get to the bathroom.

Most falls occur between 1600 (4:00 PM) and 2000 (8:00 PM). Falls also are more likely during shift changes. During shift changes, staff are busy going off and coming on duty. Confusion can occur about who gives care and answers signal lights. Shift changes vary among centers. They often occur between these hours:

• 0600 (6:00 AM) and 0800 (8:00 AM)

• 1400 (2:00 PM) and 1600 (4:00 PM)

• 2200 (10:00 PM) and 2400 (midnight)

The accident risk factors described in Chapter 12 can lead to falls. The problems listed in Box 13-1 also increase a person’s risk of falling.

Box 13-1

Factors Increasing the Risk of Falls

Care setting

• Bed: incorrect height

• Care equipment: IV (Intravenous) poles, drainage tubes and bags, and others

• Cluttered floors

• Furniture out of place

• Lighting: poor

• Setting: strange and unfamiliar

• Throw rugs

• Wet and slippery floors, bathtubs, and showers

• Wheelchairs, walkers, canes, and crutches: improper use or fit

The person

• Alcohol: over-use

• Balance problems

• Blood pressure: low or high

• Confusion

• Depression

• Disorientation

• Dizziness; dizziness on standing

• Drug side effects

• Low blood pressure when standing or sitting

• Urination: frequent

• Diarrhea

• Confusion and disorientation

• Elimination needs

• Falls: history of

• Foot problems

• Incontinence: urinary and fecal

• Joint pain and stiffness

• Judgment: poor

• Light-headedness

• Memory problems

• Mobility: decreased

• Muscle weakness

• Reaction time: slow

• Shoes that fit poorly

• Vision problems

• Weakness

See Teamwork and Time Management: Causes and Risk Factors for Falls.

TEAMWORK AND TIME MANAGEMENT

Causes and Risk Factors for Falls

The entire health team must protect the person from harm. If you see something unsafe, tell the nurse at once. Do not assume the nurse knows or that someone is tending to the matter.

Answer all signal lights promptly. This includes the signal lights of residents assigned to co-workers.

Know your role during shift changes. Nursing staff going off duty and those of the on-coming shift must work together to prevent falls.

Fall prevention programs

Nursing centers have fall prevention programs. The measures listed in Box 13-2 are part of such programs and the person’s care plan. The care plan also lists measures for the person’s specific risk factors.