The risk of falling increases with age. 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):

• Each year, of adults age 65 and older fall.

• Falls are the main cause of injuries and injury-related deaths in older adults.

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

• 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.

See Focus on Surveys: Fall Prevention.

Focus on Surveys

Fall Prevention

The Centers for Medicare & Medicaid Services (CMS) defines a fall as:

• Unintentionally coming to rest on the ground, floor, or other lower level. Force, such as being pushed, was not involved.

• When a person loses his or her balance and would have fallen if staff did not act to prevent the fall.

• When a person is found on the floor unless matters suggest otherwise.

The survey team will observe:

• For the fall risk factors described in this chapter.

• For hazards described in this chapter and in Chapter 13.

• For safety measures to prevent falls.

• For the safe repair and use of bed rails, hand rails and grab bars, and wheel locks.

• For the use of assistive (adaptive) devices. Canes, walkers, and transfer/gait belts are examples.

• For safe transfer (Chapter 19) and ambulation (Chapter 30) procedures.

• If call lights are answered promptly.

• If the person’s care needs are addressed.

• If the person’s care plan is followed.

The survey team may interview you about identifying hazards (Chapter 13) and preventing falls.

Causes and Risk Factors for Falls

Most falls are caused by multiple risk factors. The more risk factors present, the greater the risk of falling. Most falls occur in patient and resident rooms. Poor lighting, cluttered floors, throw rugs, and out-of-place furniture are causes. So are wet and slippery floors, bathtubs, and showers. Weakness, walking problems, and needing to use the bathroom are major causes. For example, Mrs. Hines is weak and has an urgent need to urinate. She falls trying to get to the bathroom.

The accident risk factors described in Chapter 13 can lead to falls. The problems listed in Box 14-1 increase a person’s risk of falling.

Box 14-1

Fall Risk Factors

Care Setting

• Bed height: too low or too high

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

• Floors: cluttered, wet, slippery, or uneven

• Furniture out-of-place

• Lacks hand rails or grab bars

• Lighting: poor or glares

• Restraint use

• Setting: new, strange, and unfamiliar

• Throw rugs or other tripping hazards

• Wet and slippery bathtubs and showers

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

The Person

• Age: over 65 years

• 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: incontinence, frequency, urgency, urinating at night (nocturia)

• Incontinence: urinary or fecal

• Joint pain and stiffness

• Reaction time: slow

• Shoes that fit poorly

• Sleep problems

• Vision problems

• Weakness

See Focus on Long-Term Care and Home Care: Causes and Risk Factors for Falls.

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

Focus on Long-Term Care and Home Care

Causes and Risk Factors for Falls

Long-Term Care

Nursing center residents are at increased risk for falls. Reasons given by the CDC include:

• Residents are often older and more frail than older adults in the community.

• Residents tend to have more problems with their health, thinking and memory, and ability to perform activities of daily living (ADL).

• Many residents have trouble walking and need help with mobility (ability to move about).

Weakness and walking problems are the most common causes of falls in nursing centers. Care setting hazards are other causes—poor lighting, wet floors, incorrect bed height. Other risk factors are transfer problems (Chapter 19), shoes that fit poorly, and improper use or fit of wheelchairs, walkers, canes, and other devices.

Teamwork and Time Management

Causes and Risk Factors for Falls

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

Answer call lights promptly. This includes the call lights of patients and residents assigned to co-workers.

During shift changes, staff are busy going off and coming on duty. Confusion can occur about who gives care and answers call lights. Falls can result. Know your role during shift changes. Nursing staff must work together to prevent falls.

Fall Prevention Programs

Agencies have fall prevention programs. The measures listed in Box 14-2 are part of the program and the person’s care plan. Many measures also apply to home settings. The care plan also lists measures for the person’s risk factors.