Falls in Nursing Homes

Mark L. ShiuMarch 12, 1999

UCLA School of Public HealthEpidemiology 247

Definition/Classification

Falling down spontaneously and unintentionally when walking, or tripping, slipping, or losing balance after being pushed or shoved.

Falls may occur when transferring from a bed, chair, or toilet.

Incidence of falls and complications in older people increases with age and physical disability.

Accidents are 5th leading cause of death in older adults– Falls are responsible for 2/3 of these accidental deaths

– ¾ of these deaths are caused by falls which occur in 13% of the population 65 +

1/3 of elderly living at home will fall each year and

5% will sustain a fracture requiring hospitalization.

Magnitude of Problem - General

Magnitude of Problem - Nursing Homes

Fall incidence rate in institutionalized elderly is 3x the rate in community living elderly. This is due to the frail nature of the patients and more accurate reporting of falls in institutions.

Most falls take place in bedroom or bathroom.

Most falls likely to occur during staff shift changes and times of increased activity.

Fractures and injuries– Studies suggest 1 to 5% of falls result in fracture– 5 to 10% in severe soft tissue injuries– Nursing home residents have a higher incidence of

hip fractures and mortality rates from fractures than compared with non-institutionalized elderly

Deaths– 1,800 fatal falls occur in nursing homes– 1 of 5 fatal falls will occur in nursing homes– Once injured, an elderly person who has fallen has a higher

case fatality than younger fallers

Loss of confidence/Fear of reoccurrence

Consequences of Falls

Risk Factors for Falls Multi-factorial nature of falls, often difficult to pinpoint one

specific cause. Major risk factors for falls in Nursing Homes

– Intrinsic factors Age Gender Physical/Mental/Physiological disorders Medication/chronic condition interactions Number of previous falls

– External or Environmental Mechanical restraints Accident or environmental related

Falls of non institutionalized persons are more related to environment.

Prevention

Due to multi factorial nature of fall, no single standard approach to prevention.

Must develop individualized plans for each patient.

Considerations– Patients overall condition– Risk factors– Quality of life

Prevention (cont’d)

Specific Intervention– Medical– Rehabilitative– Behavioral

Institutional Intervention– Environmental Assessment– Nursing/Staff Education– Technology

Conclusion Although further studies need to be conducted to

evaluate the effectiveness of these interventions…

In the meantime, we should implement these simple intervention strategies since they have proven effective in different cases.

Example

– Success of the Multidisciplinary Falls Consultation Service

– Falls consultation team developed in November 1986 at The Jewish Home and Hospital for Aged (JHHA), (Mount Sinai School of Medicine, Dept Geriatrics and Adult Development, N.Y.).