Falls in Nursing Homes Mark L. Shiu March 12, 1999 UCLA School of Public Health Epidemiology 247

Definition/Classification l Falling down spontaneously and unintentionally when walking, or tripping, slipping, or losing balance after being pushed or shoved. l Falls may occur when transferring from a bed, chair, or toilet.

l Incidence of falls and complications in older people increases with age and physical disability. l Accidents are 5 th 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 + l 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 l 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. l Most falls take place in bedroom or bathroom. l Most falls likely to occur during staff shift changes and times of increased activity.

l 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 l 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 l Loss of confidence/Fear of reoccurrence Consequences of Falls

Risk Factors for Falls l Multi-factorial nature of falls, often difficult to pinpoint one specific cause. l Major risk factors for falls in Nursing Homes –Intrinsic factors l Age l Gender l Physical/Mental/Physiological disorders l Medication/chronic condition interactions l Number of previous falls –External or Environmental l Mechanical restraints l Accident or environmental related l Falls of non institutionalized persons are more related to environment.

Prevention l Due to multi factorial nature of fall, no single standard approach to prevention. l Must develop individualized plans for each patient. l Considerations –Patients overall condition –Risk factors –Quality of life

Prevention (cont’d) l Specific Intervention –Medical –Rehabilitative –Behavioral l Institutional Intervention –Environmental Assessment –Nursing/Staff Education –Technology

Conclusion l Although further studies need to be conducted to evaluate the effectiveness of these interventions… l In the meantime, we should implement these simple intervention strategies since they have proven effective in different cases. l 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.).