Chapter 12: Falls in Older Adults

Learning Objectives Acknowledge the complex health and cost issues related to falls for older adults. Describe older adults with a predisposition for falls and falls with injury. Identify intrinsic and extrinsic risk factors for falls in older adults. Incorporate a patient-specific fall risk assessment into an individualized plan of care. Recognize medications associated with falls in older adults. Identify patients at risk for restraints. Discuss nonrestraint interventions to prevent falls.

Falls in Older Adults Preventable Life threatening Not a normal consequence of aging Geriatric syndrome Frequency increases with age and frailty May be first indicator of acute problem May stem from chronic disease May be a marker for progression of age-related changes in vision, gait, strength

Falls in the Hospital Setting Common problem for hospitalized older adults Up to 50% of hospitalized patients in the U.S. are at risk for falls; of those, 50% are injured Most common adverse incident in hospitals: 3-5 falls per 1,000 bed days (about 1,000,000 inpatient falls every year) Fall represent a national measure of quality and safety in the National Database of Nursing Quality Indicators (NDNQI).

Falls in the Hospital Setting (cont’d) Implications of Falls 20-30% suffer moderate to severe injuries 10-20% suffer fractures Repeated falls lead to ADL and IADL deficits, high risk for further hospitalization, disability, institutionalization, and death Cost of fall injuries by 2020 expected to be $54.9 billion

Falls in the Hospital Setting (cont’d) Risk Factors (Table 12-1, p. 460) Intrinsic: related to the patient’s physiology and physical changes. ex)cognitive/sensory impairments, impaired mobility, frailty, meds.. Extrinsic: related to the physical environment. Ex) stairs, poor lighting, restraints, cluttered environment, side rails, unsuitable footwear… Fall Risk Assessment Tinetti Performance-Oriented Mobility Assessment (POMA) Timed Get Up and Go Test

Falls in the Hospital Setting (cont’d) Fall Prevention and Safety Promotion Strategies Surveillance Nonrestraint fall prevention interventions Avoid Physical restraints and Chemical restraints

Torso support Leg restraint Roll belt Hand mitten Soft belt Seating restraint Wheel chair positioner

Falls in the Community Setting Risk Factors (p. 460) Intrinsic Factors Extrinsic Factors Age Gender Race Cognitive function Physical function Physical status Disease states Medications Environmental hazards Nonsupportive footwear Recent hospitalization Wheelchair use, reckless wheelchair use

Falls in the Community Setting (cont’d) Fall Prevention and Safety Promotion Strategies Fall risk assessment Evaluate functional status: ADLs, appropriate use of adaptive equipment such as canes or walkers, and fear of falling PT evaluation for safe footwear and adaptive devices OT evaluation for safe living environment: loose cords, rugs, lighting

Falls in the Community Setting Fall prevention (cont’d) Exercise programs: Tai Chi Multifactorial intervention tailored to individual cognitive and physical ability Regular eye exams Postural hypotension or other cardiovascular conditions Calcium and Vitamin D

Falls in the Community Setting (cont’d) Medications Beer’s Criteria identifies medications and doses that may be harmful to adults age 65+ Less is more; Start low and go slow Regular medication review Discontinue unnecessary therapy Medications implicated in falls benzodiazepines, sedatives and hypnotics, antidepressants, antipsychotics (neuroleptics), antiarrhythmics, digoxin, diuretics, alcohol

Falls in the Community Setting (cont’d) Modify the environment: Small children, pets Minimize clutter Throw rugs Stairs Hand rails Check flooring Educate client and family Pressure-sensitive bed alsrms

Falls in the Community Setting (cont’d) Community Resources for Fall Prevention Los Angeles Falls Prevention Coalition StopFalls Network California Centers for Disease Control National Institute on Health and Aging’s Age Page Hartford Institute for Geriatric Nursing guidelines

Summary National healthcare organizations have tools and resources nurses can use to provide health care to older adults Fall risk assessment during routine care may help older adults maintain functional status and improve quality of life. Reducing falls lowers healthcare costs due to fewer emergency room visits and hospital stays. Environmental and multifactorial assessments and interventions can make the difference between safety and falling.

Question If the nurse is assessing for extrinsic factors for falls, which of the following should be included? throw rugs ataxia cognition dizziness