1. The Epidemiology of Falls
Nursing 702
Maria Lens, RN, MSN, PHN, FNP-BC

2. EPIDIMIOLOGY OF FALLS
Most common in older population and high rank in clinical problem.
40% of adults 65 and older fall at least once a year at home.
In hospital setting after a fall only half live after a year from a fall.
2/3 of deaths from falls could have been prevented.

3. In 2000, $0.2 billion was spent on fatal falls, and $19 billion on non-fatal falls.
Estimated to costs in 2020, $ 32.4 billion.
JCAHO implemented national safety goals to reduce falls.
CMS not reimbursing for health care needed after a fall if occurred in hospital.
Incidence of falls in hospital, 1.4 falls per bed per year

4. Causes of falls Accidental/environment 31% Gait/Balance 17%
Dizziness/vertigo
13%
Drop Attack
10%
Confusion/cognitive impairment 4%
Postural hypotension 3%
Visual Impairment
Unspecified or unknown
18%

5. Assessment Tools Morse Fall Scale Schmid Fall Scale
Hendrick Fall Scale

6. Background Acute care facility in suburb area Schmid Fall Scale used
Pt assessed every 4 hours for falls on medical/telemetry, ICU, TCU, and peds, every 8 hours med/surg
Many falls occurring still despite interventions
Bed alarms, restraints, room near nurses station
One death this year from from after hip replacement due to fracture from fall.

7. audits Bed alarms not on Score not same from observer.
Least restrictive restraint not used (lap belt)

8. Data on Facility Falls

9. Surveillance Figure out PPV and NPV from Schmid Fall Assessment tool
Determine sensitivity and specificity
Look at retrospectively, for a years worth
Do case-control study.
Look for relationships, associations and causation

10. Example: diseases (DM, Cardiac, Alzheimer's, CVA)
Diagnosis: (ETOH, ALOC, UTI)
Environment: Specific room, low-staffed day, skill mix
Determine odds/ratios to diagnosis

11. Figure Odds/Ratio
ALOC
No ALOC
Falls a b
a/a+b
No falls c d
c/c+d

12. Health Promotion
Do pilot study based on outcomes from retrospective study.
Target most common reasons for falls at our specific facility.
Implement new interventions (low-beds, chair alarms, hip protectors)
After pilot study, determine outcomes

13. If benefits are seen, implement change in policy and procedure for falls
Contact CNO, Director of adult care services.
Let it be known, it is evidenced-based practice.
Promote health and wellness.

14. Conclusion
Change policy and procedure based on new data not on outdated policy.
Disseminate results
Decrease falls, injury from falls, and most important deaths

15. References Boyer, C. (2010). Falls by Quarter. (Email)
Gordis, L. (2009). Epidiomiology. (Fourth edition ed.). Baltimore, Maryland: Saunders Elsevier.
Jensen J. Nyberg, L., Gustafson, Y., & Lundin-Olsson, L. (2003). Fall and injury prevention in
residential care-effects in residents with higher & lower levels of cognition. Journal of  
American Geriatrics, 51,
Rubenstein, L. (2006). Falls in older people: epidemiology, risk factors and strategies for  
prevention. Age and Aging, 35-S2, ii37-ii47.
Sizewise. (2010). Sizewise fall risk toolkit: Understanding fall risk, prevention, & protection., 1-
37.