1. Towards Fall Prevention

2. You need to know that… falling is not a normal part of aging.
the risk of falling can be minimized.
falling may be an early sign of illness.

3. What causes falls? Person Factors Poor balance Postural hypotension
Weakness
Functional, cognitive, and sensory, changes
Medication effects
Pain
Environment Factors
Poor lighting
Slippery or uneven flooring or sidewalks
Unexpected objects (tubing, pets)
Restraints
Lack of structural supports
Can you think of some other causes of falls?

4. Falls & Person-Environment Fit
We must always assess both the individual person and the environment.
However, at any given time or in any given
setting, our focus may be greater on one than on the other.

5. In the acute care setting…
Factors related to falls involve both the person and the environment. For example:
Immobility
Medication effects
Weakness and pain
Tubing ( e.g., IVs, catheters, oxygen)
Lack of familiar supports (e.g., eyeglasses, ambulation devices)
Unfamiliar setting, people, and routines
Person Factors
Environment Factors
What other factors have you observed?

6. In the home setting… The focus of fall prevention tends to be
more on the environment. For example:
Lack of grab bars in bathrooms
Lighting
Scatter rugs
Pets
Cluttered walkways
Stairs
Person Factors:
Medication effects
Decreased ability to manage personal care
Functional, cognitive, and sensory changes
What other factors have you observed?

7. Take a walk through your living environment.
What environmental hazards could cause a fall?

8. Prevention: In the Hospital
Assess history of falls on admission.
Minimize restraint use.
Ensure use of glasses and hearing aids.
Frequently assess elimination, pain, and cognitive status, making individualized adaptations.
Keep patient area clutter-free.
Monitor effects of medications.

9. In the Hospital (continued)
Lock wheels on wheeled tables and other devices that may be used as supports.
Use alert system to notify staff about individual fall risk.
Move patient closer to nursing station.
Restore and maintain functional status.
Use assistive devices.
Educate regarding safe transfers.
Obtain referrals for OT, PT,
Home Health.

10. Prevention: In the Home
Secure or eliminate loose rugs
Remove clutter
Assess for adequate lighting (inside and outside, especially on stairs)
Assess bathroom for grab bars
Obtain referrals for OT and PT
(What can OT and PT do in the home
to prevent falls?)

11. Fall Prevention: Occupational Therapy (OT)
Evaluate need for:
Assistive devices (especially those for bathing, toileting, eating and dressing)
Home modifications

12. Fall Prevention: Physical Therapy (PT)
Transfer training
Balance training
Standing
Uneven surfaces
Curbs and steps
Gait training
Assistive device training
Canes, crutches, walkers
Strengthening exercises

13. Fall Prevention: Additional Nursing Interventions
Encourage to take classes in Tai Chi
Encourage the use of assistive devices
Monitor medications
Monitor elimination and
pain issues
Instruct to change positions
slowly
Instruct regarding non-slip
footwear

14. Fall Prevention: Interdisciplinary
Nursing has a KEY role in
facilitating referrals for
evaluations in both the acute care
and home settings.
Primary in fall prevention are the
interdisciplinary team and
coordination between settings.
Older adults benefit most from the collective
expertise of all related disciplines.

15. Towards Fall Prevention was created by Catherine Van Son, Ph.D., R.N. for the Older Adult Focus Project, OHSU School of Nursing.