Falls in Nursing Homes

1
Falls in Nursing Homes

• Mark L. Shiu
• March 12, 1999
• UCLA School of Public Health
• Epidemiology 247

2
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.

3
Magnitude of Problem - General

• 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.

4
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.

5
Consequences of Falls

• 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

6
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.

7
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

8
Prevention (contd)

• Specific Intervention
• Medical
• Rehabilitative
• Behavioral
• Institutional Intervention
• Environmental Assessment
• Nursing/Staff Education
• Technology

9
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.).