According to research provided by the Center for Disease Control (CDC), adults aged 65 and older are falling at rates of one in four annually. Falls in older adults can be very serious and are actually the leading cause of injury deaths in the United States. And for some reason, older adults are not bringing up slips and falls they’ve had with their health care providers.
As caregivers and health care professionals, we are often the major advocates and knowledge base for our patients regarding the prevention of falls. It is up to us to initiate the conversations and intervene to help create safe environments for those we care for.
To gain an understanding of how your patients feel about aging and what they perceive the risk of a fall to be, begin with a conversation. Discuss whether or not they view themselves as a fall risk. From there, you should have a good baseline understanding of where your teaching needs to begin.
Keep in mind that changing someone’s perspective is not always an easy conversation. They may be resistant to changing behaviors that contribute to falls. Prepare yourself to have a few materials ready for them to digest and reread later on. The main goal of the initial conversation is to judge their willingness to change the key behaviors in reducing falls.
In order for prevention to occur, clients need to understand that they are active participants in reducing falls. We can assist them with mechanical aspects, but they need to change their mindset and be on the lookout for areas where they could use assistance. Some of the best prevention strategies will discuss:
- Looking into medication changes where possible
- Keeping an exercise regimen
- Attending a fall prevention workshop or hearing professional strategies
- Changing their home environment
Not all four prevention strategies will pertain to each client, but the more that older adults are made aware of how each of these points can increase fall risks, the better the outcomes will be.
There are also fall risk surveys and checklists you can use to interview your patients. The organization Stopping Elderly Accidents, Deaths, and Injuries (STEADI) has some great material that can be used to provide patient education.
Key Points for Facilities
While working in a facility, make sure you are aware of the fall risk procedures and how to properly implement them. Falls are not 100% preventable, but most come down to a few specific integral components.
- Physical obstacles. Items in the way of a patient’s walking path or cluttered spaces can contribute to falls. Anticipate where they would likely be going and make sure the path is clear.
- Fall risk assessments are not being done often enough. Remember, as a patient’s condition worsens or changes, fall risks need to be reassessed.
- The facility isn’t up to standards. This can include handrails in a proper location, no loose floorboards or tiles. Ensure messes on the floor are properly blocked off and cleaned. Ensure brakes working on wheelchairs and that any patient care items are in working order.
- Supervision plays a large role. Making sure patients who are at the greatest risk for falls are supervised properly and assisted at proper intervals.
- Teaching patients to sit up and pause. Having a patient pause for a moment at the end of the bed before attempting to stand can help. This will allow for blood pressure to adjust as well as slow down.
- Medications need to be reviewed. You should check if some meds may be causing drowsiness, weakness, or a diuretic effect. Also, patients with certain health conditions are prone to use the bathroom more frequently, and this needs to be accommodated for them.
- Answer call bells quickly. The entire team needs to answer call bells in a timely manner. This can help stop a fall before it happens.
Reducing the Risk of Falls at Home
When working in home health, it can be even harder to control the environment around the patient as they likely enjoy things the way they are. It may take some time to educate patients and their family members about the importance of reducing fall risks by keeping areas free from obstacles. Here are some tips for reducing falls in a home care environment:
- Remove tripping hazards such as throw rugs and loose carpet.
- Clean or toss any built-up clutter or furniture to allow for safe walking space. Pay special attention to clutter that builds up around stairways or hallways. Suggest that clients have a clear path to the bathroom as they can frequently attempt to use it at night without the lights.
- Suggest or rearrange lamps to make sure the home is well lit.
- Suggest slippers that have rubber soles and proper backs to them. Or perhaps your client can make a habit of wearing clean shoes around the house to avoid walking around in socks.
- Use textured mats in the shower or bathroom to avoid slips and falls on wet surfaces.
- If your client must use the stairs, make sure the handles are the appropriate height, and that they are secured properly to the wall. Make sure the railings and banisters are also secure. You may also need to suggest handrails in the hallway, or even near the toilet for easy on and off.
Avoiding falls is critical for the elderly as it can cause head injuries and broken bones, which are very hard to recover from at an advanced age. As we age, our balance and gait often change, making it difficult to walk with ease. Having patients participate in physical therapy and engage in exercise will help them increase bone and muscle mass and keep them mobile and less prone to falls.
Addressing fall risks needs to be approached from the standpoint of a multi-disciplinary team; it involves coordination with Physical Therapy, Ophthalmology (to ensure vision is sufficient) MDs, nurses, and other caregivers, to ensure the best possible outcomes for patients.