Fall Risk: Nursing Strategies to Prevent Falls in the Older Adult
Falls among the older adult population in the United States are a common and serious danger. For many reasons, older adults fall and oftentimes sustain injuries that can set back healing times or in many cases trigger a downward spiral of health complications and injuries. As healthcare professionals we need to be aware of the dangers to older adults, because falls are mostly preventable if appropriate precautions are taken. I will discuss the major causes of falls among older adults in healthcare settings, the consequences of falls, and the actions that we can take to prevent as many incidents as possible. Every year in the United States, there are hundreds of thousands of falls that occur in hospitals alone, (The Joint Commission, 2015, para. 2) which means that there are hundreds of thousands of chances for additional injuries and longer stays for patients who are in our care. Within the older adult community, approximately 30% of people will experience a fall (Florence, Bergen, Atherly, Burns, Stevens, Drake, 2018, pg. 1) and these individuals often sustain lasting injuries as a result.
Furthermore, it is widely found that having a history of falls can be a significant indicator of future incidents of falling (Plaskin, 2014, para. 2) Because this is such a significant risk for the older adult, much research has been aimed toward finding out how we can face these statistics head-on and find sustainable solutions to put a stop to avoidable injuries. Of the risk factors I found in my research, I found that three specific factors stood out as the most common: common pathophysiological changes in older adults, environmental concerns in hospital settings, and the effects of medications including polypharmacy and medication changes. Common pathophysiological changes in the older adult covers a large scope of changes, including muscle and joint degeneration, sight and hearing loss, metabolic change, and decreases in mobility in addition to other things (Boss, Seegmiller, 1981). Because of the gradual overall degeneration of the various body systems, an older adult may overestimate their balance or fail to see an obstacle in their way. Likewise, ear and muscle changes can negatively impact balance leading to a higher risk for falling. According to Boss and Seegmiller “Degenerative joint disease occurs in 85 percent of persons older than 70 years of age and is a major cause of disability. ”, which causes unexpected pain and loss of stability (Boss, Seegmiller, 1981, pg. 440). Some interventions are possible, such as cataract surgery to restore vision.
In the another more recent publication, however, it is stated that there is reduced risk of falls after a patient’s first cataract surgery, but not necessarily after a second surgery, suggesting that only limited improvements can be made before the risks outweigh the benefits (Brannan, Dewar, Sen, Clarke, Marshall, Murray, 2013, 561). Closely associated with pathophysiological degeneration is polypharmacy and other medication complications. While there is some evidence that a reduction in the quantity of medications can positively affect fall risk (Plaksin, 2014, para. 10) some medications are unavoidable and can result in dizziness, postural hypotension, and other complications that may result in a fall. Environmental concerns in a hospital setting mainly include numerous tripping hazards including rugs, IV lines, and unfamiliar furniture. As many as 50-70% of falls occur around the bed where various lines and cords are run (Spoelstra, Given, Given, 2012, pg. 5), many being caused by tripping hazards. Other potential causes include poor lighting and higher beds than patients are expecting, and when combined with poor eyesight either of these are much more serious. Cumulatively, environmental obstacles, medication effects, and pathophysiological changes in the older adult combine to magnify the risks of falling in a healthcare setting. The consequences of falls are monumental.
At its worst a fall can be fatal, not unfrequently fall result in broken bones and head trauma (The Joint Commission, para. 4)). In fact, fatal falls were ranked as the highest cause of unintentional injury resulting in death to the elderly from 1999 to 2010 (Boltz, 2016, pg. 286), with the very old being at higher risk. Just as individuals see great consequences from fall incidents, a society carries a large consequence as well. The monetary cost of falls to Medicare and Medicaid in 2015 was over 37 billion dollars, with private payers shelling out an additional 12 billion total (Reinberg, 2018). According to Reinberg, 10,000 adults are turning 65 every day and as Americans age the risks go up. Luckily, there are steps that healthcare providers can take to minimize fall risks and the damage that goes along with them. Firstly, taking the time to complete a fall risk assessment on admission identifies risk factors that are frequently associated with falls (Spoelstra et at, 2012).
The Hendricks II Fall Risk Model assesses things like dizziness, prescriptions taken, and disorientation to quantify a patient’s risk for falling, and in doing so enables healthcare providers to take the necessary precautions (Hendrich, 2016). Many of the nursing interventions taken stem from assessment tools like this, such as teaching the patient and family about strategies to avoid falls, environmental alteration, audible alerts, mobility and toileting assistance, and medication management. In the case of patient teaching, a nurse may counsel a patient to use a call button to acquire assistance when they need to use a restroom or explain why rising suddenly from bed can cause hypotension (Mayo Clinic, 2017). Assisting patients with transfer, movement, and toileting eliminates many risks associated with patients navigating darker rooms when they need to void at night (Spoelstra et al, 2012). Many patients experience a frequent need to void throughout the night, and many falls are caused by having a harder time seeing in the dimmed lights and can easily trip on unfamiliar surroundings. Likewise, a helpful nursing intervention includes maintaining both a familiar and clutter-free environment. This can mean making sure that walkways are clear of cords and tubes, chairs, and other tripping hazards. Making sure to keep the room the same gives patients a chance to familiarize themselves with barriers to movement as well, meaning that a groggy patient who attempts to use the restroom at night alone won’t be surprised by a new trashcan or plant in the way of the restroom (Plaskin, 2014, para. 6).
In order to minimize patients with higher fall risks wandering or attempting to ambulated alone, many facilities use door and bed alerts to let staff know when someone may be in danger. These alerts may sound when a patient opens a door or gets out of bed and allows staff to assist the patient quickly to minimize risks (Robinson, Gibson, Kingston, Newton, Finch, Brittain, 2013, para. 17). Finally, a very successful nursing strategy is to monitor medications and their effects on individual patients. Because some side effects are difficult to foresee, monitoring individuals for their specific reactions can alert healthcare providers to possible medication change needs. Benzodiazepines, specifically, were found in a recent study to be in use in 50% of the control group among adults over 65 who fell and broke their hip (Chen, Zhu, Zhou, Elimination Half Life para. 3). Monitoring these more dangerous medications can reduce risks to already at-risk patients.
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