There are many reasons that falls occur among aging adults. But those reasons should not include lack of provider awareness or patient education. This article offers guidance on how falls might become more preventable among your patients.
Statistics related to the rate of falls among older Americans are in and of themselves quite staggering. According to the National Council on Aging (NCOA), one in four Americans over the age of 65 falls each year, though not all instances are reported. In 2014, 29 million falls were said to have occurred among older adults according to the NCOA, resulting in 7 million injuries. The average cost for treating a fall is $30,000 and falls remain the leading cause of fatal injury among older adults as well as the most frequent reason for non-fatal trauma as well. It is that unpredictability that makes falls so dangerous for the general population and so important for nurses and other healthcare providers working in rehabilitation settings and hospitals to appreciate awareness. This article will offer guidance on how falls are more likely to happen and education on how to best attempt to reduce that rate of recurrence and general preventative methods.
Where And Why Do Falls Occur?
Bathrooms are certainly risky settings for falls. According to the National Institute on Aging, 80 percent of all falls take place in the bathroom, which may help explain why many falls go unreported. For instance, a 2009 study published by the Journal of Clinical Nursing that investigated older people’s experiences of recent falls and their impact on patients’ health, lifestyle and quality of life1 found that the majority of non-injurious falls went unreported to formal services. But that is not to suggest that all bathroom falls are confined to the privacy of one’s home. Generally speaking for the elderly living in the community, as many as half of all falls experienced are due to environmental reasons such as poor lighting, slippery floors and/or uneven surfaces, according to the NCOA.
Not surprisingly, one’s health status is significant in relation to falls occurring, particularly as that pertains to the need to take medication that can increase the likelihood of a fall and recent surgery that can exacerbate risk and lead to more dire consequences following a fall all at once.
Regardless of environmental factors that lead to higher falls risk, the top contributing factors to someone falling are (in order) age, being female, a history of previous falls and a fear of falling, according to NCOA officials. Living alone may also factor into higher falls risk, and adults are said to lose 10 percent of their strength and endurance for every decade after the age of 30. This decrease in physical function likewise places aging adults them at more risk for falling, according to the NCOA. Additionally, nearly 25 percent of all adults ages 65 and older consider themselves to be living with an ambulatory disability, such as difficulty walking or climbing stairs. For those adults who are actively taking prescription medication, benzodiazepines, which are commonly used for treating panic attacks, insomnia, seizures, restless leg syndrome and alcohol withdrawal, are associated with a 44 percent increase in the risk of hip fracture and nighttime falls among older adults, according to the NCOA. Sedatives, antidepressants and blood pressure medication are also linked to increased falls risk, though the risk severity associated with blood pressure medication is not thought to be as significant, NCOA officials claim. From a clinical and comorbid standpoint, vascular diseases, chronic obstructive pulmonary disease, depression and arthritis are each associated with a 32% increased risk of falls among the elderly, according to the NCOA.
How Can Healthcare Providers Affect Falls?
By tracking their medication intake, patients can reduce their risk of falls. The NCOA offers a medication record tool that nurses and other providers can share with their older patients as a means of helping them schedule a safe time to take certain medications that may make them feel drowsy or impact ambulation and decision making.2 The tool can also be used to record the purpose of each pill and the correct dosage. All patients should also be encouraged to speak with their doctor and pharmacist about all prescribed medications and their side effects. The NCOA also offers tips for social media messaging that can help adults be more aware of the need for falls prevention.3 Additionally, the Centers for Disease Control and Prevention (CDC) has established an Algorithm for Fall Risk Screening, Assessment and Intervention4 as part of its STEADI (Stopping Elderly Accidents, Deaths & Injuries) program offers a coordinated approach to implementing the American and British Geriatrics Societies’ clinical practice guidelines for falls prevention. The algorithm starts with a screening measure that compiles a risk-adjusted score based on such parameters as history of falls and evaluation of balance, gait and strength. The algorithm then tiers falls risk based on a path chosen by responses to background questions and the clinician’s assessment.
Other educational materials available to providers through the STEADI program include guidance on discussing falls prevention with patients, case studies, directions on how to screen and how to conduct standardized functional assessments for falls risk, and literature on how to integrate fall prevention into
- Roe B, Howell F, Riniotis K, Beech R, Crome P, Ong BN. Older people and falls: health status, quality of life, lifestyle, care networks, prevention and views on service use following a recent fall. J Clin Nurs. 2009 Aug;18(16):2261-72.
- My medication record. NCOA. No date. Accessed online: www.ncoa.org/wp-content/uploads/NCOA-My-Medical-Record-Form.pdf
- Falls prevention clearinghouse. NCOA. 2018. Accessed online: www.ncoa.org/resourcetype/falls-prevention
- Resource algorithm for fall risk screening, assessment, and intervention. CDC. No date. Accessed online: www.cdc.gov/steadi/pdf/STEADI-Algorithm-508.pdf