Each year, long-term care facilities with an average census of 100 elderly residents, report 100 to 200 falls per year. Of those that fall, 1,800 will die. Those who don't die as a result of the fall sustain serious injuries have limited ambulation and their quality of life is significantly reduced.
The causes of these falls are termed risk factors. The top five risk factors that contribute to falls in nursing homes are osteoporosis, lack of physical activity, impaired vision, medications, and environmental hazards. In addition, lack of knowledge and fall prevention contributes to the higher incidence of falls in long-term care facilities.
Osteoporosis is a condition where bones become very porous, less resistant to stress and more prone to fractures. This decrease in bone density contributes to falls and can results in injuries. To prevent this condition, it is recommended that long term care facility residents eat and drink sufficient calcium rich products, get sufficient vitamin D and do regular weight bearing exercises.
Another risk factor that contributes to falls in the elderly is a lack of physical activity which can result in poor muscle tone, decreased strength and loss of bone mass and flexibility. All of these deficits can contribute to falls. Prevention tips include regular exercise designed to increase muscle and bone strength such as with physical and occupational therapy and restorative services. Also, residents should always wear proper fitting shoes with low heels or rubber soles.
A person with a visual impairment also has a greater risk of falling. Age related vision diseases increase the risk for falls. Cataracts and glaucoma alter the resident's depth perception, visual acuity and may cause glares. This may hinder the resident's ability to navigate safely around their environment. To prevent this, residents of long term care facilities should have annual eye examinations to determine the extent of the age related eye disease, and what modifications should be implemented to make their environment safer. Some of these modifications for visually impaired residents can include installation of grab bars and handrails, clean eyeglasses on a regular basis, and maintain clutter free environments.
Medications are often overlooked as risk factors for falls but medications are often one of the most influential risk factors of falls in the elderly. Sedatives, anti depressants and anti- psychotic drugs can contribute to falls because they reduce mental alertness, worsen balance and gait, and can cause the blood pressure to drop while standing. Medical staff can prevent this by being aware of all of the side effects of residents' medications, encourage physician's to use the lowest dose possible, have anti-psychotic medications reviewed and attempt trial reductions and eliminations of these types of medications.
New guidelines have been released by the American Geriatrics Society and the British Geriatric Society in regards to fall prevention measures. This is the first time an update has been made by AGS in ten years. The new guidelines state that all interventions for preventing falls should include some type of exercise. New guidelines also state that assessment of a person's fall risk should include a thorough foot exam. The foot exam should include assessment of a person's footwear as well. Both are imperative to obtaining safe mobility. The assessment should also include the person's fear of falling and his/her ability to complete activities of daily living. Other recommendations in the new guidelines are as follows: physical therapy, adapting the environment to the person at risk, cataract surgery as indicated and medication reduction.
Finally, environmental hazards cause at least one third of all falls in the elderly. The most common cause is a resident tripping over an object. Other causes can be poor lighting and unsteady furniture. Staff should conduct routine room rounds to ensure there is adequate lighting, including night lights, as well as reducing all clutter and checking stability of furniture.
It is a known fact that the risks of falls increases with age. Even though most falls do not result in death, they can result in serious injuries as well as have a profound psychological impact on the resident. The key is prevention. Fall prevention in long term care facilities has to be a combination of medication monitoring, rehabilitation to increase physical strength and wellness, and environmental changes. In addition, fall prevention includes assessing residents after falls to address future risk factors, educating the staff of potential risk factors, and providing a safe environment for the residents.
No comments:
Post a Comment