A Guide to Preventing Falls in Nursing Homes
As adults age, the risk of falling becomes a very real health concern. While a lot of attention is focused on seniors who fall at home, it is also a serious problem for elderly nursing home residents. Falls are frequently fatal, either directly from the fall itself or from injuries caused by it. Injuries, which can be minor or major, may include broken bones such as a broken wrist or a hip fracture. People who fall are also at great risk for head injuries that can lead to serious brain trauma. If left on the ground for long periods, a person can come down with pneumonia or become dehydrated. Seniors who fall may also develop a fear of falling that makes them afraid to move around. This may result in depression and may cause them to decline physically. To ensure the safety of their residents, it is crucial that nursing home administrators and staff provide an overall environment that reduces the risk of falls. In addition, they must also tailor care to individual residents and their needs.
Identify and Eliminate Environmental Risks
Environmental factors can be an enormous contributor when it comes to patient falls. An environmental audit of the nursing home can reveal areas that are problematic and may cause elderly residents to lose their footing and fall. Things to look for include loose carpeting, slick or glossy flooring, poorly arranged furniture, and dim lighting. Steps to remedy these problems include using non-slip rugs and replacing carpets with more solid surfaces such as vinyl to reduce the risk of slipping. Improve lighting in dark or dim areas with brighter light bulbs for visibility, and arrange furniture in a way that reduces any tripping risk. Nursing homes should also equip bathrooms with handrails and toilets that are raised. This is important because toilet bowls that are too low or too high can result in a patient falling. In rooms, keep shelves low enough for residents to use without stretching or straining to reach the items on them. All staff members should also maintain a constant state of awareness when it comes to the state of the nursing home environment, which includes wiping up any spills that may make floors slick and removing any obstacles from walkways.
- ABC's of Minimizing Fall Risks in Health Facilities (PDF)
- Falls in Nursing Home Elderly
- Focus on Fall Prevention (PDF)
- The Impact of Health Care Environmental Design on Patient Falls (PDF)
Assess Potential Health Risks
When an individual is first placed into a nursing home, the facility should conduct an assessment of the person's needs and any current or past health issues. In conducting this assessment, it is important to obtain a health history. This includes any past incidents of falling. The individual should be asked about any mobility issues that they may have or have had in the past. The nursing home will need to know if the resident requires the use of a wheelchair, walker, or a cane. Certain medications can cause a person to be unsteady on their feet, dizzy, or extremely tired. The nursing home staff must also acquire information about any physical or mental health conditions that increase the risk of falling. This includes heart conditions, vision problems, dementia in its various forms, and a history of seizures.
- Identifying and Reducing the Risk of Falls in Older Adults (PDF)
- Fall Prevention in Long-Term Care: Practical Advice to Improve Care
- Preventing Falls One Step at a Time: How Ohio Nursing Homes Can Prevent Falls
- Elderly Falls: The Nurses' Preventative Role
- Focus on Fall Prevention (PDF)
- Management of Falls in Older Persons: A Prescription for Prevention
Education and Other Interventions
Introducing educational programs can go a long way in teaching staff how to provide the level of care and attention that residents need. Staff members should be able to recognize when a resident is about to fall, and there should be proper procedures in place so that they know what to do in such a situation. Additionally, nursing homes should have strategies in place to help prevent or reduce the likelihood of accidental falls occurring in the first place. Other interventions may include activities and mobility programs that are designed to strengthen the lower body and to improve the balance of capable nursing home residents, such as tai chi or yoga classes. Mobile residents should also wear appropriate footwear.
- Developing Successful Strategies for Preventing Falls
- Fall Prevention for Older Persons (PDF)
- Residents on the Move: Using Mobility to Reduce Nursing Home Falls
- Fall Precautions
- Road Map to a Comprehensive Falls Prevention Program (PDF)
What Not to Do
Some solutions that were formerly considered helpful are no longer recommended. For instance, elderly individuals living in nursing homes should not be physically restrained, as it can cause stress and injury. Bed and chair alarms can be useful in a home's efforts to prevent residents from being hurt by a fall, but while they can alert staff that a high-risk individual is standing and at risk of falling, alarms do not actually prevent them from falling. Studies have found that alarms cause stress for the residents, who may consider them a form of restraint. Alarms can also become a nuisance to other residents and to staff, who may begin to ignore or grow accustomed to them. The presence of an alarm also may result in staff relying on them more than personal observation.
A safe nursing home will also avoid the use of bed rails. While bed rails can prevent seniors from rolling off of the bed accidentally, their benefits aren't worth the drawbacks. Seniors who have conditions such as dementia may get their heads stuck in the railing and suffocate accidentally. Others with rails may attempt to get out of the bed while the rails are in place by climbing over them, which can cause the resident to fall from an awkward position and a greater height.