If current rates continue, by 2030 the number of Americans 65 and over living in nursing homes will rise to about 3 million. About 5% of adults 65 and older live in nursing homes, but nursing home residents account for about 20% of deaths from falls in this age group. Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Many falls go unreported.  As many as 3 out of 4 nursing home residents’ fall each year: That’s twice the rate of falls for older adults living in the community.

  • Patients often fall more than once. The average is 2.6 falls per person per year.
  • About 35% of fall injuries occur among residents who cannot walk
  • About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures.

Falling can be a sign of other health problems. People in nursing homes are generally frailer than older adults living in the community. They are generally older, have more chronic conditions, and have difficulty walking. They also tend to have problems with thinking or memory, activities of daily living, and to need help getting around. All of these factors are linked to falling.

  • Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents. These problems account for about 24% of the falls in nursing homes.
  • Environmental hazards in nursing homes cause 16% to 27% of falls among residents:  Wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs.
  • Medications can increase the risk of falls and fall-related injuries. Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs are of particular concern.
  • Difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care, poorly fitting shoes, and improper or incorrect use of walking aids.

Falls result in disability, functional decline and reduced quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation.

 

Preventing falls takes a combination of medical treatment, rehabilitation, and environmental changes. The most effective interventions address multiple factors. Interventions include:

  • Assessing patients after a fall to identify and address risk factors and treat the underlying medical conditions.
  • Educating staff about fall risk factors and prevention strategies.
  • Reviewing prescribed medicines to assess their potential risks and benefits and to minimize use.
  • Making changes in the nursing home environment to make it easier for residents to move around safely. Such changes include putting in grab bars, adding raised toilet seats, lowering bed heights, and installing handrails in the hallways.
  • Providing patients with hip pads that may prevent a hip fracture if a fall occurs.
  • Alarms that go off when patients try to get out of bed or move without help.

Exercise programs can improve balance, strength, walking ability, and physical functioning among nursing home residents. However, it is unclear whether such programs can reduce falls.

 

References:  Centers for Disease
Control and Prevention,
National Center for Injury Prevention and Control
(NCIPC)

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