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Beth Janicek
Beth Janicek
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Falls in Nursing Homes

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About 1,800 people living in nursing homes die each year from fall-related injuries. Falls can also result in disability, functional decline, and reduced quality of life, while the fear of falling can lead to depression and feelings of helplessness. Only 5% of adults 65 years and older live in nursing homes; however, over 20% of deaths from falls occur in nursing homes. The New York Times has an interesting article regarding falls and the elderly. The article discusses how devastating a fall can be for an elderly person but also how important it is for the medical providers to look at all the medical aspects when an elderly person falls.

This leads to the question why do falls occur more often in nursing homes?

The answer to this question is that falling can be a sign of other health problems. People in nursing homes are generally older, have more chronic conditions, and have difficulty walking. In addition, they tend to have more problems with thinking or memory, have difficulty with activities of daily living, and need help getting around and taking care of themselves. All of these factors are linked to falling.

The most common causes of falls in nursing home residents are muscle weakness and walking or gait problems. These problems account for 24% of nursing home falls. The next highest percentage of accidents occur from environmental hazards in the nursing homes, such as wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs. Other causes of falls can include medications (which can affect the central nervous system), poor foot care, poorly fitting shoes, and improper use of walking aids.

Fall prevention in nursing homes requires a combination of medical treatment, rehabilitation, and environmental changes. Some 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.
  • Using devices such as alarms that go off when patients try to get out of bed or move without help.

In the past physical restraints were thought to be an effective fall prevention method, but it has been found that routinely using restraints does not lower the risk of falls or injuries. Limiting a patient’s freedom to move around leads to muscle weakness and can reduce physical function and can actually increase the risk of fall-related injuries. Since 1990, when federal regulations took effect, nursing homes have reduced the use of physical restraints.

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    Articles like this give me a chance to let you know about a fall prevention exercise program that works on many levels. It is well known that exercise can help reduce falls. However positive results can be achieved only with the full participation of the patient.
    The Benevolent Ballet-Fall Prevention for the Elderly program offers a solution to this and several other challenging concerns of the healthcare industry. Besides the exercise syllabus a methodology was developed to include motivational and communication skills which help reduce the apathy and negative attitudes that often keep the elderly from participating in group programming and enable them to enjoy and benefit from this program. These skills echo the ‘Person Centered Care’ approach that is revolutionizing long-term care. The program works by using these skills to deliver a carefully developed exercise curriculum which integrates classical and semi classical music with movement. This results in an enriching arts component which allows for creativity and self expression while building confidence and self-esteem.
    I believe that this approach to exercise works because:
    1. It addresses several concerns of the elder care community including falls, mobility, pressure sores, depression, boredom, and apathy.
    2. It improves posture, range of motion and general mobility.
    3. It motivates and inspires residents to participate to the best of their physical and cognitive ability enabling them to reach their prescribed goals.
    4. It inspires feelings of well being and joy.

    One facility, Heritage Park Senior Living Communities of Fort Wayne, IN recognized an 80% reduction in falls, plus improvement in mood and behaviors.

    Training seminars can be sponsored by individual healthcare corporations, QIOs (Quality Improvement Organizations contracted to Medicare.) or other professional organizations that are concerned with quality of life issues and fall prevention.

    Sheila Lehner
    http://www.benevolentballet.com
    Phone: 407-889-7770
    Email: lehners1@yahoo.com