Falls As We "Mature"

 Every year millions of older adults, meaning those over 65 years of age, fall.[1] A definition of a “fall”   means anyway they end up on the ground or floor, one way or another, included, “I tripped”, “I slid”, “there was a crack in the sidewalk”, “I didn’t see the last step.  There can be many excuses.   This can be a common concern and event amongst adults, young or “mature.”

They can develop a mental  fear of falling, if they have already had one fall.  This fear even increases with a fracture.  This can be a home or in any type of facility.

Per the CDC, one out of four older adults fall each year, yet less than half of these adults will tell their doctor, or even tell anyone.  Falling will also double the chances of falling again.[2]  They are embarrassed, don’t want to be lectured by friends,  family members, facility staff or anyone.  They may even may think this was an rare occurrence and it will not to happen again.

Fall assessments for risk factors and history are completed frequently by healthcare professionals in private homes and in facilities.  It is a common and very necessary assessment in order to set up an appropriate plan of care for prevention of future falls in any setting.  

Falls are serious, can be very costly, increase the risk of death and change their quality of life.  One out of every five falls can have broken bones or worse yet head injury.   The fall victim goes to the emergency room, assessed, diagnosed with a fracture and can be admitted.  This hospital admission increases their risk of being sent to a nursing home (also called a rehabilitation center) for physical therapy. 

Other risks of falls are wrists, arms, ankle, hip fractures and traumatic brain injuries.  These falls decreased the ability of the adult to care for themselves, such as their activities of daily living (ADLs).  They will have to depend on others to assist them with  these ADLs including but not limited to feeding, bathing, toileting needs, personal hygiene and dressing. 

This assistance with ADLs is embarrassing, loosing independence in their lives, become dependent on others when they have been so independent in their lives prior to the fall. 

Patients should not be left alone in wheelchairs, should be always and closely monitored for needs to be met.  Patients may forget and try to get out of a wheelchair, or any assistive device and risk a fall and injuries. The patient should be in line of sight.  With the many monitoring and observing devices, this is an easy nursing skill and intervention for the nursing standard of care.  

Many of the conditions which lead up to falls are lower body weakness, lack of appropriate mobility, exercise, strengthening programs, Vitamin D deficiency, difficulties with walking due to arthritis and other diseases and loss of balance.  Lack of appropriate exercise, movement, and incorrect footwear lead to deconditioning and increase the risk of falls whatever the setting.  Medications and are another contributing cause due to older adults taking multiple medications.

All the risk factors can occur both in the community, private homes or in healthcare facilities.  In healthcare facilities, the individual has been entrusted in the facilities care and the facility  staff have a duty to provide a safe environmentto prevent accidents such as falls and injuries.[3]

The most frequently cited cause of falls is “going” to the bathroom unassisted” and “slipping in urine or unable to see a clear path to the bathroom.   Again a fall is defined as an event when the person / patient come to rest on floor or ground in any fashion, such a slipping, weakness, tripping, etc.  Some will say, “Oh, I just tripped, stumbled, or slid on something” and they do not consider it to be the “fall”.  A fall to them is a four letter word. This is still a fall and must be treated as such to consider what must occur, be care planned, nursing intervention and staffing to prevent another fall. 

Fact:  Per the CDC, approximately 300,000 older adults are hospitalized annually for hip fractures.  In 2015, the total medical costs for falls with injuries totaled more than $50 billion in Medicare, Medicaid and supplemental insurance costs.  This does not mention the loss in quality of life, pain and suffering.

[1] https://www.cdc.gov/falls/facts.html

[2] https://www.cdc.gov/falls/facts.html

[3] 42 CFR 483.25 (d)