The Dangers of Falling For Older Adults

When someone falls, facility staff must call the family or designated representative when their loved one falls.

A fall indicates a change in condition; it is not considered a normal part of the day. No matter how the person ends up on the floor and how the resident or staff describe the incident, it is considered a fall. 

And with every fall, an unintentional event, an incident report is completed.  If the person is sent to the hospital for evaluation and treatment, the incident is reported to the state’s department of health. 

In most cases, the family or injured person does not receive a copy of the incident report.  It is considered part of internal quality assurance programs in the facility to help develop a safe environment, so further falls do not occur.

When families receive this call, it is essential that they document and address the following: 

• Date, time, and the full name of the person that called from the facility.
• What was reported by the facility representative?
• Keeping track of the calls is important so that problems can be addressed immediately to prevent other falls.
• Have a contact you can reach out to in person, by email, or by phone to find out so you can find out what is the root cause of these falls. Conversations should always be documented.
• Determine what type of intervention is being done to prevent another fall.
• If a problem with the medication is suspected, is the healthcare provider involved in updating the treatment plan?
• Falls should be discussed at the Care Plan conferences attended by the families in person, by phone, or via zoom.

Facilities are required to provide an environment that is free from accident hazards it can control. Facilities must provide supervision and assistive devices to each resident to prevent avoidable accidents. 42 CFR 483.25 (d) accidents

Falls are not a “normal part of aging”

Frequently there is a reason behind a fall. It may be something like the wrong pair of shoes, infections such as a urinary tract infection, medication problems causing an imbalance, dehydration, and other medical situations. 

Sadly, falls can be deadly. Every year millions of older adults, meaning those over 65 years of age, fall.[1]

A definition of a “fall” means any way someone ends up on the ground or floor, including…

• “I tripped.”
• “I slid.”
• “There was a crack in the sidewalk.”
• “I didn’t see the last step.”

There may be many excuses, and it is a common concern and event amongst adults, young or “mature.”

The person may even develop a mental fear of falling if they’ve already had one fall. This fear may increase with a fracture at home or in any facility.

According to the CDC, one out of four older adults falls annually.

However, less than half of these people will ever tell their doctor or anyone, even though they are asked, “Have you had any falls?” as part of the standard screening process during a visit with their provider.

When people fall, it doubles their chances of falling again.[2]

Most are embarrassed and don’t want to be lectured by anyone, including friends, family members, or facility staff. Some think that a fall is a rare occurrence and will not happen again.

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

Falls are serious!

They can be costly, change the quality of life, and even increase the risk of death.

One out of every five falls may result in broken bones or, worse yet, head injuries.

If the fall victim goes to the emergency room, is assessed, and is diagnosed with a fracture, they can be admitted.  Unfortunately, hospital admission increases the risk of being sent to a nursing home (also called a rehabilitation center) for physical therapy.

Other fall risks are wrist, arm, ankle, hip fractures, and traumatic brain injuries. These falls decrease the ability of the adult to care for themselves, affecting 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.

Often, people feel embarrassed by needing assistance with ADLs and losing independence when they have been so independent before the fall.

People should not be left alone in wheelchairs and should always be 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 the line of sight. And today, with the many monitoring and observing devices, this is an easy nursing skill and intervention for the nursing standard of care. 

Many conditions leading up to falls include lower body weakness, lack of appropriate mobility, exercise, strengthening programs, Vitamin D deficiency, difficulty walking due to arthritis or other diseases, and loss of balance. 

Footwear, Medications, Exercise...

Lack of appropriate exercise, movement, and incorrect footwear lead to deconditioning and increase the risk of falls, whatever the setting. 

Medications may also contribute to falls since many older adults take multiple medications. All the risk factors may occur in the community, private homes, or healthcare facilities.

When living in a healthcare facility, the individual has been entrusted to the facility’s care. As such, the facility has a duty to provide a safe environment to 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 being unable to see a clear path to the bathroom. “ 

Here again, a fall is defined as an event where the person/patient comes to rest on the floor or ground in any fashion, such as slipping, weakness, tripping, etc. 

Some will say, “Oh, I just tripped, stumbled, or slid on something,” They do not consider it the “fall.”  A fall to them is a four-letter word.

But it is still a fall and must be treated as such, considering what must occur… care planning, nursing intervention, and staffing to prevent another fall.

Some alarming numbers...

According to the CDC, approximately 300,000 older adults are hospitalized annually for hip fractures. In 2015, the medical costs for falls with injuries totaled more than $50 billion in Medicare, Medicaid, and supplemental insurance costs.

These figures do include nor measure 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)