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The Five Risk Factors of Resident Falls

According to the Centers for Disease Control (CDC), every year one-in-four adults over the age of 65 falls. Ninety-five percent of hip fractures for that group result from falls, usually from falling sideways. In addition, falls are the most common cause of traumatic brain injuries. The most common causes of falls are lower body weakness, difficulties with ambulation and balance, use of medications such as sedatives, tranquilizers, or antidepressants, vitamin D deficiencies, vision related problems, improper footwear, and environmental hazards. Most falls are caused from a combination of the above risk factors.

Professors Kenneth Trembley, PhD and C. E. Barber from Colorado State University identified five risk factors that increase the likelihood of falls. The more risk factors a resident has, the more likely it is that a fall will occur. Assess residents for the following:

  1. Osteoporosis – Porous bones are less resistant to stress and more prone to fractures. This can result from hormonal changes, calcium and vitamin D deficiency, and decreased physical activity. An adequate supply of calcium, sufficient vitamin D to enhance calcium absorption, sunlight exposure, and regular weight-bearing exercise all help to prevent Osteoporosis.

  2. Lack of Physical Activity – Failure to exercise results in poor muscle tone, decreased strength, and loss of bone mass and flexibility. Encourage regular exercise designed to increase muscle and bone strength as well as to improve balance and flexibility. Physical therapy, participation in exercise groups, restorative nursing programs, or a floor-walk program will also help to improve strength and balance.

  3. Impaired Vision – Cataracts, glaucoma, and other disease states impair depth perception, visual acuity, peripheral vision, and glare tolerance. Impaired vision impacts safe navigation in the physical environment. Schedule eye exams and treat vision-impairing conditions. Use color and contrast in the environment so items stand out. Provide adequate lighting in all areas.

  4. Medications – Psychoactive drugs reduce alertness, affect balance and gait, and cause orthostatic hypotension. Have your pharmacy conduct a targeted medication review for residents who fall. Monitor for orthostatic hypotension. Learn the side effects of medications, use the lowest dose possible, and regularly assess to determine if the drug is still needed.

  5. Environmental Hazards – Objects on the floor that cause tripping, poor lighting, lack of grab bars, poorly located or mounted grab bars, and furniture that is not sturdy or that blocks free movement are all considered environmental hazards. Practice regular walk-throughs by staff to identify and address hazards that may lead to falls.

Once you’ve assessed each resident and addressed these risk factors, here’s what you can do to continually maintain a safe environment for your residents.

  1. Provide staff education to raise overall safety awareness. Include all departments so everyone takes responsibility for preventing falls. Seek staff ideas to create a safety-conscious atmosphere where unique care plans meet individual resident’s fall prevention needs.

  2. Use the Falls Care Area Assessment (CAA) in your efforts. Study incident/accident reports looking for trends. Do more falls occur on one unit or shift? Are particular caregivers on duty when most falls occur?

  3. Develop a list of fall-related things you want to know, such as response to call bells, timely toileting assistance, and more. As you implement these steps you will finally see those numbers falling instead of your residents!       

  4. Provide fall prevention education to residents and family members. The CDC offers brochures that can be shared with residents and families. To access these brochures, go to: https://www.cdc.gov/steadi/patient.html