Commentary
They're falling for you (and not in a good way)
Assessing and minimizing risk for falls
Friday January 4, 2008
Submitted and compiled by Scott Ladoucier, Supportive Measures Specialist at Springdale Country Manor
According to Stats Canada, falls account for two-thirds of the most serious activity-limiting injuries sustained by seniors, and about half such falls involve bone fractures. In a single year, almost 14,000 people over the age of 65 die from injuries related to falls. Emergency Departments treat 1.8 million elderly people with non-fatal injuries from falls every year. People over the age of 85 are five times more succeptable to falls than those aged 65 to 74.
Some Common Causes of Falls.
Any of the following can put our residents at risk for a fall:
- adverse reaction to medication
- vision problems
- decreased physical functioning & weakness
- confusion & memory loss issues
- gait or balance problems
- neurological disorders, such as stroke
- agitation
- environmental hazards, i.e. poor lighting
- difficulties with bowel and/or bladder elimination
- movements such as stretching for objects out of reach.
- improper footwear
- previous fractures
- improper use/ of psychotropic
- pain
Risk for Fall Evaluations are done for all residents upon their admission to our homes. However, even if we assume that the accuracy of every one of these evaluations is 100 per cent perfect, we know that residents and their needs and conditions can change over time — or over night. Communicating a resident's current and potential risks for falls among all members of the care team is crucial in even the most modest and unambitious prevention strategy. Reporting a change in a resident's gait is a must for any care giver, be you a PSW, Registered Nurse, Environmental Services Worker, or Maintenance Worker.
Medications are routinely assessed to ensure they are the most appropriate dosages and combinations. However, there are several environmental factors that anyone (even those of us without a university degree) can be aware of and monitor.
We don't ensure there is adequate lighting throughout all common-use areas of our homes merely out of fear of being slapped with a non-compliance notice from a government ministry. Poorly-lit rooms and hallways put anyone at risk of a fall. Add in other factors, such as poor balance, cataracts, and the onset of the early stage of Alzheimer's, Parkinson's, or other medical condition and it won't be a question of if there will be a fall, but rather when and how often.
We'll ensure that the wheels on our residents' beds are locked. We're going to ensure that the objects that the resident routinely uses are within reach, especially the call bell. We will also continue to encourage our residents to engage in physiotherapy and routine exercise programs to improve, or at least maintain, their physical strength and sense of balance.
We're not going to rush our residents. We won't say to an ambulatory resident that they should "hurry up... supper's ready." We may inadvertently be using figures of speech that they might take to heart in their desire to be punctual or to please us. This will put them at risk, even if every spill in the home were promptly cleaned up and there was not poor lighting in the hallways that camouflaged changes in floor elevation, or gave the illusion of a change in floor elevation. And we all know that those changes in floor colours and patterns will contribute to an elevated risk of a fall.
I used to wonder why we called them "slippers." Now I know. "Warm, cute & fuzzy" does not equal "safe and functional". Inadequate footwear, or a lack thereof, plays a major factor in many incidents of falling. I know people like to knit. Knitted hats, sweaters, and eyebrows are fine. Knitted indoor shoes? Not so much.
Here's one last point that shouldn't have to be made, but does. Alzheimer's is not a miracle cure for poor eyesight. We'll continue to ensure that every resident that wears glasses . . . wears their glasses.
There are many new year's resolutions we can make, both as individuals and as a group. Reducing falls within our homes is one I actually care about keeping, and knowing my OMNI colleagues as I do, I'm quite sure I'm not alone.
References: Stats Canada, University of Iowa Gerentological Interventions Research Center, Nursing 2007 Vol. 37 No. 12, Washington University School of Medicine - Environmental Health & Safety Department, and the falls of 3 friends in as many weeks.
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