QUESTION: Falls in nursing homes are preventable – True or False.
ANSWER: Depends on who is answering the question.
A few years ago we represented the Estate of a woman who died as a result of a nursing home fall. The physician who was testifying for the defendant nursing home told me in her deposition that not all falls were preventable. I assumed she would say this as she was designated to say the decedent’s fall could not be prevented (although the decedent was alone in a shower room on a walker with broken tiles)..
Q. Are all falls preventable? (I asked)
A. Are all falls preventable? No.
Q. Could you give me an example of a fall that is
not preventable?
A. Well, there are residents who have what are
called syncopal episodes. Do you know syncope?
Q. I do but if you could explain it for the
record.
A. Syncope is a sudden loss of consciousness. If
you’re in an upright unsupported position, you fall.
I loved this answer because she was sort of admitting that most falls could be prevented. So why do they happen so often?
According to CDC, Each year, an average nursing home with 100 beds reports 100 to 200 falls.
About 1,800 older adults living in nursing homes die each year from fall-related injuries. Those who experience non-fatal falls can suffer injuries, have difficulty getting around and have a reduced quality of life.
WOW. Those are scary statistics.
Why do falls occur more often in nursing homes?
According to CDC, “Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents. These problems account for about 24% of the falls in nursing homes. Environmental hazards in nursing homes cause 16% to 27% of falls among residents. Such hazards include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs. Medications can increase the risk of falls and fall-related injuries. Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs, are of particular concern.
So what should facilities do?
According to the CDC, “Fall prevention takes a combination of medical treatment, rehabilitation, and environmental changes. The most effective interventions address multiple factors. 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.
– Exercise programs can improve balance, strength, walking ability, and physical functioning among nursing home residents. However, it is unclear whether such programs can reduce falls.
So what can families do?
Be involved. Make sure if a fall has occurred, the above preventions are in place. Discuss care plan on falls – ask to see the Fall Risk Assessment or Post fall assessment.
If someone is injured from a fall, we can help evaluate your options and provide advice.
Nursing home falls ARE preventable.