By | September 27, 2019

Knowing how to prevent falls is an important responsibility for all home care providers, as falls are the leading cause of injury in older adults. Each year about one out of every four adults 65 and older falls, according to the National Institute on Aging. Tragically, falls lead to around 33,000 deaths every year in people over age 65, the Centers for Disease Control and Prevention (CDC) reports. The number of deaths from falls is increasing every year, and the CDC notes that the risk for falling rises with age.

Understanding common risk factors that contribute to falls and how to prevent falls is essential. Your organization should have clear guidance on assessing for falls risks, a falls prevention strategy, and proper training.

What Causes Falls?

Why are falls common among older adults? There is no single factor that is responsible for all falls. Older adults who have already had one fall are more likely to fall again. In fact, the best predictor for falls is a previous fall, according to Jill Jin, MD, MPH. A fear of falling is common as people get older, even for people who have never fallen. Older adults may start to limit their activities out of fear. This can lead to weak muscles and stiff joints. Both can affect how a person moves and keeps their balance.

Other reasons the CDC cites for falls in older adults are:

  • Weakness
  • Balance problems
  • Movement issues
  • Poor vision
  • Blood pressure problems
  • Chronic conditions such as:
    • Arthritis
    • Stroke
    • Diabetes
    • Parkinson’s disease
    • Dementia and other problems with clear thinking
    • Incontinence

Incorrect or unsafe use of a device such as a cane, walker, or wheelchair can put someone at risk for falling. Some medications have side effects that increase the risk for falls. Taking more than one medication also increases the risk for falls.

Conditions in the Home

There are also conditions in the home that increase the likelihood that an older adult may fall, including:

  • No handrails on stairs
  • Stairs that are steep or uneven
  • No grab bars in the bathroom
  • Tripping hazards, such as throw rugs, in walking pathways
  • Walking surfaces that are slippery or uneven

Lighting is another environmental factor that can cause falls. Poor lighting or a strong glare from overhead lighting can be a problem. Some individuals have cataracts or glaucoma and may be sensitive to very bright light. Notice how individuals react when in different types of lighting.

It is also important to pay attention to the floor. Polished or wet floors and throw rugs, particularly those without non-slip backing, can lead to falls. Carpeting that is thick-pile, wrinkled, curled-up, or worn can be very hazardous, especially if the person uses a walker or a cane.

Addressing Risks

The keys to fall prevention are screening for fall risk and taking action in ways that address the risk factors that can be changed. Initiatives such as the CDC’s STEADI, which stands for Stopping Elderly Accidents, Deaths, and Injuries, can help with assessing fall risk, educating individuals, and selecting interventions.

A fall prevention program can be implemented after an individual is identified as being at risk. The success of a fall prevention program depends on you, the agency team, and the individual. The program should include exercise, medication reviews, vision checks, and an inspection of the home.

If the person’s home doesn’t accommodate their safety needs, they may need recommendations for changes. Your best approach is a sensitive, compassionate one, as items in the home may have great sentimental value.

Educating Yourself

Your role in fall prevention is to know why older adults fall, recognize hazards in the home that may cause a fall, support the fall prevention program, and know how to respond to a fall and report it.

Your agency policies and procedures will guide you in your role as you participate in a fall prevention program. It will outline:

  • How and when risk assessment will be performed and by whom.
  • Measures that should be taken for each individual.
  • What to watch for.
  • How to report your observations and concerns and to whom.

You can encourage each individual to take some responsibility for fall prevention by asking clients to stay active, use their prescribed assistive devices, use caution, and make choices that maintain or improve their health.

Responding to Falls

It is important to remember that despite a home health agency team’s best efforts, intentions, and interventions, some falls are unavoidable.

Your agency has its own system and structure for reporting falls. If you are ever in doubt about whether you should report a fall or how to document it appropriately, consult your supervisor for guidance.

Keeping the number of falls to a minimum is important for client safety but also for your organization’s quality measures and compliance record. With proper guidance and training, you and the rest of your team will be prepared to respond appropriately to falls risks and make each individual’s safety a priority in the home.

Jennifer Burks, RN, MSN

Jennifer W. Burks, R.N., M.S.N., has over 25 years of clinical and teaching experience, and her areas of expertise are critical care and home health. She earned her Bachelor of Science in Nursing from The University of Virginia in 1993 and her Master of Science in Nursing from The University of North Carolina, Greensboro, in 1996. Her professional practice in education is guided by a philosophy borrowed from Florence Nightingale’s Notes on Nursing, “I do not pretend to teach her how, I ask her to teach herself, and for this purpose, I venture to give her some hints.”

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