Coronavirus Puts a New Spin on Falls Prevention

Like so much in our world these days, clinicians’ focus on falls prevention can be viewed through a coronavirus filter. Restrictions accompanying the COVID-19 pandemic have led to changes in physical conditioning and mobility for some older adults, as reported in the University of Michigan Poll on Healthy Aging. Along with those changes, we are seeing a higher rate of injuries.

Of the adults 50 to 80 responding to the poll, 25% reported at least one fall, and 70% of those who had fallen reported they experienced an injury.

Even though Falls Prevention Awareness Day is recognized on the first day of fall, healthcare professionals working with older adults know that preventing falls requires year-round attention. Awareness is even more important given the higher percentage of injuries from falls during the pandemic and the tendency of older adults to delay medical care for fear of COVID-19 infection.

Higher Injury Rates and Fewer Referrals to Rehab

The percentage of injuries reported in the Poll on Healthy Aging is much higher than previous studies. The CDC’s Morbidity and Mortality Weekly Report in July 2020 noted that 27% of adults 65 and over reported at least one fall in 2018 and 10% were injured. Clearly, a 70% injury rate during the pandemic vs. 10% previously is extremely concerning.

In addition to the higher rate of injuries, a 2021 American Physical Therapy Association study found physician referrals to rehab decreased by 36% across all settings.

Rehabilitation therapists, nurses, and nurse aides all can support clients in maximizing their mobility during this time of unusual constraints on activity. As I noted in my recent webinar on falls prevention, healthcare leaders need to make sure all team members are playing their parts and clearly communicating with one another to reinforce best practices.

Education Is the Starting Point

Naturally, we can make a difference by employing evidence-based interventions when patients fall and need rehab therapy. But we can also help people avoid getting to that point through patient engagement and empowerment.

When people are aware of falls risks in general and their own risk of falling in particular, they have an incentive to take action to avoid future falls. As therapists, we can encourage patients to regularly screen for their own fall risk and to participate in regular movement and exercise to maintain mobility and function. We must start where the person is and educate them to move forward in ways that suit their personal situation and goals.

As nurses, physical therapists, occupational therapists, speech-language pathologists, and nurse aides work together, we have different strengths. Although every healthcare team’s composition is different, we all have superpowers that we can leverage to assist our clients.

Digital Support for Physical Mobility

Rehabilitation therapists have a role in encouraging strength and balance exercises. Most people experience a fall when they’re in a standing position. With that in mind, we want our clients to regularly do their strength and balance exercises and challenge their bodies to stay in standing positions.

With COVID-19 limiting interactions, we have had to get creative with exercise programs. Many older adults have responded to the pandemic by increasing technology adoption and getting more comfortable with digital health tools. Virtual programs that support health and wellness have grown amid the restrictions implemented to limit the spread of COVID-19.

For example, the Silver Sneakers program reports that 74% of its members are participating in live streaming for exercise classes or medical appointments. Virtual options are absolutely effective for supporting movement.

Patient education and empowerment are so important to improving outcomes, no matter the care setting. We also have to keep in mind the variability among COVID patients. We should encourage them to self-monitor their energy levels, which can go up and down from day to day and even hour to hour.

Effective Prevention in Different Settings

Skilled nursing and long-term care have the highest rates of falls than any other setting, and that is understandable because that is where we’re caring for our most medically complex and frail patients.

Looking at acute settings, a study of a falls prevention toolkit showed a 15% reduction in falls and a 34% reduction in injurious falls. The toolkit studied was an evidence-based fall-prevention intervention that involved communicating patient-specific risk factors for falls and tailoring prevention plans to each patient.

For people receiving care at home, one home care company is challenging its clients to complete the Stay Independent falls risk self-assessment each quarter. The assessment is part of the CDC’s STEADI initiative, which also offers a checklist for home safety. When we take steps like these to identify risks early, our care teams and clients can plan interventions to avoid falls before injuries occur.

We also need to consider social determinants of health and how they affect risk of falling. When we see challenges related to those factors, we need to connect clients with effective programs that can support their particular needs.

Person-Centered Assessments and Interventions

Keep in mind that when we analyze the falls reported in skilled nursing facilities and long-term care, we find that 50% to 60% of falls are experienced by a small portion of the population. Taking a closer look, we find that frequent fallers — people who fall more than once in a 30-day period — have different clinical presentations than other clients. It is important to identify the patient-centered reason for falling and choose intervention strategies accordingly.

To be the most effective at preventing falls, we must communicate interventions across all team members. Make sure to include your nurse aides because they are the ones who see the clients most frequently. Of course, proper training for all team members can ensure that we are using client-appropriate evidence-based practices.

Education and awareness are crucial for our clients to prevent injuries and maintain maximum mobility. To prepare and protect them, we must keep our own education and awareness in tip-top condition.

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Tiffany E. Shubert

Senior Product Manager, Relias

Dr. Tiffany Shubert is a leader in the field of fall risk management and prevention. She has received funding from the CDC and NIH to develop and evaluate evidence-based fall prevention programs. She has over 25 publications in peer-reviewed journals and has presented on topics from community-based to clinical management of falls at national and international meetings. She has contributed to the development of technologies and programs to promote health and wellness in older adults. Dr. Shubert is passionate about making the world a better place for older adults and those who care about them. She has a B.A. in Communication from UC San Diego, a Master’s in Physical Therapy from UC San Francisco, and a Ph.D. in Movement Science from UNC Chapel Hill.

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