Falls and Fall Risk Prevention

A fall occurs when an individual unexpectedly drops from a higher surface to a lower surface like from a standing position to the floor falls can occur in healthcare facilities, the community or in an individual's home and are one of the leading causes of injuries and death in older adults.

As the nurse youll identify factors impacting fall risk, consider the consequences of falling and provide patient centered care to prevent falls.

Now typically falls don't occur for a single reason but rather from a combination of risk factors which can be intrinsic or extrinsic.

Intrinsic risk factors are specific to the individual such as age related changes. These include impaired sensory input from both vision and hearing, which can blunt the subtle visual and auditory cues that help an individual keep their balance and walk safely.

Moreover, cardiovascular changes like decreased arterial elasticity can cause BP instability during position changes. This can result in lightheadedness and neuromuscular changes such as slowed reaction time and joint instability, which can make it more difficult to regain stability after losing balance.

Other intrinsic risk factors include cognitive impairment, unsteady gait, chronic conditions like arthritis and certain medications like beta blockers On the other hand, extrinsic risk factors are associated with the individual's environment like poor lighting, presence of hazards such as throw rugs or standing water and lack of safety devices like grab bars in the bathroom.

In health care settings, factors like staff shortages or lack of a toileting schedule may increase the risk for falls since patients are more likely to attempt to get up without assistance.

Ok. So once a fall occurs, the likelihood of falling again, increases also keep in mind that not all falls result in injuries.

However, older adults who fall are at greater risk of sustaining injuries that can range from a bruise or a scrape to more serious injuries like a hip fracture or traumatic brain injury or TBI.

Now, a hip fracture refers to a break in the upper third of the thigh bone or femur sustaining a hip fracture due to a fall is associated with higher rates of mortality in older adults.

And for those who do recover functional ability often remains altered. A TBI can result in temporary or permanent brain dysfunction as well as a cerebral hemorrhage or bleeding in the brain, especially for those taking anti coagulant or anti platelet.

Medications concerning TBIS can be misdiagnosed as age related neurologic changes causing a delay in treatment and worse prognosis, especially when patients have cognitive disorders like dementia.

All right, when providing patient centered care to prevent falls begin by reviewing individual and environmental factors that increase your patient's fall risk first, ask if they've fallen before and if so whether any injuries were sustained from the fall.

Keep in mind, you may need to use words such as trip or slip. Since some older adults may not perceive such incidents as falls or they may minimize the accident out of embarrassment or fear of losing independence.

You may use a validated tool such as the Morse fall scale to determine the degree of fall risk or the timed up and go test to observe their coordination and steadiness.

You'll also complete a medication review looking for medications that can increase fall risk like antidepressants and anti hypertensives.

Once fall risk is determined, talk with your patient and their family about fall prevention strategies. This can include home safety interventions like removing tripping hazards using handrails while on stairs, ensuring proper lighting and installing, grab bars around the shower or toilet.

Additionally, discuss how and when to use assistive devices like canes and walkers as needed and remind them to change positions.

Slowly also discuss maintaining bone health by safely and consistently engaging in weight bearing exercise and consuming a diet high in calcium, Vitamin D and protein.

Lastly, you provided resources on obtaining a medical alert device in case of an unwitnessed fall when caring for a patient in an acute care facility, a bed or chair alarm should be used to prevent falls, especially for those with impaired cognition.

Additionally, using safe patient handling techniques and equipment while lifting, transferring or repositioning patients can reduce falls.

Finally, instruct your patient what to do if they fall at home, remind them to stay calm and take some deep breaths to try to relax.

If they think they're seriously injured, they should remain still and call for help. If not badly hurt, instruct them to roll on their side and slowly crawl to a chair to alert someone for assistance.

All right, as a quick recap, falls occur when an individual unexpectedly drops from a higher surface to a lower surface and are a leading cause of injuries and death.

In older adults, falls occur due to a combination of intrinsic and extrinsic risk factors and can result in minor injuries or more serious injuries like a hip fracture or traumatic brain injury.

As the nurse, you'll gather information about your patients fall risk, implement fall prevention strategies and provide education and resources.