Geriatric considerations - Falls and fall risk prevention: Nursing

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, you’ll 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 blood pressure 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 healthcare 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.

Okay 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 anticoagulant or antiplatelet medications. Concerningly, 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.

Alright, 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.