Fall Prevention in Long-term Care: Practical Advice to Improve Care



Topics in Advanced Practice Nursing eJournal. 2008;8(3) 

In This Article

Trends in Falls: Older Adults

Three days ago, Ms. P fell in her home and suffered a Colles' fracture of her right arm. The wrist was surgically repaired and, following a brief hospitalization, Ms. P has now been admitted to a skilled nursing facility. Her medical history includes early dementia, paroxysmal atrial fibrillation, hypertension, diabetes, peripheral neuropathy, osteoarthritis, glaucoma, urge incontinence, and history of falls. In addition to this most recent episode, Ms. P has been hospitalized 4 other times in the past 18 months for diagnoses, including dehydration, pneumonia, and twice for delirium due to medications. She has also been seen in the local emergency department 3 more times in the past 5 months after having fallen.

At her baseline, Ms. P is fully oriented but has difficulty in new situations and has some short-term memory deficits. Prior to admission, she had lived in senior housing where she was independent with activities of daily living and simple household tasks, but was assisted by her daughters with shopping, strenuous household chores, and her finances.

Falls are common among older adults. One third of adults over 64 years old, living outside of institutions, fall each year, and the likelihood of falling continues to rise with older age.[1] Among the elderly, falls cause significant morbidity and mortality, and often contribute to functional decline, depression, social isolation, and nursing home admission. Compared with community-dwelling elders, nursing home residents generally have more comorbidities and advanced disease, including dementia. It is not surprising then that nursing home residents are nearly 3 times more likely to fall than elders living in the community.[2] In a 100-bed facility, there will generally be 100-200 falls each year, and many residents will fall more than once.[3] No nursing home will be able to prevent all falls, but there is a great deal that can be done to reduce fall risk and thereby the total number of falls and injuries.


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