Long Term Care Facilities and Fall Prevention for Older Adults

Falls among elderly patients in long-term care institutions are one of the most common causes of problems on a daily basis. The consequences of falls and injuries experienced during falls have a negative impact on the quality of life of the majority of senior patients over the age of 65, since they frequently result in a high incidence of mortality and morbidity among this population. Furthermore, falls have additional devastating repercussions, such as increased medical bills. Except from falls in long-term care and nursing home settings, research indicates that there are no additional greater medical expenditures related with trauma. In addition, more than a third of falls reported among elderly patients often occur in medical facilities offering long-term care and nursing homes. According to various studies done on the prevention of falls in long-term care facilities, more than a third of elderly patient aged 65 years and above suffer or experience falls at one point during their hospitalization (Jung, Shin, & Kim, 2014). This implies that older patients in long-term care and nursing facilities are predisposed to higher risks of developing complications from hospital falls. Additionally, research has demonstrated that in facilities where a significant population of the elderly patients are suffering from dementia, they tend to experience more than 80% of falls annually (Jung, Shin, & Kim, 2014). However, some scholars argue that falls are a normal symptom that should be associated with aging. Nonetheless, in the recent decades, more focus has been directed at the negative psychological, physical, and economic consequences rather than emphasizing on the incidence of falls. Thesis: falls among the elderly aged 65 and above lead to significant psychological, physical, and economic costs among this population living in nursing homes and long-term care facilities.

Fall Prevention among Older Adults

According to research done on fall prevention among elderly patients, it is estimated that 23% to 42% of falls among elderly patients tend to happen in patients who reside at home. This is in comparison to 6% to 22% of falls that happen in nursing homes and other long-term care facilities. It is also estimated that 3% to 16% of falls happen among elderly patients who are hospitalized or admitted to health care facilities (Balzer, Bremer, Schramm, Lühmann, & Raspe, 2012). Approximately a fifth of all elderly patients in long-term care facilities in Korea experience falls at a point in their hospitalization. Fractures are the most common complication that is accompanied by falls among elderly patients. Fractures account for 60% of all reported injuries resulting in falls (Jung, Shin, & Kim, 2014; Vlaeyen et al., 2015). Other complications that arise from diverse types of fractures such as hip joint fractures often lead to death or permanent immobility. The latter often results in secondary complications such as constipation, social isolation, weakness, low fitness, as well as reduced quality of life.

The economic consequences of falls are equally dire because medical costs that develop out of falls and injuries usually constitute more than 9% of the total medical bill for patients aged 65 years and above. In 2011, the medical costs among elderly patients increased by two to three times in comparison to the figures reported in 2004 resulting from patient falls. In the United Kingdom, medical costs associated with falls among elderly patients comprised 21% of the entire medical expenditure (Choi, Wakeling, & Robinovitch, 2015). In this regard, falls among elderly patients aged 65 and above continue to be highlighted as a significant safety threat, especially in long-term care facilities and nursing homes. This has led to enhanced focus on studies and survey that study fall prevention among this population. Moreover, long-term care facilities have begun to evaluate probable fall hazards and are increasingly becoming cognizant of the importance of effective interventions to mitigate or prevent the effects of such hazards on elderly patients (Vandenberg, van Beijnum, Overdevest, Capezuti, & Johnson, 2016).

Some of the risk factors associated with falls among elderly patients can be classified in two categories that intrinsic and extrinsic factors. Intrinsic factors encompass an individual’s physical and cognitive state while extrinsic factors include non-physical factors and environmental hazards. Falls among the elderly population in health care facilities are rarely caused by a single factor, but rather happen due to an interaction of multiple causes. Therefore, addressing the challenge of fall necessitates a comprehensive approach to evaluation and intervention (Faul et al., 2016). Diverse approaches have been designed for long-term care and nursing home facilities that include exercise regimes such as gait training, balancing, as well as walking. It also encompasses fall prevention education, educational programs, multidimensional intervention strategies, as well as environmental hazards. Empirical research has widely supported the efficacy and efficiency of these interventions.

Nonetheless, fall prevention strategies implemented in most long-term care facilities like risk factor assessments and risk evaluations are usually one-off approaches implemented when elderly patients are initially admitted to such facilities. Moreover, they are usually superficial, which implies that risk factors are only assessed in a cursory manner. Therefore, a systematic and continuous administration is virtually non-existent. In addition, due to nursing and staff shortages, as well as heavy workloads that are a frequent characteristic in long-term care facilities, it is very challenging for nurses to effectively manage falls in a comprehensive and systematic way (Kehinde et al., 2014). In this respect, comprehensive guidelines that can assist nurses in long-term care facilities and nursing homes to make the appropriate decisions in relation to fall management in clinical settings are required. Evidence from previous research implies that nursing based guidelines encourage evidence-based practice and positive attitudes towards care provision. In this regard, the British Geriatrics Society and the American Geriatrics Society have developed several structures and frameworks to prevent falls among elderly patients, but most of these guidelines are targeted at older individuals living in community settings (Valcarenghi et al., 2014). Even though a guideline to prevent falls among elderly patients in long-term facilities exists in Canada, there is still an absence of evidence-based guidelines for the management of falls in long-term care facilities in the United States.

Some of the interventions used to manage and prevent falls among elderly patients in long-term care facilities include environmental planning, using hip protectors, movement alarms, removal of hazards, identification of fallers, as well as constant monitoring. Environmental planning involves all the sequences that are geared at making critical adjustments to the facilities where elderly patients receive care such as medical institutions or nursing homes (Leland, Gozalo, Teno, & Mor, 2012). For instance, these adjustments include lowering the height of beds to reduce the impact of falls when they do occur. Moreover, chairs used by elderly patients are modified to reduce the chances of falling. It is also vital that patients should be educated on how to interact with their immediate environment to reduce the incidence of injuries.

Movement alarms are used to ensure that the nursing staff are alerted whenever patients move from their beds and also when they approach areas classified to have high fall risks. Alarms serve best in long term care facilities because they promote the process of monitoring patients within the facility. However, it is critical that elderly patients should also be taught and educated on the significance and use of these alarms to ensure efficiency and effectiveness. It is also vital that nurses should be on stand-by to respond to alarms to prevent patients from falling (Sakamoto et al., 2012). Another strategy used to reduce injuries during falls is the use of hip protectors. These gadgets are utilized by health care institutions that offer long-term care to elderly patients to protect them from the impact of falls on their hips. They are often fitted on the hip area because it’s the section of the body that experiences most trauma and injuries during patient falls among the elderly. Evidence from research has demonstrated that elderly patients who use hip protectors often sustain minimal injuries to their hips during falls in comparison to those who do not use them.

Removal of hazards is regarded as the sequence of removing any potential harmful object either biological or chemical that could result in fall cases. A majority of fall cases are usually untimed and predetermined. In this regard, falls often occur anywhere at any time. Therefore, to prevent injuries, it is prudent to ensure that all hazards are removed from the vicinity of elderly patients. Getting into close contact with such various chemical hazards could result in adverse effects. Moreover, patients should be educated to stay away from hazardous environments to prevent falls. Constant monitoring can also be used prevent patient falls in long-term care facilities. It has been developed from evidence-based research and is very effective in reducing instances of falls among elderly patients (Jung, Shin, & Kim, 2014). The nursing staff in long-term care facilities are required to make effective plans that can assist them constantly monitor the movement of their patients. In this respect, technology can be utilized to increase the effectiveness and efficiency of the monitoring plan. Constant monitoring helps to ensure that most patients are situated in the right locations either on their beds or chairs.

Finally, the identification of probable fallers is also critical prevention intervention that has the potential to significantly reduce the incidence and number of falls to a great extent. Through the use of constant monitoring, frequent fallers are easily identified and noted for future surveillance. For instance, after certain patients have been identified as frequent or probable fallers, the nursing staff can try to devise strategies and preventive measures that are specific to such individuals (Jung, Shin, & Kim, 2014). In addition, through the same process, nursing staff can be able to identify the primary causes of falls among the identified patients. Identification of fallers is very critical because it enhances monitoring, which subsequently leads to reduced incidence of falls.

Conclusion

Evidence from research demonstrates that falls among elderly patients aged 65 and above are frequently experienced in most nursing homes and long-term care facilities. A considerable number of patients fall due to their medical; conditions or because of environmental factors in the places where they reside. Falls among elderly patients accounts for problems that affect the patient and the institution. Falls have psychological, physical, and economic costs. They result in mortality and immobility, as well as severe injuries that reduce the quality of life. Moreover, falls result in huge medical costs in comparison to other types of accidents that affect elderly people. In this regard, it is vital that preventive measures should be developed to mitigate and prevent falls. Some of the proposed preventive measures include the incorporation of alarms, hazard removal, educating nurses and patients, use of hip protectors, constant monitoring, as well as the identification of probable and frequent fallers. These prevention techniques have the potential to significantly reduce the prevalence and incidence of patient falls among the elderly population residing in nursing homes and long-term care facilities.

References

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